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Introduction: Poor genital self-image is a common phenomenon leading to an increasing interest in female genital surgery over the last years., Aim: The aim was to correlate objective measurements of the labia minora with the individual subjective perception of the labial size., Methods: In a cross-sectional study with 200 premenopausal women (median age 33.5 years) presenting for gynecological issues other than vulvar diseases, labial width and length were measured, and psychological and physical complaints were assessed. Multivariable logistic regression analyses were performed to identify factors that influenced self-reported complaints and subjective perception of labia size., Main Outcome Measure: The main outcome measure was labial appearance (width and length in mm, color), subjective perception of the labial size, and complaints., Results: The median width of the labia minora was 19.0 mm (interquartile range = 12.6-27.5), and the median length was 35.5 mm (interquartile range = 27.8-48.9). The objective size of the labia was significantly associated with womens' subjective perception of the labial size, but not with self-reported complaints. Nearly one-third of the women (n = 53, 27%) reported complaints of their labia minora which were mainly physical (n = 41, 77%) or a combination of physical and psychological problems (n = 9, 17%), while only a small group reported experiencing only psychological complaints (n = 3, 6%). Predictors of complaints were previous cosmetic surgery and the subjective perception of the labia size. The latter was significantly associated with discomfort during intercourse and when visiting a sauna and by labia minora that protruded over the labia majora., Clinical Implications: Cutoff values to define labial hypertrophy and to justify labial reduction surgery should be avoided., Strength & Limitations: This is a large sample of labial measurements in women not seeking labiaplasty. Standardized and validated questions regarding quality of life, sexuality, and body image could have provided more insight into psychological aspects., Conclusion: These data demonstrate the variability of labial anatomy and its perception. Widschwendter A, Riedl D, Freidhager K, et al. Perception of Labial Size and Objective Measurements-Is There a Correlation? A Cross-Sectional Study in a Cohort Not Seeking Labiaplasty. J Sex Med 2020;17:461-469., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)