Diagnosis: Labial hypertrophy
Treatment: Vulvectomy (removal of part of the vulva)
The insurer denied the Vulvectomy (removal of part of the vulva).
The determination is upheld.

The patient has a diagnosis of labial hypertrophy. There is documentation that it bothers her and she feels she has to "adjust herself down there". She desired reduction. The physical exam indicated "redundant left labia minora tissue" at 3 centimeters (cm) in length and the right labia minora is 1 cm in length. She had a partial vulvectomy/labiaplasty. At issue is the medical necessity of the procedure.

The requested health service/treatment of vulvectomy (removal of part of the vulva) is not medically necessary for this patient.

The patient has self-documented discomfort with her labia minora and desired reduction. On exam the left labia minora was 3 cm and the right labia minora was 1 cm. The average length of the labia minora is 0.4 to 6.4 cm in length, and about 2 cm wide. This patient had a completely normal exam without any documentation of labial hypertrophy. Her labia minora are on the smaller side of normal. She does have a self-perceived problem, however, there is no medical necessity for the surgery as her labia minora are normal.