Article

Labiaplasty: A 24-Month Experience in 58 Patients: Outcomes and Statistical Analysis

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Abstract

Background: Because there has been a great raise in the interest of this type of surgery in our area, we decided to study if there were any differences among our patients and also to review our results. Objective: The purpose of this study was to review our experience with labiaplasty. We assessed surgical complications and quality outcomes and compared surgical results according to maternal parity. Methods: We conducted a retrospective chart review of all cases of primary or secondary labia minora reduction surgery performed by the same surgeon from January 2014 to December 2015. We recorded patient demographics, sexual activity, parity, and presurgical and postsurgical quality of life, as well as surgical technique and complications. Results: During the study period, we performed 58 labia minora reduction procedures. The average patient age was 32.16 years. Among the patients, 50% were single, 65.52% sexually active, and 62.07% nulliparous. A wedge excision was performed in 75.8% of cases. A complication occurred in 12.06% of cases, usually owing to underresection. The surgical experience was rated very good or excellent by 96.55% of patients. Women with children reported greater satisfaction with their surgical outcome on our postoperative questionnaire. We identified no statistically significant outcome differences according to surgical technique. Conclusions: Labiaplasty is safe and shows high rates of overall satisfaction. Women with children reported greater postoperative satisfaction than women who had never given birth.

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... [22][23][24][25] Plastic surgeons commonly consider a labiaplasty to be medically and ethically consistent with these interventions, with comparable complication rates, patient satisfaction, and recommendation rates. [26][27][28][29][30][31][32][33][34][35][36][37][38] However, labiaplasty is met with considerably greater public opposition relative to these other procedures. 39,40 The results of our study show that reduction of an unspecified sexual organ and breasts are met with equal public acceptance, but when the specifics of reducing vaginal labia are presented, there is significant opposition. ...
... [51][52][53] Given that patients are overwhelmingly pleased with the results of surgery, we believe it is a responsibility for the benefit of our patients to persist in these educational attempts. 35,37,[54][55][56] FGM is often performed on young girls between infancy and 15 years of age without their consent to delay or prevent sexual activity. 57,58 Conversely, female genital plastic surgery (ie, labiaplasty) is carried out with autonomous decision-making by consenting adult patients to improve self-confidence through enhanced sexual self-image, satisfaction, and function. ...
Article
Background Heightening interest in labiaplasty has driven potential patients to online forums, permitting the dissemination of material by potentially unqualified or inexperienced individuals. The discourse surrounding this procedure has been injected with strong opinions that are not entirely consistent with medical best-practice or evidence-based knowledge. Objectives Explore the rationale for ongoing public opposition to labiaplasty and if bringing awareness to the similarities of labiaplasty and breast reduction can alter an individual’s perception. Methods 448 adult women were surveyed concerning their opinion of a surgical procedure to reduce the size of an unspecified organ related to a woman’s sexuality, breast reduction, and labia reduction. Results Reduction of an unspecified organ and breasts were met with significantly greater acceptance than labia reduction (p < 0.0001). Presenting responders with an educational tool comparing each procedure’s indications, risks, and potential benefits did not alter respondent opinions, indicating notions about sexual surgery are relatively fixed. The most common reason respondents persisted in their relative opposition to labia reduction was a perceived deficiency in social acceptance (27.1%), followed by a perceived similarity to female genital mutilation (14.8%). Conclusions Attitudes towards labiaplasty seem firmly based on emotion or correlation to other unacceptable practices. Informational resources do not sway these biases; thus, there is a limited role for surgeon-led education in the normalization of labiaplasty, as it requires a societal shift in acceptance. Labiaplasty is a procedure whose time has not yet come to be popularly accepted by the public at large.
... Forming a triangular configuration, this provision facilitates fine-tuned adjustments to the tissue volume intended for removal, all while ensuring preservation of the original labial contour. 3,29,54,56,82,83 Nevertheless, noteworthy considerations accompany this technique, including a statistically significant risk of dehiscence (0.08, CI: 0.05-0.13). This potential complication can be ascribed to the inherent characteristics of this approach, particularly the extensive excision area, which surpasses that in alternative methods, leading to heightened tension along the newly created suture lines. ...
Article
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Background Various surgical techniques have been devised for the surgical cosmetic enhancement of female outer genitalia. The selection of an optimal method should be based on satisfaction rates and safety; however, a comprehensive, contemporary systematic assessment of these factors in has been limited in the literature. Objectives Our aim was to conduct a comprehensive systematic review and meta-analysis to evaluate the overall satisfaction rates and risk factors associated with various labiaplasty techniques and tools. Methods The authors performed a systematic literature search in three medical databases: PubMed, Elsevier and Cochrane Library (CENTRAL) with the closing date of October 2023. Original articles with quantitative satisfaction rates and frequencies of most common complications (hematoma, dehiscence, swelling, bleeding and infection) were included. Results Systematic search provided a total of 3954 records. After selection and review of the articles, 86 eligible, peer-reviewed studies were identified, of which 53 provided quantitative data. High overall satisfaction rate was found for all methods (Prop: 94%; CI: 93–95%), with highest satisfaction for deepithelization (Prop: 97%; CI: 85%–99%). Complications were generally rare, with elevated incidences for some techniques (wedge resection – dehiscence: Prop: 8%; CI: 5%–13% and composite reduction – swelling: Prop: 13%; CI: 2%–54%). Scalpel has significantly higher incidence of complications than laser, namely for bleeding, swelling and hematoma. Conclusions Labiaplasty can be considered a generally effective approach to outer female genitalia beautification, with low associated risks. Surgeons must tailor their approach to the patients’ needs and anatomy to achieve maximal satisfaction, given the differences in the frequency of complications for each method.
... Two occurred using wedge resection and one was not specified. 21,36,46 Dyspareunia was reported in 44 patients: 41 after wedge resection and three after edge linear resection. 37,41,51 Among other complications, recurrence of labia minora hypertrophy occurred in two cases and discoloration in four cases, six patients reported unresolved labia swelling, there was one episode of postoperative urinary retention, one labial fistula, and one patient reported decreased sensation. ...
Article
Background: The considerable increase in labiaplasty, demands plastic surgeons to be acquainted with the surgical techniques, their respective complications and satisfaction rates. This is a systematic review of the available evidence on labia minoraplasty looking at surgical techniques, clinical outcomes and patient satisfaction. Methods: A comprehensive search across PubMed, Web of Science, SCOPUS and Cochrane CENTRAL was executed through October 2020. A random-effect model meta-analysis was performed to assess the satisfaction and complications rates. Results: Forty-six studies including 3804 patients fulfilled the inclusion criteria. The pooled satisfaction rate following labia minoraplasty was 99% (95%CI: 97%-99%). Substantial heterogeneity was present across studies (I2 = 63.09%, p < 0.001). The highest pooled incidence of dehiscence was reported for laser-assisted labiaplasty (5%, 95%CI: 2%-8%) and wedge resection (3%, 95%CI: 1%-5%). The highest pooled incidence of hematoma formation (8%, 95%CI: <1%-23%) and postoperative bleeding (2%, 95%CI: <1%-15%) was reported for W-shape resection. The highest pooled incidence of transient pain or discomfort was reported for deepithelialization (2%, 95%CI: <1%-23%) and W-shape resection (2%, 95%CI: <1%-15%). Three flap necrosis were reported, two occurred using wedge resection labia minoraplasty and one was not specified. The most common causes for revision surgery (n=169) were dehiscence and aesthetic concerns. Conclusion: Overall, labia minoraplasty is a very safe procedure. However, serious complications requiring surgical management have been reported. In this sense, an experienced surgeon, proper knowledge of female genital anatomy, and a thorough technique selection in accordance with the patient characteristics is mandatory.
... The literature overwhelmingly describes high rates of patient satisfaction and low rates of complications associated with labiaplasty [8][9][10][11][12][13][14]. While positive outcomes in the literature are encouraging, follow-up rates and intervals vary widely, and the measures used to assess outcomes are not standardized and therefore not comparable [2]. ...
Article
Introduction and hypothesisHigh-quality data are lacking to understand outcomes in women who undergo labiaplasty for labial hypertrophy and whether there is an association with body dismorphic disorder (BDD).Methods This was a cross-sectional study of a retrospective cohort of women who underwent labiaplasty for labial hypertrophy at a tertiary care referral center. Women were identified by CPT codes and were included if the procedure was performed by a urogynecologist. The health record was queried for demographic, pre-, intra-, and postoperative data. For the cross-sectional component of the study, participants were contacted to complete a survey.ResultsThirty-six women met study inclusion criteria; 21 participated in the survey, and retrospective data were available for 20. At the time of labiaplasty, the women had a mean age of 30 ± 12 years and mean BMI of 23.9 ± 4.4 kg/m2. The most common preoperative motivation for undergoing labiaplasty, based on the medical record, was pain (85.0% 17/20). Complications were uncommon and minor. No women met criteria for BDD. Participant survey-reported primary motivation for undergoing partial simple vulvectomy was “pinching” in 10 (47.6%), “pain” in 4 (19.0%), and “appearance” in 7 (33.3%). The majority of women reported that labiaplasty achieved their preoperative goal (20/21, 95.2%).Conclusions Women who underwent labiaplasty were primarily motivated by functional concerns, and outcomes indicate a high satisfaction with genital appearance postoperatively as well as a positive effect on body image and quality of life. We recommend that surgeons work to understand what motivates women to pursue surgical intervention by asking about cosmetic concerns.
... The leading cause of labial hypertrophy is unknown. 4 However, it can be congenital, or can occur after multiple pregnancies, due to stretching; depending on asymmetry due to excessive tissue protrusion, labial hypertrophy is classified as type I (<2 cm), type II (2-4 cm), type III (4-6 cm), or type IV (>6 cm). 5 Although there is no ideal surgical technique for labiaplasty, each technique has pros and cons. Standard labial reduction procedures include either elliptical excision or wedge excision. ...
Article
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Background Female cosmetic genital surgery (FCGS) aims for better aesthetic genital appearance and improved functional aspects, to enhance women’s self-esteem and satisfaction. Objectives This study aims to assess the satisfaction of women who have undergone FCGS, and its impact on their sexual, psychological, and aesthetic aspects. Methods An observational cross-sectional study was conducted in private clinics in Riyadh, Kingdom of Saudi Arabia, between March and June of 2019, in women who underwent FCGS. Phone interviews were conducted in the Arabic language. The survey comprised four sections: demographics, motives for FCGS, quality of life (QoL) questionnaires about genital appearance satisfaction, and sexual function. Results Out of the 196 women undergoing FCGS during the study period, 11.7% refused to participate, and 37.2% did not answer phone calls; 51% of the women participated in the study. The women's age ranged between 23 and 55 years; 64% underwent vaginoplasty, and 73% underwent other cosmetic procedures. Ninety-two percent of the women did not have any complications after these procedures. Conclusions In this group of women, FCGS was safe and effective, and the majority of participants reported overall satisfaction and improvement of sexual function, genital appearance, and self-esteem.
... In an Australian study, close to three quarters of women desiring labiaplasty voiced concern about their labia's appearance; this was followed by nonsexual functional difficulties, difficulties with sexual intercourse/sexual relationships, and psychological issues ( [88]: 473; see also [46,89,90]). In Spain, Surroca reported that 81% of her labiaplasty patients cited aesthetic concerns, while aesthetic dissatisfaction accounted for 87% of labiaplasty requests in Bramwell and Morland's UK study of 2009 [91,92]. It is difficult to disaggregate these rationales, as body image and self-confidence are crucial for sexual well-being. ...
Article
Full-text available
Purpose of Review To examine the ‘zero tolerance’ policy for female genital cutting (FGM/C) in the international health community in light of the growing popularity of FGCS (female genital cosmetic surgery) worldwide. Recent Findings ‘Traditional’ FGM/C performed in Egypt and Sudan and cosmetic labiaplasty performed in Europe, the Americas, and Antipodes by medically trained gynaecologists and plastic surgeons are based on similar aesthetic logics: labia minora that protrude beyond the labia majora are deemed ugly, masculine, and ‘abnormal’. Drawing on the burgeoning medical, social science, and humanities literature surrounding labiaplasty, the paper documents the narrowing of aesthetic standards governing ‘normal’ genital appearance and finds that, in addition to adult women, thousands of (mainly Caucasian) adolescents have undergone these operations whose long-term health consequences are unknown. Summary Western heteronormativity, gender binarism, ageism, and the colonial association of protruding labia minora with animality contribute to body image insecurities and fuel the labiaplasty phenomenon, despite the ethical challenge that the procedures are clearly defined by the WHO as type II (a–c) female genital mutilations.
... In current literature, few studies report on the surgical outcomes of labiaplasty with a patient satisfaction rates ranged from 95 to 100 percent [62][63][64][65][66][67][68]. The most common complications are dehiscence, hematoma, unsatisfactory scarring, infections, flap necrosis, fistulas, clitoral hood excess and pain [69][70][71]. ...
Article
Full-text available
Labiaplasty is the most commonly performed female cosmetic genital surgery procedure. Women sought labiaplasty for aesthetic reason and/or for functional impairment. Despite increasing numbers of procedures performed, there is a lack of consensus of standards of nomenclature, of care and of outcomes. The aim of this study was to clarify the current notions and the management of these women. A systematic literature review of the last 5 years (2015-2020) was performed using the PubMed database. The search returned 111 articles; after applying inclusion criteria to identify studies evaluating classification of labia minora hypertrophy, surgical techniques, complications and outcomes, 50 articles were selected (11 reviews, 3 clinical trials, 36 prospective and retrospective studies). In this brief review the authors clarify that no consensus exists in the literature regarding the classifications of labia minora hypertrophy. Overall, 7 different techniques have been reported, and patient satisfaction rates ranged from 95 to 100 percent. The most common complication described was wound dehiscence (around 5%). The analysis of literature clearly shows that the counselling is fundamental and women’s motivations for treatment should be carefully explored. A complete medical, sexual, psychological and gynecological history should be obtained in all patients before surgery. To achieve the best outcomes in both functionality and appearance with minimal complication rates and greatest patient satisfaction, trained surgeons must inform patients about normal variations and about the potential risks of surgery, perform psychological evaluations (multidisciplinary approach), discuss realistic expectations, and personalize the technique of surgery. Although labiaplasty was described as a safe procedure with a high satisfaction rate, current study includes few patients with short follow-up. Further clinical studies should be performed to: validate current practices, define optimal management of patients and investigate long-term outcomes.
... Data concerning pregnancy in patients who have undergone labiaplasty are scarce: some of the best currently available published evidence is by Surroca et al, who reported a series of patients who underwent labiaplasty in Barcelona from 2014 to 2015, 13 with 62.07% of patients nulliparous prior to labiaplasty. Three of these patients became pregnant after labiaplasty; 2 of these had a vaginal delivery, and 1 had an episiotomy (which had delayed wound healing). ...
Article
Background A significant proportion of patients seeking labiaplasty are nulliparous and may experience later changes to their labia following vaginal delivery. Objectives In the present study, we report the long-term outcomes of a single surgeon’s patient cohort who had vaginal delivery after labiaplasty. Methods A retrospective chart review of the senior author’s database was conducted. All patients undergoing in-office labiaplasty from 2007-2018 were surveyed. The resulting cohort was stratified into patients who had delivered children prior to labiaplasty, and those that delivered after labiaplasty. Results 204 patients responded to a phone survey. 70 patients had children prior to undergoing labiaplasty, while 33 had children after labiaplasty. The rate of vaginal delivery was lower in the women who had children before labiaplasty (82.6% vs. 91.8%, p = 0.015). The tear/episiotomy rate for vaginal deliveries was lower in women who had children prior to labiaplasty compared to after labiaplasty (3.1% vs. 17.8%, p < 0.001). Among the women who had children only after labiaplasty, the reported tear/episiotomy rate was 7/39 vaginal deliveries (17.9%). Conclusion Patients in our cohort had over 90% success with vaginal deliveries after labiaplasty. For nulliparous patients contemplating the procedure, the data we present suggest the risk of episiotomy or vaginal tear risk with vaginal birth after labiaplasty is comparable to or lower than the general population, further supporting the safety of this procedure. For patients with prior delivery, the data are more limited but suggest no increased risk in this small cohort.
Article
Background Labiaplasty, a surgical procedure designed to address labia minora hypertrophy, has been closely linked to the improvement of genital self-image and the alleviation of symptoms related to body dysmorphic disorder. Brazil stands as the global leader in the prevalence of labiaplasty procedures. Objective This study aimed to assess alterations in genital self-image and symptoms of body dysmorphic disorder in individuals with labia minora hypertrophy who underwent either wedge or trim labiaplasty. Methods A total of 48 adult women undergoing labiaplasty were enrolled in this randomized clinical trial with two parallel groups. Allocation ratio was 1:1. The Study Group (SG) underwent wedge labiaplasty, while the Control Group (CG) underwent trim labiaplasty. Genital self-image and symptoms of body dysmorphic disorder were assessed both preoperatively and six months postoperatively, using validated tools. Results After a six-month intervention period, a statistically significant improvement in genital self-image was observed (p<0.001), alongside a marked decrease in the score of symptoms related to body dysmorphic disorder (p<0.001). There were no significant differences in outcomes between the groups. Furthermore, no statistically significant associations were noted between complications and the specific technique employed. Conclusion The study findings underscore the noteworthy improvement in genital self-image and a concurrent reduction in symptoms of body dysmorphic disorder, evident in both the wedge and linear labiaplasty groups at the six-month postoperative assessments. These results suggest that the choice of surgical technique does not significantly impact these outcomes.
Article
Background: Standardized photographic recording and anatomic evaluation is crucial to refined and comprehensive preoperative design and enhanced aesthetic effect of female genital cosmetic surgery. Objectives: The authors aim to propose a standard photographic scheme and physical examination form for the anatomical assessment of patients undergoing female genital surgery. Methods: The scheme containing two positions (standing and lithotomy positions) and 11 views (one frontal and two oblique views from standing position, six frontal views with labia minora open and close, pulled to the opposite side, clitoral hood pushed up, posterior fourchette stretched, two oblique views from lithotomy position) (2P11V) is applied to record pre- and postoperative appearance of the vulva. The evaluation form is utilized to record characteristics of different anatomical subunits during photography. Results: 245 patients who underwent female genital surgery were enrolled in the research from October 2018 to October 2022. All the patients received preoperative and postoperative 2P11V photography with about 5-minutes' shooting time. Various anatomical variations containing hypertrophy and prolapse of mons pubis, redundant types of labia minora and clitoral hood, incremental exposure of clitoral glans, hypo to hypertrophy of labia majora, disappearance of interlabial groove, hypertrophy of posterior fourchette and relation of subunits were accurately documented. Conclusions: 2P11V photographic scheme displays the isolated features of each organ and proportion relation among different parts of vulva. The standard photographic record and physical examination form offer detailed anatomical structure to surgeons and facilitate surgeons to carry out an accurate surgical design, which deserve to be promoted and applied.
Chapter
As labiaplasty is a highly requested procedure, it is essential to take into account its postoperative implications. In this chapter, emphasis is placed on knowing the prognostic factors of postoperative sequelae, such as the age of performance, smoking, the presence of female sexual dysfunction, and preoperative expectations, in addition to early and late symptoms and the involvement of pregnancies after the procedure. Evaluation scales to apply on patients both before and after labiaplasty are added to their annexes.
Article
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Background: Labiaplasty is an increasingly popular procedure performed for both cosmetic and pathologic etiologies. Questions have been raised regarding the efficacy of the procedure, especially for cosmetic etiologies. Objectives: To examine the complication profiles of labiaplasties for both cosmetic and pathologic etiologies. Methods: The 2005-2017 National Surgical Quality Improvement Program (NSQIP) database was analyzed using Current Procedural Terminology (CPT) codes for patients who underwent labiaplasties. Our cohort was further separated into cosmetic and pathologic groups based on International Classification of Diseases (ICD) codes. Information was collected on patient demographic characteristics, patient comorbidities, and operative variables. Outcomes of interest included surgical complications and delayed length of stay (DLOS). A univariate analysis and multivariate logistic regression were applied to determine statistically significant predictors of our outcomes of interest for both etiologies. Results: There were 640 patients in the cosmetic cohort and 1919 patients in the pathologic cohort. There were no significant differences in rates of surgical complications between the two groups, but there was a statistically significant increase in length of stay for the pathologic group. Univariate analysis revealed operative time and plastic surgeon specialty to be predictive of DLOS in the cosmetic cohort. No covariates were implicated with multivariate analysis for either surgical complications or DLOS in the cosmetic cohort. Conclusions: Our findings suggest that cosmetic labiaplasty is a safe and efficacious procedure with low complication rates and no predictors of adverse outcomes.
Article
Résumé Objectif Fournir aux chirurgiens et autres fournisseurs de soins canadiens qui réalisent des interventions chirurgicales ou thérapeutiques esthétiques génitales féminines, et tout praticien demandeur, des directives fondées sur des données probantes en réponse à l’augmentation des demandes et de la disponibilité des interventions chirurgicales et thérapeutiques vaginales et vulvaires sortant du cadre traditionnel de la reconstruction avec indication médicale. Population cible Les femmes de tous âges qui consultent pour subir une intervention chirurgicale ou thérapeutique esthétique génitale. Bénéfices, risques et coûts Les professionnels de la santé qui prodiguent des soins aux femmes jouent un rôle important en renseignant les femmes sur leur anatomie et en les aidant à prendre conscience des variations individuelles. La plupart des femmes qui demandent une intervention chirurgicale ou thérapeutique esthétique génitale féminine ont des organes génitaux normaux, et jusqu’à 87 % d’entre elles sont rassurées par des conseils. À l’heure actuelle, étant donné le manque de données probantes cliniques et scientifiques rigoureuses sur l’efficacité et l’innocuité à court et à long terme, il n’y a aucune base pour se prononcer en faveur des interventions chirurgicales ou thérapeutiques esthétiques génitales féminines sans indication médicale. Les interventions chirurgicales ou thérapeutiques esthétiques génitales féminines sont généralement réalisées dans le secteur privé, où les coûts sont assumés par la patiente. Données probantes La littérature publiée a été rassemblée par des recherches dans les bases de données Medline, Scopus et Cochrane Library au moyen de termes et mots clés pertinents et validés. Les termes de recherche sélectionnés se composaient de mots clés sur les interventions chirurgicales ou thérapeutiques esthétiques génitales féminines (labiaplasty, surgery, vaginal laser therapy, laser vaginal tightening, vaginal laser, vaginal rejuvenation, vaginal relaxation syndrome, hymenoplasty, vaginal cosmetic procedures) combinés à female genital counselling, consent, satisfaction, follow-up, adolescent et body dysmorphic or body dysmorphia. La recherche a été limitée aux articles publiés après 2012 afin de mettre à jour la documentation depuis la dernière directive à ce sujet. Les résultats ont été restreints aux revues systématiques, aux essais cliniques randomisés et aux études observationnelles. Les études ont été limitées à celles menées chez l’humain seulement, et aucune restriction linguistique n’a été appliquée. La recherche a été effectuée le 20 mai 2020 et mise à jour le 10 novembre 2020. Méthodes de validation Les auteures ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d’évaluation, de développement et d’évaluation (GRADE). Voir l’annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l’interprétation des recommandations fortes et faibles). Professionnels concernés Gynécologues, fournisseurs de soins primaires, chirurgiens réalisant des interventions chirurgicales et/ou thérapeutiques esthétiques génitales féminines. RECOMMANDATIONS 1.Les professionnels de la santé qui prodiguent des soins aux femmes doivent jouer un rôle important en renseignant les femmes sur leur anatomie et en les aidant à prendre conscience des variations individuelles, y compris les différentes transitions au cours du cycle de la vie reproductive (forte, faible). 2.Il y a lieu de faire un bilan complet des antécédents médicaux, sexuels et gynécologiques et de confirmer l’absence de toute dysfonction sexuelle ou psychologique importante, y compris l’obsession d’une dysmorphie corporelle, auprès de chaque femme qui demande une intervention esthétique vaginale. Il est aussi essentiel d’écarter toute possibilité de coercition ou d’exploitation (forte, élevée). 3.Les données probantes sont insuffisantes pour appuyer toute intervention chirurgicale ou thérapeutique esthétique génitale féminine visant à améliorer la satisfaction sexuelle et/ou l’image de soi. Les médecins qui choisissent de réaliser ce genre d’interventions esthétiques ne doivent pas promouvoir ces interventions chirurgicales dans une optique d’amélioration de la fonction sexuelle ou de l’image de soi (forte, faible). 4.L’hyménoplastie est une intervention chirurgicale sans indication médicale. Les conseils à la femme sont essentiels pour la rassurer et lui fournir de l’information exacte sur le fait que l’intervention ne donnera pas nécessairement le résultat escompté d’un saignement au premier rapport sexuel conjugal (forte, moyenne). 5.Le laser n’est pas recommandé pour le traitement du syndrome génito-urinaire de la ménopause ni pour une indication esthétique génitale tant que des données de recherche clinique rigoureuses supplémentaires n’auront pas été publiées concernant les effets à court et à long terme (forte, faible). 6.Les conseils aux femmes qui consultent pour une intervention chirurgicale ou thérapeutique esthétique génitale féminine sans indication médicale doivent être une priorité. Les sujets abordés doivent traiter des variations et changements physiologiques normalement observés tout au long de la vie en plus du risque de conséquences imprévues d’une intervention chirurgicale esthétique dans la région génitale. Il y a également lieu de discuter et de tenir compte du manque de données probantes de haute qualité sur les résultats de ces interventions dans le cadre du processus de décision éclairée (forte, élevé). 7.Il faut faire preuve de prudence dans la publicité sur les interventions chirurgicales esthétiques génitales féminines pour éviter toute publicité trompeuse et non factuelle (forte, élevée). 8.Tout médecin qui reçoit une adolescente demandant une intervention chirurgicale esthétique génitale doit avoir une expertise supplémentaire en conseils aux adolescentes (forte, faible). 9.Aucune intervention chirurgicale esthétique génitale féminine ne doit être réalisée avant la maturité génitale (forte, faible). 10.Toute intervention chirurgicale réalisée pour une atteinte fonctionnelle confirmée, qu’il s’agisse d’un problème structurel, psychologique et/ou anatomique, n’est pas considérée comme une intervention esthétique (forte, modérée).
Article
Objective To provide Canadian surgeons and other providers who offer female genital cosmetic surgery (FGCS) and procedures, and their referring practitioners, with evidence-based direction in response to increasing requests for, and availability of, vaginal and vulvar surgeries and procedures that fall outside the traditional realm of medically indicated reconstructions. Target Population Women of all ages seeking FGCS or procedures. Benefits, Harms, and Costs Health care providers play an important role in educating women about their anatomy and helping them appreciate individual variations. Most women requesting FGCS and procedures have normal genitalia, and up to 87% are reassured by counselling. At this time, due to lack of rigorous clinical or scientific evidence of short- and long-term efficacy and safety, FGCS and procedures for non-medical indications cannot be supported. FGCS and procedures are typically provided in the private sector, where costs are borne by the patient. Evidence Literature was retrieved through searches of MEDLINE, Scopus, and The Cochrane Library using appropriate controlled vocabulary and keywords. The selected search terms represented keywords for FGCS (labiaplasty, surgery, vaginal laser therapy, laser vaginal tightening, vaginal laser, vaginal rejuvenation, vaginal relaxation syndrome, hymenoplasty, vaginal cosmetic procedures) combined with female genital counselling, consent, satisfaction, follow-up, adolescent, and body dysmorphic or body dysmorphia. The search was restricted to publications after 2012 in order to update the literature since the previous guideline on this topic. Results were restricted to systematic reviews, randomized controlled trials, and observational studies. Studies were restricted to those involving humans, and no language restrictions were applied. The search was completed on May 20, 2020, and updated on November 10, 2020. Validation Methods The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). Intended Audience Gynaecologists, primary care providers, surgeons performing FGCS and/or procedures. RECOMMENDATIONS 1.Health providers should play an important role in educating women about their anatomy and helping them appreciate individual variations, including transitions through the reproductive life cycle (strong, low). 2.For women who present with requests for vaginal cosmetic procedures, a complete medical, sexual, and gynaecological history must be obtained, and the absence of any major sexual or psychological dysfunction, including body dysmorphic disorder, should be ascertained. Any possibility of coercion or exploitation must also be ruled out (strong, high). 3.There is insufficient evidence to support any female genital cosmetic surgery or procedure to improve sexual satisfaction and/or self-image. Physicians choosing to proceed with these cosmetic procedures should not promote these surgeries for the enhancement of sexual function or self-image (strong, low). 4.Hymenoplasty is a surgical procedure that is not medically indicated. Counselling of the woman is paramount to provide both reassurance and accurate information that the procedure does not reliably result in the desired outcome of bleeding at first marital intercourse (strong, moderate). 5.Laser is not recommended for genitourinary syndrome of menopause or cosmetic genital indications without further rigorous short- and long- term clinical research (strong, low). 6.Counselling should be a priority for women requesting female genital cosmetic surgery and procedures that are not medically indicated. Topics should include normal variation and physiological changes over the lifespan, as well as the possibility of unintended consequences of cosmetic surgery to the genital area. The lack of both high-quality evidence and data regarding outcomes should also be discussed and considered as part of the informed decision-making process (strong, high). 7.Caution should be used in advertising female genital cosmetic surgeries, to ensure such advertising is factual and not misleading (strong, high). 8.Physicians who see adolescents requesting female genital cosmetic surgery require additional expertise in counselling adolescents (strong, low). 9.Female genital cosmetic surgery must not be performed until genital maturity (strong, low). 10.Surgery is not considered cosmetic if there is documented functional impairment, which may include structural, psychological, and/or anatomical concerns (strong, moderate).
Article
Background Labia minora reduction is a surgery in the rise. Surgeons are left with a large choice of described techniques yet there is a paucity of visual data to guide surgeons through this procedure. Also, many gynecologic surgeons are reluctant to perform this operation emphasizing potential complications. Technique We present a step by step visual support of a wedge resection technique. Experience This technique of labia minora reduction is safe and carries a great satisfaction rate among patients. Conclusion We believe that a visual description of a simple and quick technique will help standardized patient care and achieve good outcomes.
Article
Objective Cosmetic gynecology, a field which has garnered substantial attention over recent years, lacks a universally accepted nomenclature. The aim of this systematic review is to evaluate techniques, outcome measures reported, and adverse events in patients undergoing cosmetic gynecology procedures and offer recommendations to improve reporting metrics.MethodsA systematic literature search was performed using electronic databases from inception to April 2019. The search was based on 51 unique cosmetic gynecology keywords such as: “labiaplasty,” “vaginal rejuvenation,” and “liposuction mons pubis.” All English full-text prospective and retrospective observational and interventional studies with at least five subjects that describe a cosmetic gynecology procedure were included. Only full-text articles were included. This protocol has been registered with PROSPERO (CRD 42019131860).ResultsA total of 1837 articles were identified from the search strategy with 42 included in the quantitative synthesis. Procedures described included: labia minora reduction with or without clitoral hood reduction, labia majora augmentation, surgical vaginal caliber reduction, mons pubis reduction/suspension, and energy-based therapy for vaginal laxity or vulvar laxity. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. Complication rates varied by procedure but were generally low and ranged between Clavien-Dindo grades I–III.Conclusions Although there is a breadth of literature on cosmetic gynecology surgical techniques and short-term complication rates, the terminology and outcome measures utilized are heterogeneous. To address this, standardized terminology along with uniform cosmetic and functional endpoints must be developed.
Article
Background The popularity of genital cosmetic procedures in women is increasing. These procedures are often assumed and promoted as having have a positive effect on women’s psychological well-being, particularly their self-esteem. Empirical support for these claims is lacking. Objectives To conduct a systematic review and meta-analysis of the impact of genital cosmetic procedures on self-esteem in women. Methods The authors performed a systematic literature review using MEDLINE, PreMEDLINE, Ebase, EMBASE, OVID, CINAHL, Cochrane, PsycINFO, and PubMed to identify articles which measured self-esteem in women after a genital cosmetic procedure. A meta-analysis was conducted to assess the pooled effect of these procedures on self-esteem. Results The authors identified 5 eligible studies for the meta-analysis, including two prospective and three retrospective studies. Labia minora reduction was the most commonly studied procedure. All 5 studies used different measures of self-esteem, with only one study employing a validated psychometric measure at both preoperative and postoperative time-points. The meta-analysis results showed a pooled logit rate estimate of 1.230 indicating a positive effect of surgery on self-esteem. However, there was substantial heterogeneity across studies. Conclusions Female genital cosmetic procedures, particularly labiaplasty, appear to have a positive effect on women’s self-esteem. However, inconsistencies in study measures and methods limit our conclusions. Future research should involve the development of standardized outcome measures to more accurately assess the impact on self-esteem and psychological well-being more generally.
Article
A new development in female genital cosmetic surgery (FGCS) is the promotion of revision surgery for ‘botched labiaplasty’. This content analysis study reviews the quality of information offered on websites specifically advertising revision labiaplasty. Twelve websites were identified through online searches and were examined for the quality of their clinical information. All sites defined botched labiaplasty as unsatisfactory appearance after labiaplasty. Four gave no further details and five listed asymmetry, irregular labial edges or removal of too much or too little tissue. Four websites described primary botched labiaplasty as ‘mutilation’. Inadequacy of the primary surgeon was cited as the cause of botched labiaplasty in 11/12. Only two websites mentioned risks of surgery. Good outcomes were not defined and no website provided outcome data although guaranteed satisfaction was implied in two websites. This study highlights the existence and promotion of services for botched labiaplasty using non-specific and emotive descriptions. These findings suggest that unsatisfactory results from consumers’ perspectives are far from uncommon. The same women whose expectations have not been met by primary surgery are now being targeted for repeat surgery with online advertising capitalising on their unchanged motivations. • Impact Statement • What is already known on this subject? Female genital cosmetic surgery (FGCS) is mainly advertised online with labiaplasty as the most commonly performed procedure. A market for labiaplasty revision to correct ‘botched’ primary procedures is developing. Academic literature and advertising materials are inconsistent when defining indications and determinants of success for labiaplasty or revision. • What the results of this study add? A content analysis of websites specifically advertising revision labiaplasty describes the emotive and nonspecific terms used online to promote revision labiaplasty. • What the implications are of these findings for clinical practice and/or further research? The existence of services for botched labiaplasty suggests dissatisfaction is common. Women whose expectations have not been met by primary surgery are targeted for repeat surgery through online advertising capitalising on their potentially unchanged motivations. This study demonstrates the need for clearer outcome data for labiaplasty and highlights the need for better advertising standards for FGCS promotion.
Article
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Background In the subspecialty of female genital cosmetic procedures, patient satisfaction and quality of life are key outcome measures. As such, valid and reliable patient-reported outcome measures (PROMs) examining these outcomes are essential. Objectives To identify and scrutinize all PROMs developed for female patients undergoing genital cosmetic procedures. Methods The authors performed a systematic literature review using MEDLINE, PreMEDLINE, Ebase, EMBASE, OVID, CINAHL, Cochrane Library, PsycINFO, PubMed, and Google Scholar to identify PROMs developed and validated for use in female genital cosmetic procedure patients. Instruments identified were assessed according to international guidelines for health outcome measures development and validation. Results The authors identified 50 outcome questionnaires used in the female genital cosmetic procedure literature. Of these, 26 were ad hoc instruments (ie, had not been formally developed and tested) and 22 were generic instruments (ie, intended for use in broad groups of people, not only specific patient groups). Only two instruments have been validated in a female genital cosmetic procedure patient population. These were the Genital Appearance Satisfaction (GAS) scale and the Cosmetic Procedure Screening Scale - Labiaplasty (COPS-L). Although both the GAS scale and COPS-L had undergone fairly rigorous psychometric development and validation, both had content limitations. Conclusions There is a lack of specific, valid and reliable satisfaction and quality of life PROMs in the field of female genital cosmetic procedures. Future research should involve the development of such measures to more accurately assess the outcomes and benefits of these procedures.
Article
Learning objectives: After studying this article and viewing the video, the participant should be able to: 1. Accurately describe the relevant aesthetic anatomy and terminology for common female genital plastic surgery procedures. 2. Have knowledge of the different surgical options to address common aesthetic concerns and their risks, alternatives, and benefits. 3. List the potential risks, alternatives, and benefits of commonly performed female genital aesthetic interventions. 4. Be aware of the entity of female genital mutilation and differentiation from female genital cosmetic surgery. Summary: This CME activity is intended to provide a brief 3500-word overview of female genital cosmetic surgery. The focus is primarily on elective vulvovaginal procedures, avoiding posttrauma reconstruction or gender-confirmation surgery. The goal is to present content with the best available and independent unbiased scientific research. Given this relatively new field, data with a high level of evidence are limited. Entities that may be commonly encountered in a plastic surgery practice are reviewed. The physician must be comfortable with the anatomy, terminology, diagnosis, and treatment options. Familiarity with requested interventions and aesthetic goals is encouraged.
Article
Résumé Objectifs La nymphoplastie est une intervention consistant en la résection partielle des petites lèvres. Les motivations des patientes à la réalisation de cet acte chirurgical sont fonctionnelles (gêne lors des rapports, lors des activités sportives, etc.) ou esthétiques. À ce jour, peu de données concernent la satisfaction des patientes en postopératoire, alors que le nombre d’opérations pratiquées augmente. En effet, on note une augmentation du nombre de nymphoplasties en France de 57% en France entre 2008 et 2016. L’objectif principal de l’étude est d’évaluer la satisfaction postopératoire des patientes. Les objectifs secondaires sont d’évaluer les motivations à se faire opérer et les complications postopératoires. Méthodes Une étude prospective observationnelle a été menée entre août et novembre 2016 et entre mars 2017 et mai 2018. Toutes les patientes consultant pour nymphoplastie dans un centre hospitalier universitaire ont été incluses dans l’étude. Les patientes étaient interrogées par auto-questionnaire le jour de leur opération sur leur motivation, ainsi que sur le risque de présenter une dysmorphophobie à l’aide d’un score validé : BDDQ. Toutes les patientes étaient à nouveau interrogées sur leur satisfaction postopératoire, à 3 mois et 6 mois de l’opération. Résultats Trente patientes ont été incluses. Dix-neuf patientes ont répondu à l’intégralité des questionnaires. L’âge moyen des patientes était de 31,5 ans (± 10,58). La médiane de réflexion préopératoire était de plus de 12 mois (IQR 1). L’ensemble des patientes ont été opérées en ambulatoire et 1(3%) a dû être reprise. La motivation principale exprimée par les patientes était la gêne au port de vêtements serrés : 90% des patientes ; la gêne lors d’activités sportives : 83% des patientes ; la gêne lors des rapports sexuels : 80% des patientes ; la gêne lors de la marche : 66% des patientes. Soixante-treize pour cent des patientes espèrent une amélioration de leurs activités physiques. La gêne fonctionnelle a été améliorée chez 94% des patientes à 6 mois dont 84% se déclarent énormément améliorées. Quatre-vingt-quatre pour cent ressentent une amélioration de la gêne esthétique à 6 mois. L’ensemble des patientes recommanderait l’intervention à une proche. L’ensemble des patientes déclarent accepter cette modification physique. Au total, 55% déclarent que le regard d’autrui/partenaire n’a pas changé. Conclusion Les patientes consultant notre service présentent une réelle gêne fonctionnelle. Les patientes sont majoritairement très satisfaites de leur opération à 3 et 6 mois.
Article
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Purpose of Review To examine the peer-reviewed publications on the topic of female cosmetic genital surgery (FCGS) and discuss recent trends, the factors motivating patients to request these procedures, and the controversy surrounding them. Recent Findings In studies with the primary goal being esthetic improvement (e.g., labiaplasty), post-operative satisfaction rates are generally high. When procedure outcomes are focused more on functional aspects, such as enhancement of sexual function and response, statistically significant improvements are also reported after treatment. Complication rates vary across treatment sites and operating physicians. Summary While FCGS procedures continue to rise, great variation still exists across patient-centered outcomes, treatment modalities offered, and quality of published studies examining outcomes. Small sample sizes and lack of standardization across study centers make scientifically validating existing data challenging. Consensus across disciplines pertaining to standardization of procedures and outcomes is necessary to optimize patient satisfaction, care, and safety.
Article
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Vaginal labiaplasty has become a more frequently performed procedure as a result of the publicity and education possible with the internet. Some of our patients have suffered in silence for years with large, protruding labia minora and the tissue above the clitoris that is disfiguring and uncomfortable and makes intercourse very difficult and painful. We propose four classes of labia protrusion based on size and location: Class 1 is normal, where the labia majora and minora are about equal. Class 2 is the protrusion of the minora beyond the majora. Class 3 includes a clitoral hood. Class 4 is where the large labia minora extends to the perineum. There are two principal means of reconstructing this area. Simple amputation may be possible for Class 2 and Class 4. Class 2 and Class 3 may be treated with a wedge resection and flap advancement that preserves the delicate free edge of the labia minora (Alter, Ann Plast Surg 40:287, 1988). Class 4 may require a combination of both amputation of the clitoral hood and/or perineal extensions and rotation flap advancement over the labia minora. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Article
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The aesthetic and functional procedures that comprise female genital cosmetic surgery (FGCS) include traditional vaginal prolapse procedures as well as cosmetic vulvar and labial procedures. The line between cosmetic and medically indicated surgical procedures is blurred, and today many operations are performed for both purposes. The contributions of gynecologists and reconstructive pelvic surgeons are crucial in this debate. Aesthetic vaginal surgeons may unintentionally blur legitimate female pelvic floor disorders with other aesthetic conditions. In the absence of quality outcome data, the value of FGCS in improving sexual function remains uncertain. Women seeking FGCS need to be educated about the range and variation of labia widths and genital appearance, and should be evaluated for true pelvic support disorders such as pelvic organ prolapse and stress urinary incontinence. Women seeking FGCS should also be screened for psychological conditions and should act autonomously without coercion from partners or surgeons with proprietary conflicts of interest.
Article
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The elongation of the labia minora is classified as a Type IV female genital mutilation by the World Health Organization. However, the term mutilation carries with it powerful negative connotations. In Rwanda, the elongation of the labia minora and the use of botanicals to do so is meant to increase male and female pleasure. Women regard these practices as a positive force in their lives. This paper aims to assess whether Rwandan vaginal practices should indeed be considered a form of female genital mutilation and whether the botanicals used by women are detrimental to their health. Research was carried out in the northeast of Rwanda over the course of 13 months. Semi-structured interviews were conducted with thirteen informants. Two botanicals applied during stretching sessions were identified as Solanum aculeastrum Dunal and Bidens pilosa L. Both have wide medicinal use and contain demonstrated beneficial bioactive compounds. We suggest that it is therefore more appropriate to describe Rwandan vaginal practices as female genital modification rather than mutilation.
Article
Female genital cosmetic surgery is becoming more and more widespread both in the field of plastic and gynaecological surgery. The increased demand for vulvar surgery is spurred by the belief that the vulva is abnormal in appearance. What is normal in terms of labial anatomy? Labia minora enlargement or hypertrophy remains a clinical diagnosis which is poorly defined as it could be considered a variation of the normal anatomy. Enlarged labia minora can cause functional, aesthetic and psychosocial problems. In reality, given the wide variety of vulvar morphology among people, it is a very subjective issue to define the "normal" vulva. The spread of nudity in the general media plays a major role in creating an artificial image and standards with regard to the ideal form. Physicians should be aware that the patient's self-perception of the normal or ideal vulva is highly influenced by the arguably distorted image related to our socio-psychological environment, as presented to us by the general media and internet. As physicians, we have to educate our patients on the variation of vulvar anatomy and the potential risks of these surgeries. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Article
Introduction Hypertrophy and variation in the size of labia minora has long been recognized as a problem that can be bothersome for aesthetic, functional and psychosocial reasons. In the past labia minora reduction was usually performed by simple and straight resection of the protuberant segment and oversewing the edge. This paper presents a comparison of our results with each procedure. Materials and Methods From March 1997 to February 2005, 100 women from 17 to 45 years old underwent reduction labioplasty. We performed w-shaped resections with interdigitated suturing in 50 cases and de-epithelialized reduction labioplasty in 50 cases. Results Patients in both groups had minimal discomfort postoperatively and at 6 months reported improvement of their original problems with chronic irritation, inadequate hygiene, and sexual intercourse. Twenty-three patients underwent treatment of hypertrophic labia minora with excellent results and minimal postoperative discomfort. Three patients suffered from postoperative infection but were successfully treated with antibiotics. In group A, 5 patients were not satisfied with the appearance of the edge of the labia minora, and in 8 patients, it took up to 2 years for sensation to be restored to the labia minor. Conclusion The deepithelialized reduction labioplasty gives the patient more satisfaction both in the appearance of the edge of the labia minora and the neurovascular preservations of the labia.
Article
Vaginal rejuvenation has been on the rise for the past 10 years. Women seem to prefer no pubic hair and minimal if any labia minora dangling beyond the majora. Labiaplasty or labia minora reduction is the most common procedure requested by women concerned with the appearance of their vulvar area. Safe and effective surgical procedures exist to trim the labia minora and the labia majora and clitoral hood as indicated. In this article, patient selection and consent, surgical techniques, avoidance of complications, and adjunctive procedures to further enhance the aesthetics of the region are discussed.
Article
An increasing number of patients are seeking cosmetic procedures of the vulva. In 2007, the American College of Obstetricians and Gynecologists released a Committee Opinion (#378) advising against cosmetic vaginal procedures due to a lack of safety and efficacy data. A growing number of observational studies has suggested overall high satisfaction rates, and complication rates that are "acceptable," although a paucity of comparative data and validated outcomes measures remains. The issue is further intensified and complicated by the proprietary or franchised techniques and devices that surgeons "sell" to each other, and by the fee-for-service model that circumnavigates some of the rigors of the physician-payor-patient relationship. This point/counterpoint article, based on a debate held at the Society of Gynecologic Surgeons' 2014 Annual Scientific Meeting, addresses the issue of an individual seeking a cosmetic reduction labiaplasty from her gynecologist in the contexts of available literature and standard ethical frameworks. The specific question posed to the panelists was, "Should the gynecologist feel comfortable offering cosmetic labiaplasty procedures to his or her patients?"
Article
An increasing number of patients are seeking cosmetic procedures of the vulva. In 2007, the American College of Obstetricians and Gynecologists released a Committee Opinion (#378) advising against cosmetic vaginal procedures due to a lack of safety and efficacy data. A growing number of observational studies has suggested overall high satisfaction rates, and complication rates that are "acceptable," although a paucity of comparative data and validated outcomes measures remains. The issue is further intensified and complicated by the proprietary or franchised techniques and devices that surgeons "sell" to each other, and by the fee-for-service model that circumnavigates some of the rigors of the physician-payor-patient relationship. This point/counterpoint article, based on a debate held at the Society of Gynecologic Surgeons' 2014 Annual Scientific Meeting, addresses the issue of an individual seeking a cosmetic reduction labiaplasty from her gynecologist in the contexts of available literature and standard ethical frameworks. The specific question posed to the panelists was, "Should the gynecologist feel comfortable offering cosmetic labiaplasty procedures to his or her patients?"
Article
The demand for labia minora reduction surgery has increased, but previously described techniques do not provide precise dimensional reduction for varying labial deformities, and some techniques result in prominent scars. A new technique for labia minora reduction is described, and patient satisfaction with this technique is examined. The custom flask labiaplasty technique is fully described. A retrospective chart review and a postoperative survey were conducted on 50 consecutive patients who underwent this new technique for labia minora reduction over a 3-year period from March 2007 to June 2010. The mean age of patients undergoing labiaplasty was 37.7 years. The most common reasons for seeking this surgery were appearance (80%), discomfort in clothing (36%), and discomfort with sexual activity (30%). Of the 50 patients, 27 provided responses after surgery. Of the 27 respondents, 25 (93%) were satisfied with the results from surgery. Only 1 (2%) minor postoperative complication occurred in the total patient population. This new technique improves on current techniques, has a low complication rate, is highly reproducible, results in high patient satisfaction, and can be customized to optimally meet the patient's wishes.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
Article
Examine women's perceptions of what is 'normal' and 'desirable' in female genital appearance. Experiment with random allocation across three conditions. Community. A total of 97 women aged 18-30 years. Women were randomly assigned to view a series of images of (1) surgically modified vulvas or (2) nonmodified vulvas, or (3) no images. They then viewed and rated ten target images of surgically modified vulvas and ten of unmodified vulvas. Women used a four-point Likert scale ('strongly agree' to 'strongly disagree'), to rate each target image for 'looks normal' and 'represents society's ideal'. For each woman, we created two summary scores that represented the extent to which she rated the unmodified vulvas as more 'normal' and more 'society's ideal' than the modified vulvas. For ratings of 'normality,' there was a significant effect for condition (F2,94 = 2.75 P = 0.007, radj2 = 0.082): women who had first viewed the modified images rated the modified target vulvas as more normal than the nonmodified vulvas, significantly different from the control group, who rated them as less normal. For ratings of 'society's ideal', there was again a significant effect for condition (F2,92 = 7.72, P < 0.001, radj2 = 0.125); all three groups rated modified target vulvas as more like society's ideal than the nonmodified target vulvas, with the effect significantly strongest for the women who had viewed the modified images. Exposure to images of modified vulvas may change women's perceptions of what is normal and desirable. This may explain why some healthy women seek labiaplasty.
Article
Background: The demand for surgery to treat the external female genital area has increased significantly in recent years. Since 2001, the author and his colleagues have performed more than 2,100 surgical procedures to enhance the shape and function of the female genital area. The majority of these procedures were aimed at reduction of the labia minora. Drawing on the technique for labia minora reduction (labiaplasty) that the author first described in 2007 (Gress S, Gynäkologisch-Geburtshilfliche Rundschau 47:23-32, 2007), the technique was advanced such that in addition to an even reduction of the labia over their entire length (i.e., not only the part below the clitoris but also the part of the clitoral hood and above), it currently is possible to achieve further tightening of the clitoral hood and correction of a protruding clitoris (clitoral protrusion). This technique creates separate labial segments, the composition of which allows for an optimal shaping and reduction of the labia minora. Since 2006, the author and his colleagues have managed 812 cases using this technique, which has been named "composite reduction labiaplasty." Methods: After removal of the excessive tissue in an S-shaped line along the internal and external aspects of the labium minus and after cutting of a cranial pedicle flap approximately 2-3 cm long (seen as the caudal extension of the clitoral hood), a crescent-shaped skin segment below the clitoris and a centrally pointed rectangular skin segment above the clitoral hood are removed. By joining the wound margins, a tightening and balanced reduction of the labia minora as well as a correction for the protruding tip of the clitoris (clitoral protrusion) is achieved. Results: All the patients received postoperative care and follow-up assessments during a period of 6 months. Except for a few cases of wound dehiscence requiring surgical correction, wound healing was without complications, and the outcomes were both aesthetically and functionally very satisfactory. Conclusion: In contrast to most techniques published to date, the "composite reduction labiaplasty" technique ensures a balanced reduction and a tightening of all parts of the labia minora, especially in the region of the clitoral hood. In addition, this technique results in an optimal correction of clitoris positioning in cases of clitoral protrusion. Concerns regarding impairment of sexual sensation or the ability to be sexually stimulated are unfounded. Approximately 35 % of the patients even reported a postoperative increase in their ability to be sexually stimulated. Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Article
Introduction: Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? Aim: This study was designed to produce objective, utilizable outcome data regarding FGPS. Main outcome measures: 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. Methods: This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. Results: Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6-42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients undergoing vaginal tightening/perineal support procedures. Complications were acceptable and not of major consequence. Conclusions: While emphasizing that these female genital plastic procedures are not performed to correct "abnormalities," as there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. From the results of this large study pooling data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent.
Article
Background: Patient requests for plastic surgery of the female genitalia have become more common. There are several technical options to manage hypertrophic labia minora, including direct excision, wedge resection, and deepithelialization. Labia majora hypertrophy and hypoplasia can also be managed surgically. The aim of this study was to summarize labioplasty techniques to date, and describe the senior author's technique for labia minora and majora labioplasty. Methods: Seventy-four patients underwent direct labia minora excision with or without clitoral hood molding and management of labia majora by the senior author from January 2009 to August 2011. Results: The average follow-up time was 6 months. The range of the patients' ages was wide with an average age of 35 years. One patient had an infection and one had wound dehiscence. Six patients had palpable fatty cysts in the labia majora after fat injections; the cysts of five of these patients reabsorbed before 6 months. In one patient a palpable mass persisted 8 months after surgery; however, it was not visible or painful and the patient was satisfied with the result. No cases of scar contracture, painful scar, or discomfort because of labial edge distortion were noted. The satisfaction rate was close to 100 %. Conclusion: The direct excision of the excess labia minora is a good technique and does not produce scar-associated problems. Level of evidence iii: This journal requires that authors assign a level of evidence to each article.
Article
The aim of this study was to introduce a new method of labiaplasty. Here we describe the surgical procedure, outcomes and the advantages and disadvantages of this method. The medical records of 167 patients aged between 20 and 43 years who underwent reduction of the labia minora from May 2006 to March 2011 were reviewed. The procedures performed in these studies used de-epithelialised reduction of the middle and posterior sections of the labia minora. All the surgeries were performed successfully, and 164 patients experienced an uneventful postoperative period. A minor dehiscence occurred in one patient, who recovered with no requirement for additional treatment. Another two women felt that the reduction was not fully achieved. All of the patients were satisfied with the eventual aesthetic appearance. The de-epithelialised reduction of the middle and posterior portion of the labia minora is a simple and safe method that is associated with satisfactory outcomes.
Article
Please cite this paper as: Kelly B, Foster C. Should female genital cosmetic surgery and genital piercing be regarded ethically and legally as female genital mutilation? BJOG 2012;119:389-392.
Article
To evaluate postoperative satisfaction, including improvements in quality of life, among patients who had undergone labia minora reduction. In a retrospective descriptive study, women who had undergone labiaplasty for hypertrophy of the labia minora between January 2005 and December 2009 were contacted by telephone. The women were asked to answer a satisfaction survey evaluating the esthetic and functional results of the surgery. Among 21 patients who had labiaplasty using either a pedicle flap reconstruction (n=18, 86%) or a nymphectomy technique (n=3, 14%), 18 (86%) were contacted successfully and took part in the survey. All of the contacted patients were satisfied with the overall outcome of the surgery, with a mean rating of 8.7 out of 10 at a median follow-up of 17 months (interquartile range 6-25 months). From an esthetic point of view, all 18 patients reported an improvement in comfort with respect to any form of original functional discomfort. Concerning sexuality, 95% of the sexually active patients had originally described some form of physical or psychologic discomfort, and all of them reported total disappearance of this symptomatology. Labiaplasty provided overall satisfaction in terms of improvements in patient quality of life and sexuality.
Article
Female genital cosmetic surgery procedures have gained popularity in the West in recent years. Marketing by surgeons promotes the surgeries, but professional organizations have started to question the promotion and practice of these procedures. Despite some surgeon claims of drastic transformations of psychological, emotional, and sexual life associated with the surgery, little reliable evidence of such effects exists. This article achieves two objectives. First, reviewing the published academic work on the topic, it identifies the current state of knowledge around female genital cosmetic procedures, as well as limitations in our knowledge. Second, examining a body of critical scholarship that raises sociological and psychological concerns not typically addressed in medical literature, it summarizes broader issues and debates. Overall, the article demonstrates a paucity of scientific knowledge and highlights a pressing need to consider the broader ramifications of surgical practices. "Today we have a whole society held in thrall to the drastic plastic of labial rejuvenation."( 1 ) "At the present time, the field of female cosmetic genital surgery is like the old Wild, Wild West: wide open and unregulated"( 2 ).
Article
Aesthetic reduction of the labia minora has gained popularity, and a number of different techniques have been described. Each procedure has its own set of advantages and disadvantages. However, no algorithm has been defined for pairing the degree of deformity with the optimal surgical procedure. Patients were stratified into one of four groups based on labial size. The surgeon chose one of three reduction techniques based on the degree of labial hypertrophy and the patient's aesthetic preferences for labial edge color and contour. Three reduction techniques were used including the edge excision technique, the inferior wedge resection technique, and deepithelialization reduction labioplasty. The success of aesthetic reduction was evaluated, as was symptomatic relief. The 12 procedures performed included five deepithelialization techniques, four edge excision techniques, and three inferior wedge resection techniques. As reported, 92% of the patients were "very satisfied" with their aesthetic and functional results. The complications were minimal, with three patients experiencing minor wound healing difficulties that resolved spontaneously. One patient who underwent the edge excision technique was "not satisfied" and complained of overreduction. The authors found all three techniques for labia minora reduction to be useful in different clinical situations. A novel algorithm is described for matching the optimal surgical technique for each patient based on her degree of hypertrophy and aesthetic goals.
Article
The central wedge excision to reduce the labia minora was reported in 1998. The purpose of this article is to present recent modifications and results of this technique. A central wedge or V is removed from the most protuberant portion of each labium minus. The outer portion of the V excision is usually curved lateral and anterior to excise redundant lateral labium and excess lateral clitoral hood. Postoperative examinations were performed when possible. Two separate mailings of questionnaires were sent, and follow-up phone calls were made to nonresponders. A total of 407 patients had labia reductions from January 1, 2005, to December 31, 2006. All but 14 (3 percent) were bilateral. Ages ranged from 13 to 63 years (average, 32.4 years). Almost all patients had some lateral clitoral hood excisions with the extension of the lateral hockey-stick design. Postoperative examinations at least 2 weeks after surgery were performed on 123 patients. The total number of patients undergoing reoperation was 12 of 407 (2.9 percent). Patients responding to the questionnaire (166 of 407) were pleased with the surgery by an average score of 9.2 of 10 (where 10 = most pleased). Improvement in self-esteem (93 percent), sex life (71 percent), and discomfort (95 percent) was reported with a low significant complication rate (4 percent); 163 of the respondents (98 percent) would undergo the surgery again. Central wedge reduction with lateral clitoral hood reduction is a safe, effective procedure with few complications and high patient satisfaction.
Article
2 cases of bilateral hypertrophy of the labia minora are recorded. The patients presented with vulvar discomfort and redundant labia and reduction vulvoplasty was carried out. The resected specimens showed marked hyperplasia of the non-hair-bearing sebaceous glands, acanthosis, keratosis, and hyperpigmentation of the epithelium and a variable degree of neoangiogenesis and fibrosis in the upper dermis. No cause was established clinically or pathologically. The etiology and pathogenesis of this condition are briefly discussed.
Article
A new technique has been developed to reduce the labia minora yet maintain the normal labial edge and color. Labia minora enlargement can be congenital or acquired by chronic irritation, exogenous androgenic hormones, and stretching with weights. This can cause inflammation, poor hygiene, interference with sexual intercourse, or intermittent urinary self-catheterization. Aesthetically, asymmetrical or enlarged labia minora causes self-consciousness sexually and when the subject wears tight pants. Previously labia minora reduction was performed by amputation of the protuberant segment and oversewing the edge. Now, rather than amputation, a wedge of protuberant labial tissue is excised and the labial edges are reapproximated. Four patients have undergone this aesthetic procedure with excellent results. No complications occurred. The new technique is relatively simple and can greatly enhance the patient's confidence.
Article
Our purpose was to describe the surgical procedure, its results, and its complications and to determine whether patients are satisfied with surgical reduction of labia minora in cases of hypertrophy. The records of 163 patients who underwent reduction of the labia minora during a 9-year period were reviewed. The ages of the patients ranged from 12 to 67 years (median, 26). Motives for requesting surgery were aesthetic concerns in 87% of the cases, discomfort in clothing in 64%, discomfort with exercise in 26%, and entry dyspareunia in 43%. Anatomic results were assessed 1 month postoperatively. Patient satisfaction was assessed by means of a mailed questionnaire. No surgery-related significant complications were noticed. Anatomic results were satisfactory for 151 patients (93%). Ninety-eight completed questionnaires were returned. Eighty-one patients (83%) found that the results after surgery were satisfactory. Eighty-seven (89%) were satisfied with the aesthetic result, and 91 (93%) approved the functional outcome. Four patients (4%) would not undergo the same procedure again. Labia minora reduction is a simple surgical procedure associated with a high degree of patient satisfaction.
Article
To evaluate laser labioplasty for the correction of hypertrophy and asymmetry of labia minora. Between October 2003 and November 2004, 55 labioplasties were performed at the Clínica Las Condes, Santiago, Chile. On the 60th postoperative day a questionnaire was presented to the patients, who were aged between 10 and 55 years, to assess their acceptance of and satisfaction with the intervention. The primary indications for surgery were moderate hypertrophy with aesthetic and/or functional or impairment, or labial asymmetry (37 cases [67%]). Four patients (7%) experienced minimal suture dehiscence during the early postoperative period. Of the 55 patients, 50 (91%) were very satisfied, 5 (9%) were satisfied, and none were dissatisfied. Patients expressed a high degree of satisfaction with laser labioplasty, which can be combined with other surgical gynecologic interventions without increased complications.
A new method for aesthetic reduction of labia minora (the deepithelialized reduction of labioplasty)
  • Choi
Vaginal labiaplasty: current practices and a simplified classification system for labial protrusion
  • Motakef