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Female Cosmetic Genital Reconstruction: a Review of Current Trends, Treatments, and Techniques

  • Male and Female Surgical Interventions (A Burnett and C Carson, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Iglesia CB, Yurteri-kaplan L, Alinsod R. Female genital cosmetic surgery: a review of techniques and outcomes. Int Urogynecol J. 2013;24(12):1997–2009.

    Article  PubMed  Google Scholar 

  2. Hamori C, Banwell P, Alinsod RM. Female cosmetic genital surgery, concepts, classification and techniques. Stuttgart: Thieme Medical Publishers; 2017.

    Google Scholar 

  3. The American Society of Aesthetic Plastic Surgery. Cosmetic surgery national data bank statistics. Available at: https://surgery.org/sites/default/files/ASAPS-Stats2017.pdf. Accessed July 11, 2018.

  4. The American Society of Aesthetic Plastic Surgery. Cosmetic surgery national data bank statistics. https://www.surgery.org/sites/default/files/ASAPS-Stats2016.pdf. Accessed July 11, 2018.

  5. Australian Government Department of Human Services. Medicare item reports. http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp. Accessed July 11, 2018.

  6. British Association of Aesthetic Plastic Surgeons. Aesthetic genital surgery: female genital aesthetic surgery (aesthetic genital surgery, designer vaginas). London. http://www.baaps.org.uk/procedures/aesthetic-genital-surgery. Accessed July 11, 2018.

  7. Harris V, Dickison P, Lim A, Fischer G. Vulvo-vaginal rejuvenation: fact or fiction? Fractional carbon dioxide laser for genitourinary syndrome of menopause. Aust J Dermatol. 2018;59:341–3.

    Article  Google Scholar 

  8. Magon N, Alinsod R. Female cosmetic genital surgery: delivering what women want. J Obstet Gynaecol India. 2017;67(1):15–9.

    Article  PubMed  Google Scholar 

  9. Vicariotto F, De Seta F, Faoro V, Raichi M. Dynamic quadripolar radiofrequency treatment of vaginal laxity/menopausal vulvo-vaginal atrophy: 12-month efficacy and safety. Minerva Ginecol. 2017;69(4):342–9.

    PubMed  Google Scholar 

  10. Karcher C, Sadick N. Vaginal rejuvenation using energy-based devices. Int J Womens Dermatol. 2016;2(3):85–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Creighton S. AGAINST: labiaplasty is an unnecessary cosmetic procedure. BJOG. 2014;121(6):768.

    Article  PubMed  Google Scholar 

  12. Hamori CA. Aesthetic surgery of the female genitalia: labiaplasty and beyond. Plast Reconstr Surg. 2014;134(4):661–73.

    Article  CAS  PubMed  Google Scholar 

  13. Clerico C, Lari A, Mojallal A, Boucher F. Anatomy and aesthetics of the labia minora: the ideal vulva? Aesthet Plast Surg. 2017;41(3):720.

    Article  CAS  Google Scholar 

  14. Stahl D, Vercler CJ. What should be the surgeon’s role in defining “normal” genital appearance? AMA J Ethics. 2018;20(4):384–91.

    Article  PubMed  Google Scholar 

  15. Placik OJ, Arkins JP. Plastic surgery trends parallel Playboy magazine: the pudenda preoccupation. Aesthet Surg J. 2014;34(7):1083–90.

    Article  PubMed  Google Scholar 

  16. • Sharp G, Tiggemann M, Mattiske J. Factors that influence the decision to undergo labiaplasty: media, relationships, and psychological well-being. Aesthet Surg J. 2016;36(4):469–78 This recent study suggests that women seeking labiaplasty are more likely to have seen online images of female genitalia.

    Article  PubMed  Google Scholar 

  17. Crouch NS, Deans R, Michala L, Liao LM, Creighton SM. Clinical characteristics of well women seeking labial reduction surgery: a prospective study. BJOG. 2011;118:1507–10.

    Article  CAS  PubMed  Google Scholar 

  18. Portman DJ, Gass ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063–8.

    Article  PubMed  Google Scholar 

  19. Tadir Y, Gaspar A, Lev-sagie A, et al. Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med. 2017;49(2):137–59.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Goodman MP, Placik OJ, Benson RH, et al. A large multicenter outcome study of female genital plastic surgery. J Sex Med. 2010;7(4 Pt 1):1565–77.

    Article  PubMed  Google Scholar 

  21. • Mazloomdoost D, Crisp CC, Westermann LB, Benbouajili JM, Kleeman SD, Pauls RN. Survey of male perceptions regarding the vulva. Am J Obstet Gynecol. 2015;213(5):731.e1–9 This study showed that the majority of men surveyed would not want their female partner to change her genital appearance.

    Article  Google Scholar 

  22. Kelly B, Foster C. Should female genital cosmetic surgery and genital piercing be regarded ethically and legally as female genital mutilation? BJOG. 2012;119(4):389–92.

    Article  CAS  PubMed  Google Scholar 

  23. Lovel H. WHO classification of FGM omission and failure to recognise some women’s vulnerability to cosmetic vaginal surgery. J Fam Plann Reprod Health Care. 2017;43(1):78.

    Article  PubMed  Google Scholar 

  24. Cox L. Response to ‘WHO classification of FGM omission and failure to recognise some women’s vulnerability to cosmetic vaginal surgery’. J Fam Plann Reprod Health Care. 2017;43(2):166.

    Article  PubMed  Google Scholar 

  25. American College of Obstetricians and Gynecologists, Committee on Gynecological Practice. ACOG Committee Opinion No. 378: Vaginal “rejuvenation” and cosmetic vaginal procedures. Obstet Gynecol. 2007;100:737–8.

    Google Scholar 

  26. • American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. ACOG Committee Opinion No. 662: Breast and labial surgery in adolescents. Obstet Gynecol. 2016;127:e138–40 This professional committee opinion shifts a prior stance against labial surgery to one of acceptance given conditional indications.

    Article  Google Scholar 

  27. Clerico C, Lari A, Mojallal A, Boucher F. Anatomy and aesthetics of the labia minora: the ideal vulva? Aesthet Plast Surg. 2017;41(3):714–9.

    Article  CAS  Google Scholar 

  28. Radman HM. Hypertrophy of the labia minora. Obstet Gynecol. 1976;48:78S–9S.

    CAS  PubMed  Google Scholar 

  29. Friedrich EG. Vulvar dystrophy. Clin Obstet Gynecol. 1985;28:178–87.

    Article  PubMed  Google Scholar 

  30. Rouzier R, Louis-Sylvestre C, Paniel BJ, Haddad B. Hypertrophy of labia minora: experience with 163 reductions. Am J Obstet Gynecol. 2000;182:35–40.

    Article  CAS  PubMed  Google Scholar 

  31. Munhoz AM, Filassi JR, Ricci MD, et al. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast Reconstr Surg. 2006;118:1237–47 discussion 1248–50.

    Article  CAS  PubMed  Google Scholar 

  32. Alter GJ. A new technique for aesthetic labia minora reduction. Ann Plast Surg. 1998;40(3):287–90.

    Article  CAS  PubMed  Google Scholar 

  33. Ouar N, Guillier D, Moris V, Revol M, Francois C, Cristofari S. Postoperative complications of labia minora reduction. Comparative study between wedge and edge resection. Ann Chir Plast Esthet. 2017;62(3):219–23.

    Article  CAS  PubMed  Google Scholar 

  34. • Surroca MM, Miranda LS, Ruiz JB. Labiaplasty: A 24-month experience in 58 patients: outcomes and statistical analysis. Ann Plast Surg. 2018;80(4):316–22 This study shows high satisfaction rates over 2 years after labiaplasty in a contemporary practice.

    Article  CAS  PubMed  Google Scholar 

  35. Rouzier R, Louis-Sylvestre C, Paniel BJ, Haddad B. Hypertrophy of labia minora: experience with 163 reductions. Am J Obstet Gynecol. 2000;182:35–40.

    Article  CAS  PubMed  Google Scholar 

  36. Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg. 2008;122:1780–9.

    Article  CAS  PubMed  Google Scholar 

  37. Gress S. Composite reduction labiaplasty. Aesthet Plast Surg. 2013;37:674–83.

    Article  Google Scholar 

  38. Ozel B, White T, Urwitz-Lane R. The impact of pelvic organ prolapse on sexual function in women with urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:14–7.

    Article  PubMed  Google Scholar 

  39. Dobbeleir JM, Landuyt KV, Monstrey SJ. Aesthetic surgery of the female genitalia. Semin Plast Surg. 2011;25(2):130–41.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Adamo C, Corvi M. Cosmetic mucosal vaginal tightening (lateral colporrhaphy): improving sexual sensitivity in women with a sensation of wide vagina. Plast Reconstr Surg. 2009;123(6):212e-3e.

    Article  PubMed  CAS  Google Scholar 

  41. Ulubay M, Keskin U, Fidan U, et al. Safety, efficiency, and outcomes of perineoplasty: treatment of the sensation of a wide vagina. Biomed Res Int 2016;2016:2495105.

  42. Alexiades-Armenakas MR, Dover JS, Arndt KA. Fractional laser skin resurfacing. J Drugs Dermatol. 2012;11(11):1274–87.

    PubMed  Google Scholar 

  43. Alexiades-Armenakas M, Sarnoff D, Gotkin R, Sadick N. Multi-center clinical study and review of fractional ablative CO2 laser resurfacing for the treatment of rhytides, photoaging, scars and striae. J Drugs Dermatol. 2011;10(4):352–62.

    PubMed  Google Scholar 

  44. Fisher JC. Photons, physiatrics, and physicians: a practical guide to understanding laser light interaction with living tissue, part 1. J Clin Laser Med Surg. 1992;10(6):419–26.

    Article  CAS  PubMed  Google Scholar 

  45. Alexiades-Armenakas M, Dover JS, Arndt KA. Unipolar versus bipolar radiofrequency treatment of rhytides and laxity using a mobile painless delivery method. Lasers Surg Med. 2008;40(7):446–53.

    Article  PubMed  Google Scholar 

  46. Salvatore S, Leone Roberti Maggiore U, Athanasiou S, et al. Histological study on the effect of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause. 2015;22(8):845–9.

    Article  PubMed  Google Scholar 

  47. Zerbinati N, Serati M, Origoni M, Candiani M, Iannitti T, Salvatore S, et al. Microscopic and ultrastructural modifications of postmenopausal atrophis vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015;30(1):429–36.

    Article  PubMed  Google Scholar 

  48. Lee MS. Treatment of vaginal relaxation syndrome with an Erbium:YAGlaser using 908 and 3608 scanning scopes: a pilot study & short-term results. Laser Ther. 2014;23(2):129–38.

    Article  PubMed  PubMed Central  Google Scholar 

  49. • Krychman M, Rowan CG, Allan BB, et al. Effect of single-treatment, surface-cooled radiofrequency therapy on vaginal laxity and female sexual function: the VIVEVE I randomized controlled trial. J Sex Med. 2017;14(2):215–25 This is a randomized control trial showed improvement in sexual function for women treated with intravaginal radiofrequency therapy.

    Article  PubMed  Google Scholar 

  50. Sekiguchi Y, Utsugisawa Y, Azekosi Y, Kinjo M, Song M, Kubota Y, et al. Laxity of the vaginal introitus after childbirth: nonsurgical outpatient procedure for vaginal tissue restoration and improved sexual satisfaction using low-energy radiofrequency thermal therapy. J Women’s Health (Larchmt). 2013;22(9):775–81.

    Article  Google Scholar 

  51. Perino A, Calligaro A, Forlani F, Tiberio C, Cucinella G, Svelato A, et al. Vulvo-vaginal atrophy: a new treatment modality using thermoablative fractional CO2 laser. Maturitas. 2015;80(3):296–301.

    Article  PubMed  Google Scholar 

  52. •• Blaganje M, Šćepanović D, Žgur L, Verdenik I, Pajk F, Lukanović A. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2018;224:153–8 This randomized control trial demonstrates a statistically significant improvement of stress urinary incontinence in women treated with laser compared to sham.

    Article  PubMed  Google Scholar 

  53. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20.

    Article  PubMed  Google Scholar 

  54. Derogatis L, Clayton A, Lewis-d’agostino D, Wunderlich G, Fu Y. Validation of the Female Sexual Distress Scale-Revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008;5(2):357–64.

    Article  PubMed  Google Scholar 

  55. Rogers RG, Coates KW, Kammerer-doak D, Khalsa S, Qualls C. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(3):164–8.

    Article  PubMed  Google Scholar 

  56. Hajebrahimi S, Nourizadeh D, Hamedani R, Pezeshki MZ. Validity and reliability of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and its correlation with urodynamic findings. Urol J. 2012;9(4):685–90.

    PubMed  Google Scholar 

  57. Fistonic N, Fistonic I, Lukanovic A, Findri-Gustek S, Sorta Bilajac Turina I, Franic D. First assessment of short term efficacy of Er:YAG laser treatment on stress urinary incontinence in women: prospective cohort study. Climacteric. 2015;18(Sup 1):37–42.

    Article  PubMed  Google Scholar 

  58. Ogrinc BU, Sencar S. Novel minimally invasive laser treatment of urinary incontinence in women. Lasers Surg Med. 2015;47:689–97.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Pardo J, Sola V, Morales A. Treatment of female stress urinary incontinence with erbium YAG laser in non-ablative mode. Eur J Obstet Gynecol Reprod Biol. 2016;204:1–4.

    Article  PubMed  Google Scholar 

  60. Pergialiotis V, Prodromidou A, Perrea DN, Doumouchtsis SK. A systematic review on vaginal laser therapy for treating stress urinary incontinence: do we have enough evidence? Int Urogynecol J. 2017;28(10):1445–51.

    Article  PubMed  Google Scholar 

  61. The U.S. Federal and Drug Administration. FDA warns against use of energy-based devices to perform vaginal ‘rejuvenation’ or vaginal cosmetic procedures: FDA safety communication https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm615013.htm Accessed July 13, 2018.

  62. ACOG Practice Bulletin No. 119. Female sexual dysfunction. Obstet Gynecol. 2011;117(4):996–1007.

    Article  Google Scholar 

  63. Matz EL, Pearlman AM, Terlecki RP. Safety and feasibility of platelet-rich fibrin matrix injections for treatment of common urologic conditions. Investig Clin Urol. 2018;59(1):61–5.

    Article  PubMed  Google Scholar 

  64. Galliera E, Corsi MM, Banfi G. Platelet-rich plasma therapy: inflammatory molecules involved in tissue healing. J Biol Regul Homeost Agents. 2012;26(2 Suppl 1):35S–42S.

    CAS  PubMed  Google Scholar 

  65. Hersant B, Sidahmed-mezi M, Belkacemi Y, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study. Menopause. 2018;25:1124–30.

    Article  PubMed  Google Scholar 

  66. Herbenick D, Schick V, Reece M, Sanders S, Dodge B, Fortenberry JD. The Female Genital Self-Image Scale (FGSIS): results from a nationally representative probability sample of women in the United States. J Sex Med. 2011;8(1):158–66.

    Article  PubMed  Google Scholar 

  67. Berman L, Windecker MA. The relationship between women’s genital self-image and female sexual function: a national survey. Curr Sex Health Rep. 2008;5:199–207.

    Article  Google Scholar 

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Authors and Affiliations

  1. University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA

    Christopher Gonzales-Alabastro

  2. Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA

    Karyn S. Eilber & Jennifer T. Anger

  3. Berman Women’s Wellness Center, 1125 South Beverly Drive, Suite 401, Los Angeles, CA, 90035, USA

    Jennifer R. Berman

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  1. Christopher Gonzales-Alabastro
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Correspondence to Jennifer R. Berman.

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Gonzales-Alabastro, C., Eilber, K.S., Anger, J.T. et al. Female Cosmetic Genital Reconstruction: a Review of Current Trends, Treatments, and Techniques. Curr Sex Health Rep 11, 44–51 (2019). https://doi.org/10.1007/s11930-019-00191-1

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