CALME (Childhood Asymmetry Labium Majus Enlargement)

CALME stands for childhood asymmetry labium majus enlargement. It is a condition in which a girl’s outer vaginal lips (outer labia) become swollen or enlarged on one side by excess tissue growth. This mass of extra tissue causes one side of the labia to be larger than the other, leading to an asymmetrical appearance.

The outer labia are the two large folds of fatty tissue covering the vagina. They are also called the outer lips of the vulva.

Patients can be seen by Texas Children's experts in Pediatric and Adolescent Gynecology.

Causes & Risk Factors

The condition occurs when there is an excess growth of the normal tissue of the vulva, causing it to be enlarged or swollen-looking.

While the cause is not yet known, this tissue growth may be driven by hormones.

The benign (noncancerous) tissue mass develops quickly and then stops growing. It occurs in young girls just before puberty. 

Symptoms & Types

Symptoms may include:

  • Soft tissue mass on one side of the outer lips of the vulva, causing an asymmetrical appearance
  • Tan-colored growth, with orange-peel like surface
  • A “bulge” in a girl’s underwear or swimsuit
  • Irritation, discomfort or pain in the crotch when wearing tight clothing

Diagnosis & Tests

The condition may become obvious just before puberty. Diagnosis is confirmed through a physical exam.

Additional testing may include:

  • Imaging such as an ultrasound or MRI (magnetic resonance image)
  • Biopsy – a small sample of the tissue mass is removed and examined under a microscope
  • Resection of abnormal tissue

Treatment & Care

Surgery is recommended to remove the mass of tissue, confirm the diagnosis, and relieve discomfort and embarrassment caused by the bulge of excess tissue.

Diagnosis and Treatment Available at Texas Children’s:

Reviewers/Authors

Other Contributors

Jennifer Kurkowski, WHNP