[Labiaplasty: Motivations and post-surgery satisfaction]

A Bibliometric and Visualisation Analysis on the Research of Female Genital Plastic Surgery Based on the Web of Science Core Collection Database

BACKGROUND AND OBJECTIVES

Due to the increasing demand for improving the morphology and function of the external genitalia amongst women, it is necessary to conduct statistical analysis of research data on female genital reconstruction. The current study aimed to use bibliometric analysis to analyse the research hotspots and trend frontiers of the female genital reconstructive research.

METHODS

Publications on the female genital reconstructive research were extracted from the Web of Science Core Collection database. VOSviewer 1.6.18 was used to establish visualisation maps and find top authors, institutions, countries, burst keywords, co-cited authors, journals, research hotspots, and trends.

RESULTS

A total of 2207 studies published by 364 different journals authored by 7479 researchers were contained in this study. In the co-authorship analysis, the bulk of the retrieved studies was conducted by the USA, followed by England, Italy, and Netherlands, whilst the most productive institution, journal, and author were U.S. Univ Calif San Francisco, Journal of Sexual Medicine, and Bouman Mark-Bram, respectively. In the co-cited analysis, the top most-cited author and journal were Hage JJ and Journal of Sexual Medicine, respectively. The map of keywords occurrence revealed the most active research aspects were focussed on "vaginoplasty", "feminised genitoplasty", "laser treatment of vaginal atrophy", "transsexualism", and "labiaplasty". The time overlay mapping showed that the study of female genital plastic surgery focusses on the energetic treatment of genitourinary syndromes caused by transsexualism and menopause, especially by using management and treatment of vulvovaginal atrophy for the research trends, and through the vaginoplasty, feminising genioplasty, and laser treatments in the direction of treatments related to physical and mental problems.

INTERPRETATION AND CONCLUSIONS

This novel inclusive bibliometric analysis can help research workers to quickly understand the potential and active researchers, landmark studies, and topics within their interests. We are willing to provide more beneficial data to contribute valuable research of female genital plastic surgery through this study.

LEVEL OF EVIDENCE III

The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

Spanish Translation, Transcultural Adaptation, Validation and Clinical Applicability of Female Genital-Self Image Scale (FGSIS)

BACKGROUND

As female genital cosmetic surgeries have significantly increased, appropriate tools to evaluate self-esteem about women's own genitalia are necessary.

AIM

to translate, culturally adapt to Spanish women and to evaluate the psychometric properties of the Female Genital Self-Image Scale (FGSIS).

METHODS

FGSIS was forward and backward translated, culturally adapted into Spanish and its content evaluated through Delphi consensus. One item from the original scale was discarded after expert panel evaluation, developing the final Spanish scale (FGSIS-S) consisting of 6 items. Its psychometric properties were evaluated among 202 women attending gynecological consults through an online survey. The survey included socio-demographic data and FGSIS-S.

MAIN OUTCOME MEASURE

Socio-demographic items, psychometric characteristics of the FGSIS-S (construct evaluation, internal consistency and test-retest reliability) were assessed.

RESULTS

FGSIS-S proved to relate appropriately with the proposed construct (sum-content validity index 0.9, and significant inverse correlation with women concerned about their genital appearance or considering cosmetic surgery) with a 1-factor solution on exploratory factor analysis. The test proved good internal consistency (McDonald's omega 0.86) and test-retest reliability (intraclass correlation 0.86, P < .001). In 41.1% of cases, women referred concern about their genital's self-image and in 12.4% had considered undergoing cosmetic surgery.

CLINICAL TRANSLATION

The validated version of FGSIS-S can help both professionals and patients, and its implementation can be easily made in gynecological consults.

STRENGTHS AND LIMITATIONS

The main limitation is a self-selection bias in women attending gynecological consults, who may be more worried about their gynecological/sexual health. The sample is also a relatively homogeneous Caucasian population, with medium-high educational level, coming from gynecological consults. Strengths include the large sample size and the demographic survey that permitted evaluating the performance of FGSIS-S in the context of concern about genitals or consideration of cosmetic surgery.

CONCLUSION

FGSIS-S is an adequate scale to measure women's genital image self-perception in Spanish-speaking population of Spain. Bartolomé A, Villalaín C, Bermejo R, et al. Spanish Translation, Transcultural Adaptation, Validation and Clinical Applicability of Female Genital-Self Image Scale (FGSIS). Sex Med 2022;10:100558.

Labia Minora Repair

BACKGROUND

Labia minora reduction has become part of the treatment spectrum offered by most plastic surgeons. The author has performed many corrective procedures involving the outer female genital region, most of which involved reducing the labia minora of approximately 4300 women. Over the years, the number of corrective procedures to rectify poorly performed initial operations increased significantly at the author's practice. The most common iatrogenic deformity is the overresection of the labia minora below the clitoris, leaving behind excess tissue in the area around and above the clitoral hood (small penis deformity).

METHODS

Two basic procedures may be used to reconstruct the labia minora below the clitoris: reconstructing the labia minora by redundant labial tissue above the clitoris to form bilateral preputial flaps being rotated downward into the defect and reconstructing the labia minora by vaginal skin advancement. Other reconstructions depend on the deformity itself. The postoperative outcome was assessed in an anonymous questionnaire answered by 544 patients.

RESULTS

The outcome showed a significant improvement in functional and psychological impairment as a result of the deformities caused by the initial operation. Even if the reconstruction of the labia minora did not produce the desired initial result, overall satisfaction with the corrective surgery was very satisfactory.

CONCLUSION

The increase of iatrogenic deformities after the initial labia reductions is alarming. The causes of this growth are manifold: underestimation of the procedure, misjudgment and a lack of detailed knowledge. This has a heavy psychological and physical impact on patients. Reconstruction of excessively shortened labia minora is often not easy and not always satisfactory. Training and the establishment of surgical standards should be used to avoid errors and achieve the best result.

LEVEL OF EVIDENCE IV

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 .

'Botched labiaplasty': a content analysis of online advertising for revision labiaplasty

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 StatementWhat 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.