30 yo mother of two from Broomfield, Colorado referred to Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado by a local plastic surgeon. She describes having a lifelong history of undesired cosmetic appearance of her vulva. Since age 11 she has noticed very large labia that have progressed in size with her pregnancies, as well as a large anal skin tag. She has pain, pulling and dragging with initial penetration due to her large labia and posterior perineum. She feels her labia get in the way with intimacy. She has increased difficulties with orgasm and is self-conscious with regard to her anal tag and labia. She also experiences occasional stress urinary incontinence. Pelvic examination performed with a chaperone present and patient observing with a handheld mirror revealed bilateral labial hypertrophy with hyperpigmentation and a large and redundant lateral prepuce with ptosis. There is excess perineal skin and a very large anal skin tag. Dr. Aguirre discussed with patient all surgical and nonsurgical options. She decided on definitive surgical therapy. Dr. Aguirre performed in an in-office surgical setting, Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction and Clitoropexy with PRP, Excision of Anal Skin Tag and Excision of Excess Perineal Skin. She followed up for her regularly scheduled postop appointment very happy with the aesthetic results at which time Dr. Aguirre performed the O-Shot to address the difficulties with orgasm as well as addressing the occasional incidence of incontinence.