Background: Although the demand for labiaplasty has increased rapidly over the past decade, little is known about the psychological outcomes of this procedure. In particular, there is a lack of prospective controlled studies to assess the effects of labiaplasty on women's psychological well-being and intimate relationship quality. Nor has research investigated whether preoperative patient characteristics predict satisfaction with surgery. Methods: The current study used a prospective controlled design. Participants were 29 adult Australian women who underwent labia minora reduction and 22 comparison women who did not. Both groups completed a baseline questionnaire (preoperatively for the labiaplasty group) and a follow-up questionnaire 6 months later. The questionnaires contained standardized measures of genital appearance satisfaction, relationship satisfaction, sexual confidence, psychological distress, self-esteem, and life satisfaction. Results: Of the 29 women who underwent labiaplasty, the vast majority reported that they were "moderately" or "extremely" satisfied with the aesthetic (82.8 percent), functional (86.2 percent), and overall (82.8 percent) outcomes. For the standardized measures, the only significant change from baseline to follow-up for the labiaplasty group relative to the comparison group was a reduction in genital appearance dissatisfaction with large effect size (p < 0.001, d = 3.26). Higher levels of psychological distress (p = 0.001) and having a romantic partner (p = 0.016) preoperatively were significantly related to lower satisfaction with surgical outcomes. Conclusions: Labiaplasty appears to have a positive effect on women's genital appearance satisfaction, but not their general psychological well-being or intimate relationship quality. Medical professionals should be mindful of patients with greater psychological distress, as this may compromise satisfaction with surgical outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.