الفهرس 
Relation between BMI, Different body fat thickness and labia majora thickness
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Abstract
Introduction
Accurate and detailed descriptions of the external female genitalia are rare and thus reproducible definitions concerning the ‘normal’ appearance of the vulva are still being debated. Even most medical textbooks lack information of vulvar morphology (Andrikopoulou et al, 2013). In defining a ‘normal’ appearance today, we are using limited data from the beginning of the 20th century (Kreklau et al, 2018).
The necessity to set up valid standards concerning definitions of anatomical relations and dimensions of the external female genitalia is reflected in the published data in recent years.
Basaran et al. showed in a cohort with pre‐ and postmenopausal women that a wide variation in the appearance of female genitalia exists. He concluded that further studies are needed on the
‘normal’ appearance of the vulva and clear definitions (Basaran et al, 2008).
Despite the fact that the appearance differs depending on ethnicity, age, weight, hormonal status, and type of skin, young women are seeking a perfect body image (Wallenet al, 2011). This body image is not seldom influenced by the media, resulting in rising numbers of cosmetic surgery consultations (Krissi et al, 2016).
The primary purpose of our descriptive study is to present standard values concerning the fatty parts of female vulva (labia majora) and its appearance among different women with different BMI. The primary aim is to set up a database that represents reliable standard values of the vulva and to compare relation between the body fat distribution and the labia majora .Objective: To provide a baseline for the appearance of a normal labia majora, through defining specific measurements which could be used to establish standards for indications for gynecological cosmetic surgery. Patients and Methods
This is an observational study that was conducted in Kasr Al-Ainy Hospital, Maternity hospital, Cairo University. During period time from October 2021 to April 2021.
A total of 120 women females whose age range from 18 to 40-year-old and BMI range from 18.5 to 30 presenting to KasrAlainy, where included in the study.
Objectives To provide a base line for the normal appearance of the labia majora through defining spisificmeasuremens which could be used to establish standards for indication for gynecological cosmetic surgery and relation between body fat and labia majora.
Sample size calculation:
As mean of anterior Right labial width of participants whose BMI range from 18.5 – 25 is 4.3+/0.68 compared to 4.69+/-0.69 in participants whose BMI range from25 – 30 (Measurements of fatty parts of female vulva (Mons pubis and labia majora,SanaaGamil )
So sample size is 120
Sample was calculated using Open Epi program with confidence level 95% and power 80% Study population:
The patients will be divided into 4 groups as follow
group A involve 30 patients with BMI 18.5 to 25 and nulliparous
group B involve 30 patients with BMI 18.5 to 25 and multiparous
group C involve 30 patients with BMI 25 to 30 and nulliparous group D involve 30 patients with BMI 25 to 30 and multiparous -Inclusion criteria:
• Gender: female •Age :18 -40 •BMI: 18.5 – 30 -Exclusion criteria:
BMI below 18.5
Age below 18 or above 40
Pregnant women
Women with vulvar disease or disorder Women underwent FGM
Statistical methods:• Data were coded and entered using the statistical package for the Social Sciences (SPSS) version 28 (IBM Corp., Armonk, NY, USA). Data was summarized using mean and standard deviation. Comparisons between groups were done using analysis of variance (ANOVA) with multiple comparisons post hoc test. Comparison between right and left sides was done using paired t test (Chan, 2003a). Correlations between quantitative variables were done using Pearson correlation coefficient (Chan, 2003b). P-values less than 0.05 were considered as statistically significant. The following measures were taken
Triceps Skin fold
Measurement of the skin fold overlying the triceps muscle.
Abdominal Fold thickness
Measurement of the skin fold above the ASIS.
Midthigh fold thickness
Measurement of the skin fold in the middle of the thigh.
Right mid labial width: The transverse distance between the interlabial sulcus and the outer border of right labia majora at the middle of labia majora
Left mid labial width: The transverse distance between the interlabial sulcus and the outer border of left labia majora at the middle of labia majora.
Right anterior labial height: The distance between the interlabial sulcus and the upper border of right labia majora at the level of the clitoris.
• Right med labial height: The distance between the interlabial sulcus and the upper border of right labia majora at the middle of labia majora.
• Right posterior labial height: The distance between the interlabial sulcus and the upper border of right labia majora at the level of the posterior fourchette.
• Left anterior labial height: The distance between the interlabial sulcus and the upper border of left labia majora at the level of the clitoris.
• Left mid labial height: The distance between the interlabial sulcus and the upper border of left labia majora at the middle of labia majora.
• Left posterior labial height: The distance between the interlabial sulcus and the upper border of left labia majora at the level of the posterior fourchette
* The interlabial sulci are the grooves between the labia majora and the labia minora. The singular for this term is interlabial sulcus, of which there is a left and a right.The resulting data were analyzed using proper statistical parameters to provide baseline measurement for the appearance of normal labia majora, through defining specific measurements which could be used to establish standards for gynecological cosmetic surgery.