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Female Cosmetic Genital Surgery: Lifestyle Or Science?

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Female Cosmetic Genital Surgery: Lifestyle Or Science? FEATURE Female Cosmetic Genital Surgery: lifestyle or science? BY ILIAS GIARENIS AND LINDA CARDOZO he demand for female cosmetic vaginal rejuvenation®’ or ‘G shot®’, functional reasons, it might be justifiable genital surgery (FCGS) has makes the scientific assessment of these to attract public funding. A clear and increased over the last decade [1]. operations very difficult. The terminology strict selection process of appropriate TThis rise is difficult to quantify, needs to be standardised in an effort to candidates for FCGS is required to allow as the majority of these procedures are avoid ambiguity and inconsistency [7]. allocation of government funding. performed in the private sector. However, Additionally, conflicts of interest prevent this trend is also obvious within national studying trademarked or proprietary Normal anatomy and patient health systems (NHS, UK), where the treatments [8]. There is a well-recognised perception number of operations coded as ‘excision lack of robust evidence on the safety A robust selection process would be of excess labial tissue’ increased from and benefits of these procedures [9]. In impossible without understanding of the 568 in 2002 to 1,064 in 2008 [2]. view of this, colleges and associations of normal anatomy of the female genitalia. A number of reasons could explain obstetrics and gynaecology have issued A small cross-sectional study reporting the increasing demand for FCGS. warnings about the performance of such on the normal dimensions and exact Younger women favour less pubic hair, operations [10]. positioning of the vagina, urethra, clitoris which results in easier visualisation and labia, showed a wide natural variation of the external genitalia [3]. Increased Ethical issues of these features [15]. The mean labia access to female body images on the The rising number of these operations minora width was 21.8 mm, but with a Internet, TV and in magazines has raised has also highlighted the controversy broad range of 7-50mm, and their length awareness of genital appearance and about the relationship between FCGS and was 60.6 mm with a range between skewed the perception of normality female genital mutilation (FGM). FGM 20 and 100mm. These results have towards adolescent features, with flat comprises all procedures that involve challenged a previous definition of labia vulvas without protrusion behind the “partial or total removal of the external minora hypertrophy, which used a width labia majora [4]. TV shows and articles female genitalia, or other injury to the of 40mm as cut-off [16]. Surprisingly, in lifestyle magazines on FCGS might female genital organs for non-medical labial measurements of a cohort of 33 also influence the desire for a ‘face lift of reasons” [11] and is a criminal offence in women requesting labial reduction the vulva and vagina’, together with the most of the western world countries. In surgery were all within the published rising number of cosmetic procedures in the UK, the Female Genital Mutilation normal range [17]. A comparison of labial general. Advertisement and aggressive Act 2003 excludes surgical operations measurements between women seeking marketing of FCGS could also inflate the which are necessary for woman’s physical labiaplasty in an NHS gynaecology clinic demand for surgery. A recent Google or mental health [12]. However, as there and those in a private cosmetic clinic has search for ‘cosmetic genital surgery’ is limited evidence regarding the benefit shown that NHS patients appeared to highlighted more than 2,000,000 items, of FCGS for physical and mental health, have significantly greater labia minora whereas a Pubmed search found only 234 some campaigners suggest that medical width than the private patients (mean items, demonstrating the huge increase practitioners performing such procedures 40.27 vs. 28.09 mm, p<0.001) [18]. in interest regarding this type of surgery should be prosecuted [13]. Increased access to genital pictures may by the general public with the medical Another controversial issue is the narrow the social definition of normal and profession being far less well informed. funding of these procedures. The majority increase the desire to emulate what is The quality and quantity of clinical of the operations performed for purely perceived as being attractive. Considering information on FCGS provider sites aesthetic reasons are carried out in the the enormous natural variation of the is poor, with erroneous information private sector and are self-funded. But topographical features of the female in some instances [5]. This field has a share of the demand for FCGS is being genitalia and the overlap between women been described “like the old Wild, Wild absorbed by publicly funded health seeking FCGS or not, it is difficult to use West: wide open and unregulated” care services [14]. Health care providers anatomic measurements as objective [6]. The majority of FCGS procedures should discourage the use of public criteria for surgery. are poorly defined and there is no funds for the performance of purely standardised terminology. The use of cosmetic procedures. Nevertheless, if Types of FCGS non-medical terms, such as ‘designer FCGS procedures have physical or mental There are a number of procedures vagina’, ‘vaginal rejuvenation’, ‘laser health benefits or are being performed for included under the umbrella term FCGS pmfa news | FEBRUARY/MARCH 2014 | VOL 1 NO 3 | www.pmfanews.com FEATURE (Table 1). It is of paramount importance measures. Every study shows a success to use descriptive and standardised / satisfaction rate of more than 80% Table 1 terms such as those employed in [23]. In a large multicentre study, 97% the field of urogynaecology / female of patients undergoing labiaplasty and FGCS procedures urology, rather than trademarked or 83% of patients undergoing vaginoplasty commercial names. The procedures / perineoplasty felt that they achieved 1. Labiaplasty could be further subdivided based on their goals postoperatively. Improvement the operating instruments such as laser, of their sexual function was reported by I. Labia minora reduction radiofrequency, electrocautery or ‘cold 64% and 86% of women respectively [21]. a) Linear resection knife’. For laser-assisted procedures, The incidence of reported b) Wedge resection different types of laser (CO2, Er:YAG, complications varies in the literature (V-wedge, Z-plasty) Nd:YAG) have been used for excision or (3.8%-23.8%). A wide range of c) De-epithelised reduction ablation [19]. For bulking procedures, postoperative complications have been II. Labia majora augmentation the most commonly used materials are reported such as infection, haematoma, hyaluronic acid and autologous fat. dyspareunia, localised pain, altered III. Labia majora reduction sensation, poor wound healing, scarring, Indications wound separation and even bowel and 2. Vaginoplasty Women seek FCGS for aesthetic, bladder injury with fistula formation. I. Anterior colporraphy functional, sexual and cultural reasons. The majority of these complications are II. Posterior colporraphy A number of physical complaints are considered as minor by the authors of the (with or without levator described by these women, such as pain, relevant papers, which do not apparently ani plication) discomfort or irritation associated with interfere with overall satisfaction [23]. III. Lateral colporraphy clothing, exercise, sexual intercourse, as IV. Vaginal bulking procedures well as sensation of vaginal relaxation and Preoperative considerations lack of coital friction. In a retrospective Women should be adequately counselled 3. Perineoplasty study of 131 patients undergoing and provide informed consent about FCGS labiaplasty, 32% were seeking surgery procedures. They should be educated about I. Perineorrhaphy strictly for functional impairment, 37% the wide variety of normal female genital II. Fenton’s procedure for cosmetic reasons only and 31% for appearance and be reassured about their both functional and cosmetic reasons genital anatomy. Special attention should 4. Clitoral hood reduction [20]. In a different multicentre cohort be paid to younger girls, as the development of 258 women undergoing FCGS, 64% of external genitalia continues throughout 5. Hymenoplasty reported discomfort preoperatively, adolescence. Ideally, any surgical (hymenorrhaphy) 48% cosmetic reasons, 33% wanted intervention should be delayed until surgery for self-esteem and 30% for development is fully complete. Women 6. G-spot bulking sexual enhancement [21]. In the same seeking FCGS should be made aware of (amplification) study, the majority of women undergoing the lack of robust scientific evidence about vaginoplasty and / or perineoplasty the safety and efficacy of these operations. expected increase in their (58%) or their Preoperative counselling regarding partner’s (54%) sexual pleasure. Women functional, sexual and cosmetic benefits routine use of the Genital Appearance referred to an NHS gynaecology clinic by should be balanced against potential Satisfaction (GAS) scale, an 11-item tool and their general practitioner are more likely risks to help patients develop realistic the Cosmetic Procedure Screening Scale to report functional reasons, compared to expectations. Physicians should declare any modified for labia (COPS-L), a nine-item self-referred women to a private cosmetic conflicts of interest for treatments, where instrument, which are both validated in clinic [18]. commercial rights are involved. women seeking labiaplasty [25].
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