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Sasson DC, Sharp G, Placik OJ. Did She or Didn't She? Perceptions of Operative Status of Female Genitalia. Aesthet Surg J 2024; 44:1203-1208. [PMID: 38868896 PMCID: PMC11474600 DOI: 10.1093/asj/sjae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Although extensive research has explored why women undergo labiaplasty, little attention has been paid to societal and professional abilities to distinguish between altered and unaltered labia, impacting both patient concerns and broader societal perceptions. OBJECTIVES This study aimed to evaluate the accuracy of the general public and healthcare professionals in identifying labiaplasty and to pinpoint the misconceptions driving their perceptions. The goal was to inform more effective patient counseling strategies and challenge existing stigmas around cosmetic genital surgery. METHODS The authors conducted an online survey of 511 lay adults and a group of 21 gynecologists and aesthetic vulvar surgeons. The survey assessed the participants' ability to detect labiaplasty from images, focusing on aesthetic appearance, hair patterns, and size. The analysis involved Pearson correlation and Z-tests to compare perceptions against actual operative status. RESULTS Analysis of the survey findings revealed a pronounced difficulty among participants in accurately discerning labiaplasty, with neither group showing a significant ability to identify surgical alterations. Misinterpretations were notably influenced by expectations of aesthetic appearance, with 49% associating an "odd" or "fake" look with surgery, and hair and size misconceptions also misleading respondents. Additionally, 20% of participants mistakenly related surgical changes to gender-affirming surgery or female genital mutilation. CONCLUSIONS The study highlights a gap in the ability of both the general public and medical professionals to accurately identify labiaplasty, pointing to a broad misunderstanding of cosmetic genital surgery's visual outcomes. Addressing these misconceptions through targeted education could substantially improve patient counseling and help dismantle the stigmas associated with labiaplasty. LEVEL OF EVIDENCE: 3
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Affiliation(s)
| | | | - Otto J Placik
- Corresponding Author: Dr Otto Placik, Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, 880 W. Central Road Ste #6100, Arlington Heights, IL 60005, USA. E-mail: ; X/Twitter: @drplacik
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2
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Hamori CA. Discussion: Determining Degree of Hypertrophy and Extent of Resection in Aesthetic Labia Minora Reduction: Technical Highlights and Step-by-Step Video Guide. Plast Reconstr Surg 2024; 154:686e-687e. [PMID: 39314099 DOI: 10.1097/prs.0000000000011488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
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3
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Zahedi S, Bhat D, Pedreira R, Canales FL, Furnas HJ. Algorithm for Trim and Wedge Labiaplasties. Aesthet Surg J 2023; 43:685-692. [PMID: 36794378 DOI: 10.1093/asj/sjad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
In the last decade labiaplasty procedures have been on the rise in the United States. The trim and the wedge are among the most commonly used techniques. The purpose of this paper is to provide a trim-wedge algorithm to guide the surgeon based on the qualities of the individual patient. The choice of technique should be based on the reasonable labiaplasty candidate's goals, her nicotine/cocaine usage, and the physical characteristics of her labia, including edge quality, texture, pigmentation, symmetry, morphology of protrusion, and labial length. By considering these individual patient factors, the trim-wedge algorithm may improve labiaplasty outcomes and increase patient satisfaction. Some surgeons perform only the wedge or only the trim, and no algorithm should alter that. After all, the best technique is always the one the surgeon performs comfortably and safely. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Sanam Zahedi
- Plastic surgery fellow, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Sacramento, C, USA
| | - Deepa Bhat
- Plastic surgery fellow at a private plastic surgery practice in Santa Rosa, CA, USA
| | - Rachel Pedreira
- Plastic surgery resident, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, CA, USA
| | | | - Heather J Furnas
- Clinical associate professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, CA, USA
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4
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Gravina P, Farhat S, Jaraki D, De la Fuente Hagopian A, Echo A, Dinh TA. Treatment of Symptomatic Labia Minora Neuroma After Labiaplasty to Prevent Recurrence. J Low Genit Tract Dis 2023; 27:180-182. [PMID: 36649239 DOI: 10.1097/lgt.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Paula Gravina
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Souha Farhat
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Dima Jaraki
- Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX
| | | | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Tue A Dinh
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
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5
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Lange M, Hage JJ, Karim RB, Amant F. An Algorithm for Labia Minora Reduction Based on a Review of Anatomical, Configurational, and Individual Considerations. Arch Plast Surg 2023; 50:17-25. [PMID: 36755650 PMCID: PMC9902108 DOI: 10.1055/a-1938-0991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022] Open
Abstract
A variety of reduction labiaplasty techniques have been introduced to date, but no single technique will offer the optimal solution for every patient. Rather, the technique should be chosen based on anatomical, configurational, and technical considerations, as well as on patients' personal preferences regarded maintenance of the labial rim, maintenance of labial sensitivity, and prevention of iatrogenic thickening of the labium. We reviewed, defined, and assessed labial configurational variety, neurovascular supply, reduction techniques, and patient's preferences as the considerations relevant to the choice of labiaplasty technique. Based on this review, an algorithm was constructed that leads to a choice of reduction technique through five decisions to be made regarding (1) resection or (partial) retention of the labial free rim, (2) the measure of required labial width reduction, (3) labial vascular status, (4) prevention of iatrogenic labial thickening, and (5) preservation of labial sensibility. The choice of techniques includes edge trimming, central spindle form de-epithelialization or full-thickness resection, and three modifications of the wedge resection or de-epithelialization technique. These three modifications comprised a modified anterior resection or de-epithelialization combined with posterior flap transposition, a custom flask resection or de-epithelialization, and a modified posterior wedge resection or de-epithelialization combined with anterior flap transposition. Use of the five decisional steps and the inclusion of modifications of all three conventional reduction techniques offer an improved algorithm for the choice of labioplasty technique.
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Affiliation(s)
- Maurits Lange
- Departments of Plastic and Reconstructive Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J. Joris Hage
- Departments of Plastic and Reconstructive Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands,Address for correspondence J. Joris Hage, MD, PhD Department of Plastic and Reconstructive Surgery, Antoni van Leeuwenhoek HospitalPlesmanlaan 121, NL-1066 CX AmsterdamThe Netherlands
| | - Refaat B. Karim
- Department of Plastic Surgery at the A-Klinieken, Huis ter Heide, The Netherlands
| | - Frédéric Amant
- Departments of Gynecology at The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands,Department of Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands,Department of Oncology, KU Leuven, Belgium
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6
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Hamori CA. The Aesthetic Genital Consultation: Inquiry to Scheduling. Clin Plast Surg 2022; 49:435-445. [PMID: 36162938 DOI: 10.1016/j.cps.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Consultation for female esthetic genital concerns is unique in that the topic is shrouded in secrecy. Few opportunities exist for the improvement of female sexual health and well-being when compared with male counterparts. Women concerned with the appearance of their genitalia seek help with improving their confidence and reducing mental and physical discomfort attributed to large labia minora. Validated questionnaires given to patients beforehand, a detailed sexual history, and a comprehensive vulvar examination help define the esthetic and functional issues. Providing informed consent and setting realistic expectations are the key final steps to a successful esthetic genital consultation.
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Affiliation(s)
- Christine A Hamori
- Cosmetic Surgery and Skin Spa, 113 Tremont Street, Duxbury, MA 02332, USA.
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Applebaum SA, Placik OJ. Genital Self-Image and Esthetic Genital Surgery. Clin Plast Surg 2022; 49:509-516. [PMID: 36162946 DOI: 10.1016/j.cps.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Genital self-image describes the perception of one's genital appearance as being "normal" or "abnormal," and a disharmonious image leads to an increasing number of women seeking esthetic genital surgery each year. The concept of what constitutes "normal" is strongly influenced by the media, cultural norms, and sexual relations. In reality, the extent of normalcy is highly variable and overall patient education regarding extremes of size and shape should be provided to all patients considering surgery. When performed with appropriate training, expertise, and attention to detail in a properly selected patient, esthetic genital surgery is associated with minimal complications or sequelae.
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Affiliation(s)
- Sarah A Applebaum
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, 880 West Central Road, Street 6100, Arlington Heights, IL 60005, USA; Department of Surgery, University of Maryland Medical Center, 22 South Greene Street, S8B02, Baltimore, MD 21201, USA.
| | - Otto J Placik
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, 880 West Central Road, Street 6100, Arlington Heights, IL 60005, USA.
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Wells MW, Chang IA, Wu RT, Zheng DX, Gatherwright JR, Furnas HJ. Labiaplasty: Analysis of the National Surgical Quality Improvement Program Database. Aesthet Surg J 2022; 42:771-780. [PMID: 35226721 DOI: 10.1093/asj/sjac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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 The aim of this study was to examine the complication profiles of labiaplasties for both cosmetic and pathologic etiologies. METHODS The 2005 to 2017 National Surgical Quality Improvement Program database was analyzed for patients who, according to the relevant Current Procedural Terminology code, had undergone labiaplasties. Our cohort was further separated into cosmetic and pathologic groups based on International Classification of Diseases 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 2 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 for 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. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Michael W Wells
- Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Irene A Chang
- Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Robin T Wu
- Division of Plastic Surgery, Department of Surgery, Stanford University , Stanford, CA , USA
| | - David X Zheng
- Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | | | - Heather J Furnas
- Division of Plastic Surgery, Department of Surgery, Stanford University , Stanford, CA , USA
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9
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Zhou Y, Li Q, Li S, Cao Y, Liu M, Li Y, Che K, Yuan Y, Zhang Z, Wang K, Li F. Trilobal Methods for Composite Reduction Labiaplasty. Aesthetic Plast Surg 2022; 46:1472-1480. [PMID: 35303122 PMCID: PMC8932371 DOI: 10.1007/s00266-022-02841-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is difficult to plan a simple and effective surgical strategy for patients with horizontal and vertical redundant tissue of the labia minora and clitoral hood redundancy. A single edge resection or wedge resection labiaplasty with clitoral hood reduction that simultaneously resolves these three issues has yet to be reported. This study investigated the clinical effects and safety of trilobal labiaplasty via a composite incision. METHODS The single-center, retrospective, observational study included data from patients with hypertrophy of the labia minora and clitoral hood who underwent trilobal labiaplasty. RESULTS Altogether, 136 patients (average age: 31.6 ± 8.82 years; range: 21-53 years; 224 sides) sought surgery for aesthetic (39/136, 28.7%), functional (17/136, 12.5%), or both reasons (80/136, 58.8%). Overall, 134 patients (134/136, 98.5%) were followed up for 3 months. No serious complications or malformations occurred. Three patients (2.2%) underwent secondary repair surgery due to incomplete bilateral symmetry, 122 (91.0%) scored ≥ 21 points on the Female Genital Self-Image Scale, 107 (91.5%) were satisfied with the cosmetic outcomes, and 93 (95.9%) were satisfied with the functional improvement. CONCLUSIONS Trilobal labiaplasty performed via a composite incision using edge and wedge labiaplasty to adjust horizontal and vertical hypertrophy of the labia minora and remove lateral folds of the clitoris is a safe and effective method to improve the appearance and rearrange the position of the clitoral hood and clitoral frenulum while preserving the fine structure of the surrounding tissue. This method results in few complications and high functional and aesthetic satisfaction rates. 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 .
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Affiliation(s)
- Yu Zhou
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Qiang Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Senkai Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Yujiao Cao
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Meichen Liu
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Yilin Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Kexin Che
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Ye Yuan
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Zhen Zhang
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Keke Wang
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Fengyong Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China.
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10
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Abstract
BACKGROUND Heightening interest in labiaplasty has driven potential patients to online fora, 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 The aim of this study was to explore the rationale for ongoing public opposition to labiaplasty and to investigate if awareness of the similarities between labiaplasty and breast reduction can alter an individual's perception. METHODS Four hundred and forty-eight 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 was 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 because it requires a societal shift in acceptance. Labiaplasty is a procedure whose time for popular acceptance has not yet come.
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Affiliation(s)
- Daniel C Sasson
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Otto J Placik
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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11
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Shaw D, Allen L, Chan C, Kives S, Popadiuk C, Robertson D, Shapiro J. Directive clinique n o 423 : Interventions chirurgicales et thérapeutiques esthétiques génitales féminines. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:215-226.e1. [PMID: 35181012 DOI: 10.1016/j.jogc.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Shaw D, Allen L, Chan C, Kives S, Popadiuk C, Robertson D, Shapiro J. Guideline No. 423: Female Genital Cosmetic Surgery and Procedures. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:204-214.e1. [PMID: 35181011 DOI: 10.1016/j.jogc.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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
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13
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Discussion: Mapping a Danger Zone of the Dorsal Nerve of the Clitoris: Implications in Female Cosmetic Genital Surgery. Plast Reconstr Surg 2021; 148:1011-1012. [PMID: 34705774 DOI: 10.1097/prs.0000000000008495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Furnas HJ, Canales FL, Pedreira RA, Comer C, Lin SJ, Banwell PE. The Safe Practice of Female Genital Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3660. [PMID: 34249585 PMCID: PMC8263325 DOI: 10.1097/gox.0000000000003660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 01/11/2023]
Abstract
The purpose of this article is to guide surgeons in the safe practice of female genital plastic surgery when the number of such cases is steadily increasing. A careful review of salient things to look for in the patient's motivation, medical history, and physical examination can help the surgeon wisely choose best candidates. The anatomy is described, with particular attention given to the variations not generally described in textbooks or articles. Descriptions are included for labiaplasty, including clitoral hood reduction, majoraplasty, monsplasty, and perineoplasty with vaginoplasty. Reduction of anesthetic risks, deep venous thromboses, and pulmonary emboli are discussed, with special consideration for avoidance of nerve injury and compartment syndrome. Postoperative care of a variety of vulvovaginal procedures is discussed. Videos showing anatomic variations and surgical techniques of common female genital procedures with recommendations to reduce the complication rate are included in the article.
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Affiliation(s)
- Heather J. Furnas
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
- Plastic Surgery Associates, Santa Rosa, Calif
| | | | - Rachel A. Pedreira
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Carly Comer
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Samuel J. Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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15
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Propst K, Ferrando CA. Outcomes of labiaplasty in women with labial hypertrophy. Int Urogynecol J 2020; 32:1247-1251. [PMID: 33245385 DOI: 10.1007/s00192-020-04621-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS High-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. RESULTS Thirty-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.
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Affiliation(s)
- Katie Propst
- Urogynecology & Reconstructive Pelvic Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-81, Cleveland, OH, 44195, USA.
| | - Cecile A Ferrando
- Urogynecology & Reconstructive Pelvic Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-81, Cleveland, OH, 44195, USA
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Abstract
LEARNING OBJECTIVES After studying this article, participants should be able to: (1) Identify the most appropriate type of anesthesia for the female genital plastic surgical patient and minimize risks of nerve injury and thromboembolic event through proper preoperative evaluation and knowledge of positioning. (2) Define the vulvovaginal anatomy, including common variants, and assess vulvovaginal tissues after childbirth and menopause. (3) Apply surgical techniques to minimize complications in female genital plastic surgery. (4) Classify the types of female genital mutilation/cutting and design methods of reconstruction after female genital mutilation/cutting. SUMMARY Female genital plastic surgery is growing in popularity and in numbers performed. This CME article covers several aspects of safety in the performance of these procedures. In choosing the best candidates, the impact of patient motivation, body mass index, parity, menopause and estrogen therapy is discussed. Under anesthesia, consideration for the risks associated with the dorsal lithotomy position and avoidance of compartment syndrome, nerve injury, deep venous thromboses, and pulmonary embolus are covered. Anatomical variations are discussed, as is the impact of childbirth on tissues and muscles. Surgical safety, avoidance of complications, and postoperative care of a variety of vulvovaginal procedures are discussed. Videos showing anatomical variations and surgical techniques of the most common female genital procedures with recommendations to reduce the complication rate are included in the article. Finally, female genital mutilation/cutting is defined, and treatment, avoidance of complications, and postoperative care are discussed.
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17
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Abstract
BACKGROUND Labiaplasty has grown in popularity, but it remains controversial. Few studies have quantified the change in specific symptomatology from before to after labiaplasty to establish its effectiveness in improving quality of life. METHODS In a prospective study, 62 patients undergoing labiaplasty completed written surveys privately in an examination room preoperatively and postoperatively about the presence of 11 physical and appearance-related symptoms. RESULTS Mean patient age was 33.5 years (range, 17 to 61 years). Two patients were of minority age. All patients presented with at least one symptom, averaging 6.5 (range, one to 11). Most (82.2 percent) had a trim labiaplasty, and the rest (17.7 percent) had a wedge. After labiaplasty, 93.5 percent of patients were symptom-free, with the average dropping to 0.23 of 11 symptoms. Symptom-prevalence changes from preoperatively to postoperatively included self-consciousness, dropping from 93 percent to 6.5 percent; tugging (from 66.1 percent to 0 percent); feeling less attractive (from 66.1 percent to 0 percent); negative impact on self-esteem (from 64.5 percent to 1.6 percent); negative impact on intimacy (from 62.5 percent to 0 percent); twisting (from 58.1 percent to 3.2 percent); being uncomfortable (from 56.5 percent to 4.8 percent); clothing restriction (from 54.8 percent to 3.2 percent); visible outline (from 46.8 percent to 1.6 percent); pain (from 43.5 percent to 1.6 percent); and exposure in swimsuits (from 38.7 percent to 1.6 percent). No major complications occurred. Two patients felt their labia were still too long and revision was offered. Average follow-up was 13.3 months (range, 6 to 24 months). CONCLUSIONS Patients with elongated labia have a high incidence of functional and appearance-related symptoms. Labiaplasty is a safe procedure that yields significant improvement in quality of life. CLINICAL QUESTIONS/LEVEL OF EVIDENCE Therapeutic, IV.
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Assessing Patient-Reported Outcomes After Female Cosmetic Genital Surgery. Ann Plast Surg 2020; 85:S17-S22. [PMID: 32530846 DOI: 10.1097/sap.0000000000002337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Patient-reported outcomes after female cosmetic genital surgery (FCGS) have been well documented; however, methods vary widely between studies and are often very detailed, time-consuming, and difficult to reproduce. The purpose of this study was to assess patient-reported outcomes after FCGS using a novel method and survey as well as to present the results of a pilot study aimed at validating this survey. METHODS A retrospective chart review identified patients who underwent FCGS. Demographic, clinical, operative, and outcome characteristics were recorded. A novel survey, including 14 items administered by telephone interview, was developed and extrapolated from the BREAST-Q for augmentation mammaplasty, to assess patient-reported outcomes after FCGS with regard to satisfaction with outcome and physical, psychosocial, and sexual well-being. RESULTS The survey response rate was 50.6% (39 patients). Over a mean time after surgery of 56 months, 14 complications occurred in 11 patients (28.2%), and 10 complications required revision surgery. Postoperative asymmetry and dehiscence were the most common complications. Despite the higher complication and revision surgery rates, 97.4% agreed that the surgery was a good experience and were satisfied with the results after surgery. In addition, patient-reported outcomes after FCGS showed significant improvement in physical well-being, psychosocial well-being, and sexual well-being (P < 0.001). CONCLUSIONS This novel survey can be used to assess patient-reported outcomes after FCGS in an efficient approach. Despite the potential complications and need for revision surgery, the vast majority of patients who undergo FCGS feel that it is a good experience, are satisfied with the results after surgery, and show significant improvement in physical, psychosocial, and sexual well-being after surgery.
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Abstract
PURPOSE Outcomes after female cosmetic genital surgery (FCGS) performed by plastic surgeons working in a group practice setting have not been well documented. This article aimed to assess outcomes and to describe FCGS techniques used in a large group private plastic surgery practice. METHODS A retrospective chart review identified patients who underwent FCGS from 2009 to 2018. Demographic, clinical, and operative information was reviewed and recorded. Outcomes were assessed by evaluating postoperative complications and the need for revision surgery. RESULTS Seventy-seven women between the ages of 14 and 53 years underwent FCGS performed by 1 of 6 surgeons. Forty-five patients underwent central wedge excision for labia minora hypertrophy, whereas 32 patients underwent extended central wedge excision for labia minora and clitoral hood hypertrophy. Four patients underwent liposuction of the mons pubis as an additional procedure. Over a mean follow-up of 37.4 months, postoperative asymmetry/redundancy occurred in 12 patients, requiring revision in 10. Wound dehiscence occurred in 12 patients, requiring revision in 9. There was one hematoma postoperatively requiring evacuation, one case of dyspareunia, and one case of decreased sensation. A single-layer wound closure (P = 0.050) and mons liposuction (P = 0.011) were risk factors for wound dehiscence. CONCLUSIONS Central wedge excision and extended central wedge excision labiaplasty were the techniques used in a large group plastic surgery practice. Postoperative asymmetry and dehiscence were the most common complications, and the revision surgery rate was high. A single-layer wound closure and additional mons liposuction were risk factors for dehiscence after central wedge labiaplasty.
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20
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Cosmetic gynecology—a systematic review and call for standardized outcome measures. Int Urogynecol J 2020; 31:1979-1995. [DOI: 10.1007/s00192-020-04294-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
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Kelling JA, Erickson CR, Pin J, Pin PG. Anatomical Dissection of the Dorsal Nerve of the Clitoris. Aesthet Surg J 2020; 40:541-547. [PMID: 31768527 DOI: 10.1093/asj/sjz330] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The clitoris is the primary somatosensory organ of female sexual response. Knowledge of its neural anatomy and related landmarks is essential for safe genital surgery. OBJECTIVES The aim of this study was to describe the distal course of the dorsal nerves of the clitoris and associated structures. METHODS Clitorises of 10 fresh cadavers were dissected. Measurements of the dorsal nerves, suspensory ligament, clitoral body, clitoral hood, and clitoral glans were obtained. The course of the dorsal nerves was examined. RESULTS The dorsal nerves of the clitoris were larger than expected, ranging from 2.0 to 3.2 mm in diameter, on average, along their course in the clitoral body. In 9 of 10 specimens, the dorsal nerves could be traced to within 6 mm of the glans. They traveled deep to a superficial clitoral fascia but superficial to the tunica albuginea, were variably located between 10 and 2 o'clock, and were separated by the deep suspensory ligament (DSL) of the clitoris. The mean length of the descending clitoral body, from the angle to the base of the glans, was 37.0 mm. The mean distance from the pubic rim to the DSL was 37.7 mm. CONCLUSIONS The clitoral body is substantial in length, mostly lying superficially under the clitoral hood and mons pubis. The dorsal nerves of the clitoris are large and superficial, terminating at or near the base of the clitoral glans. Knowledge of this anatomy is critical prior to performing surgery near the clitoris.
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Affiliation(s)
- Joseph A Kelling
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Cameron R Erickson
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jessica Pin
- Baylor University Medical Center, Dallas, TX
| | - Paul G Pin
- Baylor University Medical Center, Dallas, TX
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Learner HI, Rundell C, Liao LM, Creighton SM. 'Botched labiaplasty': a content analysis of online advertising for revision labiaplasty. J OBSTET GYNAECOL 2019; 40:1000-1005. [PMID: 31826680 DOI: 10.1080/01443615.2019.1679732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
| | | | - Lih-Mei Liao
- Department of Women's, Health University College London Hospitals, London, UK
| | - Sarah M Creighton
- Department of Women's, Health University College London Hospitals, London, UK
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Kalaaji A, Dreyer S, Maric I, Schnegg J, Jönsson V. Female Cosmetic Genital Surgery: Patient Characteristics, Motivation, and Satisfaction. Aesthet Surg J 2019; 39:1455-1466. [PMID: 30423019 DOI: 10.1093/asj/sjy309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Female cosmetic genital surgery is rapidly growing. However, controversy reports raised around these procedures question their indications, motives, and safety. Warning against performing this surgery might unjustly restrict surgical alleviation of symptoms. OBJECTIVES Through anonymous research, the authors explored patient characteristics and motivation, when women started to think about surgery, and effects of surgery on psychosocial and cosmetic aspects. METHODS Of 125 patients who underwent female cosmetic genital surgery at Oslo Plastic Surgery Clinic between 2010 and 2016, 69 patients were reachable by email. A questionnaire with 40 questions was completed anonymously. Answers were processed by a third, independent party via QuestBack return mail system. RESULTS The response rate was 77%. Mean follow-up time was 31.4 months. Mean patient age was 30.8 years. Motivations for surgery were cosmetic (69.8%), physical/practical (62.3%), emotional (54.7%), and intimate (49.1%). When emotional reasons were involved, media (39.7%), pornography (31.5%), and negative comments (28.8%) influenced the decision to undergo surgery. Genital concerns had negative effects on self-esteem (63.2%) and sexual attractiveness (57.9%) among others; 90.5% thought about surgery for more than 1 year. The overall cosmetic result was satisfactory for 69.8%, and the operation as a whole was satisfactory for 75.5%. CONCLUSIONS Age, level of education, and gross income of patients who underwent this surgery seem high compared with those of breast implant patients. Genital dissatisfaction arose early in life and affected various psychosexual aspects. Most patients are satisfied with the outcome of surgery and would recommend this surgery to others. Additional anonymous multicenter studies are recommended. LEVEL OF EVIDENCE: 4
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25
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International Society for the Study of Vulvovaginal Disease Recommendations Regarding Female Cosmetic Genital Surgery. J Low Genit Tract Dis 2018; 22:415-434. [PMID: 29994815 DOI: 10.1097/lgt.0000000000000412] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Female genital cosmetic surgeries (FGCSs) and procedures are increasingly being advertised as common, simple, and complication-free, capable of not only improving aesthetic appearance but also increasing self-esteem and sexual pleasure.Guidelines for physicians and clear, scientifically correct information for patients must be made available, to minimize the number of ineffective or deleterious procedures.The International Society for the Study of Vulvovaginal Disease positions/recommendations regarding FGCS are as follows:1. There is a wide variation regarding genital normalcy; providers must be able to explain this to women.2. There are no data supporting FGCS including, G-spot augmentation, hymenoplasty, vulvar and perianal bleaching/whitening, vaginal tightening procedures, and other procedures aimed at increasing sexual function.3. Women should not be offered FGCS before the age of 18 years.4. Women undergoing FGCS should be evaluated by a provider with expertise in vulvovaginal diseases, including attention to their psychological, social, and sexual context. Evaluation by an experienced mental health provider should be considered when the motivation for seeking surgery and/or expectations are not clear or realistic.5. Female genital cosmetic surgery is not exempt from complications.6. Informed consent must always be obtained.7. Surgeons performing FGCS should refrain from solicitous advertising or promoting procedures without scientific basis, including on Web sites.8. Surgeons should not perform surgery that they do not agree with and explain their rationale/position when pressured by patients.9. The genital surgeon must be adequately trained in performing FGCS including knowledge of the anatomy, physiology and pathophysiology of the vulva, vagina and adjacent organs.
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Kaya AE, Dogan O, Yassa M, Basbug A, Çalışkan E. A Novel Technique for Mapping the Vascularity of Labia Minora Prior to Labiaplasty: Cold Light Illumination. Geburtshilfe Frauenheilkd 2018; 78:775-784. [PMID: 30140106 PMCID: PMC6102114 DOI: 10.1055/a-0647-2404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/16/2018] [Accepted: 06/21/2018] [Indexed: 11/16/2022] Open
Abstract
Objective
Aim of the study was to assess the feasibility of a novel technique to determine the vascularity of labia minora prior to labiaplasty.
Methods
A cold light source employed in laparoscopic procedures was used to illuminate the outer surface of the labia minora as described in this prospective descriptive study.
Results
Of the patients, 46.1% (n = 41) had upper third prominence, 36% (n = 32) had middle third prominence, and 18% (n = 16) had lower third prominence according to the Banwell classification of morphologies. Right labia minora width was 0 – 2 cm in 51.7% (n = 46), 2 – 4 cm in 47.2% (n = 42) and > 4 cm in 1.1% (n = 1) of cases. Left labia minora width was 0 – 2 cm in 52.8% (n = 47), 2 – 4 cm in 41.6% (n = 37) and > 4 cm in 5.6% (n = 5) of cases. The incidence of Anterior 2 and Posterior 1 vessels in the different morphologies were statistically significantly different (p = 0.007, p = 0.018). The Anterior 2 vessel was higher in the lower morphology group whereas the Posterior 1 vessel was higher in the upper morphology group. A central vessel was observed in 93.3% (n = 83) of patients in the left labium minus and the right labium minus. The incidence of the Posterior 1 vessel was significantly higher in the left labium minus than in the right labium minus (p = 0.021).
Discussion
This novel technique to assess labial vascularity using a cold light source could be very useful to reduce dehiscence by avoiding excessive resection of highly vascularized tissue. Most units can easily access a cold light source, which can be used to assess labial vascularity prior to labiaplasty.
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Affiliation(s)
- Aski Ellibes Kaya
- Department of Obstetrics and Gynecology, Duzce University Hospital, Duzce, Turkey
| | - Ozan Dogan
- Department of Obstetrics and Gynecology, Health Sciences University, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Alper Basbug
- Department of Obstetrics and Gynecology, Duzce University Hospital, Duzce, Turkey
| | - Eray Çalışkan
- Department of Obstetrics and Gynecology, Bahçeşehir University School of Medicine, Istanbul, Turkey
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