Objective To analyze the efficacy and safety of modified marginal approach in combined plastic surgery of labia minora and praeputium clitoridis. Methods A total of 70 patients who underwent plastic surgery of labia minora and praeputium clitoridis in the People's Hospital of Pizhou from January 2020 to September 2025 were selected. According to the random number table method, they were divided into the control group and the observation group, with 35 patients in each group. The control group was treated with wedge resection of labia minora combined with skin resection of the clitoral body or root, and the observation group was treated with combined plastic surgery of labia minora and praeputium clitoridis using modified marginal approach. The perioperative indicators, sexual function indexes and complication rate were compared between the two groups. Results The operation time and incision healing time in the observation group were all shorter than those in the control group, and the intraoperative blood loss was lower than that in the control group (P<0.05). At 1 month after surgery, the scores of sexual desire, sexual arousal and orgasm in the observation group were higher than those in the control group (P<0.05). The incidence of complications in the observation group (2.86%) was lower than that in the control group (20.00%) (P<0.05). Conclusion The modified marginal approach in combined plastic surgery of labia minora and praeputium clitoridis can effectively improve the sexual function indexes of patients, optimize perioperative indicators, and reduce the risk of postoperative complications, showing favorable efficacy and safety.