International Urogynecology Journal

, Volume 25, Issue 6, pp 831–839 | Cite as

Psychosexual outcome after labiaplasty: a prospective case-comparison study

  • David VealeEmail author
  • Iona Naismith
  • Ertiniss Eshkevari
  • Nell Ellison
  • Ana Costa
  • Dudley Robinson
  • Lanka Abeywickrama
  • Angelica Kavouni
  • Linda Cardozo
Original Article


Introduction and hypothesis

Our goal was to determine psychosexual outcome after labiaplasty in the long-term with specific measures of genital body image and sexual dysfunction.


We conducted a prospective study with a matched-comparison group of women not wanting labiaplasty. Forty-nine women were compared against a group of 39 women matched for age, sexual orientation, ethnicity, and marital status. The labiaplasty group was assessed before, 3 months after and between 11 and 42 months after surgery. The comparison group was assessed at two time points 3 months apart to control for the passage of time. The primary outcome measure was the Genital Appearance Satisfaction (GAS) scale.


Of the 49 women receiving labiaplasty, 19 (38.8 %) were lost to follow-up but were reassessed clinically. Twenty-four of 25 (96 %) women in the labiaplasty group showed a reliable and clinically significant improvement on the GAS scale 3 months after the procedure; 21/23 (91.3 %) showed an improvement at the long-term follow-up. A large effect size was found for improvements on the GAS scale in the labiaplasty group. Small-effect sizes were found for improvements in sexual functioning. Nine women obtaining labiaplasty met diagnostic criteria for body dysmorphic disorder before the operation; eight lost that diagnosis at the 3-month follow-up; 26 % reported minor side effects.


Labiaplasty is effective in improving genital appearance and sexual satisfaction, but larger studies are required to determine the prevalence of potential side effects.


Labiaplasty Labioplasty Body dysmorphic disorder Labia Female genital cosmetic surgery 



DV, NE, AC and IN acknowledge salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.



Conflicts of interests

We declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work other than Angelica Kavouni has received fees for services for private patients in the study.


  1. 1.
    The Health and Social Care Information Centre. HESOnline. 2012 4 April 2012; Available from:
  2. 2.
    Braun V (2010) Female genital cosmetic surgery: a critical review of current knowledge and contemporary debates. J Womens Health 19(7):1393–1407CrossRefGoogle Scholar
  3. 3.
    Liao LM, Michala L, Creighton SM (2010) Labial surgery for well women: a review of the literature. BJOG Int J Obstet Gynaecol 117(1):20–25CrossRefGoogle Scholar
  4. 4.
    Veale D, Eshekevari E, Ellison N, Cardozo L, Robinson D, Kavouni A (2014) Characteristics and motivation of women seeking labiaplasty. Psychol Med 44(3):555–566Google Scholar
  5. 5.
    Miklos JR, Moore RD (2008) Labiaplasty of the labia minora: patients’ indications for pursuing surgery. J Sex Med 5(6):1492–1495PubMedCrossRefGoogle Scholar
  6. 6.
    Veale D, Eshekevari E, Ellison N, Costa A, Robinson D, Kavouni A, Cardozo L (2014) A comparison of risk factors for women seeking labiaplasty compared to those not seeking labiaplasty. Body Image. doi: 10.1016/j.bodyim.2013.10.003
  7. 7.
    Crouch NS et al (2011) Clinical characteristics of well women seeking labial reduction surgery: a prospective study. BJOG 118(12):1507–1510PubMedCrossRefGoogle Scholar
  8. 8.
    Phillips KA, Diaz SF (1997) Gender differences in body dysmorphic disorder. J Nerv Ment Dis 185(9):570–577PubMedCrossRefGoogle Scholar
  9. 9.
    Veale D et al (1996) Body dysmorphic disorder. A survey of fifty cases. Br J Psychiatry 169(2):196–201PubMedCrossRefGoogle Scholar
  10. 10.
    Crerand CE, Menard W, Phillips KA (2010) Surgical and minimally invasive cosmetic procedures among persons with body dysmorphic disorder. Ann Plast Surg 65(1):11–16PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Tignol J et al (2007) Body dysmorphic disorder and cosmetic surgery: evolution of 24 subjects with a minimal defect in appearance 5 years after their request for cosmetic surgery. Eur Psychiatry 22(8):520–524PubMedCrossRefGoogle Scholar
  12. 12.
    Veale D, De Haro L, Lambrou C (2003) Cosmetic rhinoplasty in body dysmorphic disorder. Br J Plast Surg 56(6):546–551PubMedCrossRefGoogle Scholar
  13. 13.
    Goodman MP (2011) Female genital cosmetic and plastic surgery: a review. J Sex Med 8(6):1813–1825PubMedCrossRefGoogle Scholar
  14. 14.
    Alter G (2008) Aesthetic labia minora and clitoral hood reduction using extended wedge resection. Plast Reconstr Surg 122(6):1780–1789PubMedCrossRefGoogle Scholar
  15. 15.
    Goodman M et al (2011) The sexual, psychological and body image health of women undergoing elective vulvovaginal plastic/cosmetic procedures: a pilot study. Am J Cosmet Surg 28(4):219–226CrossRefGoogle Scholar
  16. 16.
    Michala L, Liao L-M, Creighton SM (2012) Female genital cosmetic surgery: how can clinicians act in women’s best interests? Obstet Gynaecol 14(3):203–206CrossRefGoogle Scholar
  17. 17.
    Bramwell R, Morland C (2009) Genital appearance satisfaction in women: the development of a questionnaire and exploration of correlates. J Reprod Infant Psychol 27(1):15–27CrossRefGoogle Scholar
  18. 18.
    Veale D et al (2013) Validation of genital appearance satisfaction scale and the cosmetic procedure screening scale for women seeking labiaplasty. J Psychosom Obstet Gynecol 34(1):46–52CrossRefGoogle Scholar
  19. 19.
    Zigmond A, Snaith RP (1983) The hospital depression and anxiety scale. Acta Psychiatr Scand 67:361–370PubMedCrossRefGoogle Scholar
  20. 20.
    Rogers RG et al (2001) A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol 184(4):552–558PubMedCrossRefGoogle Scholar
  21. 21.
    Cash TF, Fleming EC (2002) The impact of body-image experiences: development of the body image quality of life inventory. Int J Eat Disord 31(4):455–460PubMedCrossRefGoogle Scholar
  22. 22.
    Veale D et al (2011) Development of a cosmetic procedure screening questionnaire (COPS) for body dysmorphic disorder. J Plast Reconstr Aesthet 65(4):530–532CrossRefGoogle Scholar
  23. 23.
    First MB et al (1995) Structured clinical interview for DSM-IV axis I disorders. Biometric Research Department, New YorkGoogle Scholar
  24. 24.
    Evans C, Margison F, Barkham M (1998) The contribution of reliable and clinically significant change methods to evidence-based mental health. Evid Based Ment Health 1:70–72CrossRefGoogle Scholar
  25. 25.
    Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59(1):12–19PubMedCrossRefGoogle Scholar
  26. 26.
    Agostinis A, Morley SJ, Dowzer CN The leeds reliable change index calculator (v. 1), in Excel2008:
  27. 27.
    Lloyd J et al (2005) Female genital appearance: ‘normality’ unfolds. BJOG Int J Obstet Gynaecol 112(5):643–646CrossRefGoogle Scholar
  28. 28.
    Veale D et al (1996) Body dysmorphic disorder: a cognitive behavioural model and pilot randomised controlled trial. Behav Res Ther 34(9):717–729PubMedCrossRefGoogle Scholar
  29. 29.
    Grant JR, Cash TF (1995) Cognitive-behavioral body-image therapy-comparative efficacy of group and modest-contact treatments. Behav Ther 26(1):69–84CrossRefGoogle Scholar
  30. 30.
    Rosen C et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  • David Veale
    • 1
    Email author
  • Iona Naismith
    • 1
  • Ertiniss Eshkevari
    • 1
  • Nell Ellison
    • 1
  • Ana Costa
    • 1
  • Dudley Robinson
    • 2
  • Lanka Abeywickrama
    • 2
  • Angelica Kavouni
    • 3
  • Linda Cardozo
    • 4
  1. 1.Institute of Psychiatry, King’s College London & Centre for Anxiety Disorders and TraumaThe Maudsley HospitalLondonUK
  2. 2.King’s College HospitalLondonUK
  3. 3.Cosmetic SolutionsLondonUK
  4. 4.Department of UrogynaceologyKing’s College HospitalLondonUSA

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