In normal women, both sides of the labia are the same size and shape. If the shape, size, and volume of the labia are not the same on both sides, it is important to consider abnormalities, including whether there is congenital asymmetry of the two sides of the development and pathologic causes. If both sides are asymmetrical, consider whether inflammation, tumor or cyst is present on the swollen side. Usually in vestibulodynia, there is significant swelling of the labia majora on one side, and if a vestibular cyst is present, the vestibular gland needs to be incised for opening and drainage. If a vulvar cyst is present, resulting in swelling of the labia majora on one side of the vulva, excision of the vulvar cyst is required, and a decision is made based on pathology as to whether to proceed to the next stage of treatment. If a vulvar tumor is present, a vulvar tumor excision is needed to clarify whether it is benign or malignant, with appropriate follow-up supplemental radiotherapy. In conclusion, bilateral labia majora asymmetry requires examination to rule out pathologic causes.