Skip to main content

Female genital cosmetic surgery: a review of techniques and outcomes

Abstract

The aesthetic and functional procedures that comprise female genital cosmetic surgery (FGCS) include traditional vaginal prolapse procedures as well as cosmetic vulvar and labial procedures. The line between cosmetic and medically indicated surgical procedures is blurred, and today many operations are performed for both purposes. The contributions of gynecologists and reconstructive pelvic surgeons are crucial in this debate. Aesthetic vaginal surgeons may unintentionally blur legitimate female pelvic floor disorders with other aesthetic conditions. In the absence of quality outcome data, the value of FGCS in improving sexual function remains uncertain. Women seeking FGCS need to be educated about the range and variation of labia widths and genital appearance, and should be evaluated for true pelvic support disorders such as pelvic organ prolapse and stress urinary incontinence. Women seeking FGCS should also be screened for psychological conditions and should act autonomously without coercion from partners or surgeons with proprietary conflicts of interest.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

References

  1. Honore LH, O’Hara KE (1978) Benign enlargement of labia minora: report of two cases. Eur J Obstet Gynecol Reprod Biol 8(2):61–64

    PubMed  Article  CAS  Google Scholar 

  2. Hodgkinson DJ, Hait G (1984) Aesthetic vaginal labioplasty. Plast Reconstr Surg 74(3):414–416

    PubMed  Article  CAS  Google Scholar 

  3. Milkos JR, Moore RD (2008) Labiaplasty of the labia minora: patients’ indications for pursuing surgery. J Sex Med 5(6):1492–1495

    Article  Google Scholar 

  4. Yurteri-Kaplan LA, Antosh DD, Sokol AI, Park AJ, Gutman RE, Kingsberg SA, Iglesia CB (2012) Interest in cosmetic vulvar surgery and perceptions of vulvar appearance. Am J Obstet Gynecol 207:428.e1–e7

    Article  Google Scholar 

  5. Konig M, Zeijlmans IA, Bouman TK, van der Lei B (2009) Female attitudes regarding labia minora appearance and reduction with consideration of media influences. Aesthetic Surg J 29:65–71

    Article  Google Scholar 

  6. Bramwell A, Morland C, Garden AS (2007) Expectations and experience of labial reduction: a qualitative study. Br J Obstet Gynaecol 114:1493–1499

    Article  CAS  Google Scholar 

  7. Crouch NS, Deans R, Michala L, Liao LM, Creighton SM (2011) Clinical characteristics of well women seeking labial reduction surgery: a prospective study. BJOG 118(12):1507–1510

    PubMed  Article  CAS  Google Scholar 

  8. Michala L, Koliantzaki S, Antsaklis A (2011) Protruding labia minora: abnormal or just uncool? J Psychosom Obstet Gynaecol 32(3):154–156

    PubMed  Article  Google Scholar 

  9. Jothilakshmi PK, Salvi NR, Hayden BE, Bose-Haider B (2009) Labial reduction in adolescent population—a case series study. J Pediatr Adolesc Gynecol 22:53–55

    PubMed  Article  CAS  Google Scholar 

  10. Essen B, Johnsdotter S (2004) Female genital mutilation in the West: traditional circumcision versus genital cosmetic surgery. Acta Obstet Gynecol Scand 83(7):611–613

    PubMed  Google Scholar 

  11. Koster M, Price LL (2008) Rwandan female genital modification: elongation of the labia minora and the use of local botanical species. Cult Heal Sex 10(2):191–204

    Article  Google Scholar 

  12. Bagnol B, Mariano E (2008) Vaginal practices: eroticism and implications for women’s health and condom use in Mozambique. Cult Heal Sex 10(6):573–585

    Article  Google Scholar 

  13. Scholten E (2009) Female genital cosmetic surgery—the future. J Plast Reconstr Aesthet Surg 62(3):290–291

    PubMed  Article  Google Scholar 

  14. Kelly B, Foster C (2012) Should female genital cosmetic surgery and genital piercing be regarded ethically and legally as female genital mutilation? BJOG 119:389–392

    PubMed  Article  CAS  Google Scholar 

  15. World Health Organization. Female genital mutilation. Fact sheet N 241 February 2012, 1 October 2012

  16. Mirzabeigi MN, Moore JH, Mericli AF, Bucciarelli P, Jandali S, Valeiro IL (2012) Current trends in vaginal labioplasty: a survey of plastic surgeons. Ann Plast Surg 68(2):125–134

    PubMed  Article  CAS  Google Scholar 

  17. ACOG Committee Opinion No. 378 (2007) Vaginal “rejuvenation” and cosmetic vaginal procedures. Obstet Gynecol 110:737–738

    Article  Google Scholar 

  18. Goodman MP, Placik OJ, Benson RH et al (2010) A large multicenter outcome study of female genital plastic surgery. J Sex Med 7:1565–1567

    PubMed  Article  Google Scholar 

  19. Miklos JR, Moore RD (2011) Postoperative cosmetic expectations for patients considering labiaplasty surgery: our experience with 550 patients. Surg Technol Int 1:170–174

    Google Scholar 

  20. Goodman MP (2009) Female cosmetic genital surgery. Obstet Gynecol 113(1):154–159

    PubMed  Google Scholar 

  21. Pardo JS, Sola VD, Ricci PA, Guiloff EF, Freundlich OK (2006) Colpoperineoplasty in women with a sensation of a wide vagina. Acta Obstet Gynecol Scand 85(9):1125–1127

    PubMed  Article  Google Scholar 

  22. Kent D, Pelosi MA III (2012) Vaginal rejuvenation: an in-depth look at the history and technical procedure. AJCS 29(2):89–96

    Google Scholar 

  23. Moore RD, Miklos JR (2012) Vaginal reconstruction and rejuvenation surgery: is there data to support improved sexual function? AJCS 29(2):97–113

    Google Scholar 

  24. Dobbeleir JM, Landuyt KV, Monstrey SJ (2011) Aesthetic surgery of the female genitalia. Semin Plast Surg 25(2):130–141

    PubMed  Article  Google Scholar 

  25. Pelosi MA III, Pelosi MA II (2011) Cosmetic vaginal surgery. US Obstet Gynecol 6(1):55–58

    Google Scholar 

  26. Alinsod R (2006) Overview of vaginal rejuvenation, new frontiers in pelvic surgery. NSOCP/AAOCG, Las Vegas

    Google Scholar 

  27. Kent D (2008) Vaginal rejuvenation in review. Plastic Surgery Practice. http://www.plasticsurgerypractice.com/issues/articles/2008-12_05.asp. Accessed 23 August 2012

  28. Gaspar A, Addamo G, Brandi H (2011) Vaginal fractional CO2 laser: a minimally invasive option for vaginal rejuvenation. Am J Cosmetic Surg 28(3):156–162

    Article  Google Scholar 

  29. Gaspar A (2012) Comparison of two novel laser treatments in aesthetic gynecology. Journal of Lasers and Health Academy. Supplement(1)

  30. Brambilla M (2008) Intramuscular-submucosal lipostructure for the treatment of vaginal laxity. Paper presented at: Congresso Internazionale di Medicina Estetica; October 10; Milan, Italy

  31. Adamo C, Corvi M (2009) Cosmetic mucosal vaginal tightening (lateral colporrhaphy) improving sexual sensitivity in women with a sensation of wide vagina. Plast Reconstr Surg 123(6):212e–213e

    PubMed  Article  CAS  Google Scholar 

  32. Ostrzenski A (2012) Vaginal rugation rejuvenation (restoration): a new surgical technique for an acquired sensation of wide/smooth vagina. Gynecol Obstet Invest 73:48–52

    PubMed  Article  Google Scholar 

  33. Alinsod R (2011) Awake in-office Barbie labiaplasty, awake in-office labia majora plasty, awake in-office vaginoplasty, awake in-office labial revision. Congress on Aesthetic Vaginal Surgery, Tucson

    Google Scholar 

  34. Rouzier R, Haddad B, Deyrolle C, Pelisse M, Moyal-Barracco M, Paniel BJ (2002) Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol 186(1):49–52

    PubMed  Article  Google Scholar 

  35. Glazer HI, Ledger WJ (2002) Clinical management of vulvodynia. Rev Gynaecol Pract 2(1–2):83–90

    Article  Google Scholar 

  36. McCormack WM, Spence MR (1999) Evaluation of the surgical treatment of vulvar vestibulitis. Eur J Obstet Gynecol Reprod Biol 86(2):135–138

    PubMed  Article  CAS  Google Scholar 

  37. Foster DC, Butts C, Shah KV, Woodruff JD (1995) Long-term outcome of perineoplasty for vulvar vestibulitis. J Womens Health 4(6):669–675

    Article  Google Scholar 

  38. Kaufman RH, Friedrich EG Jr (1985) The carbon dioxide laser in the treatment of vulvar disease. Clin Obstet Gynecol 28(1):220–229

    PubMed  Article  CAS  Google Scholar 

  39. Lawson AE, Hawtof D, Gowda M, Jackson I, Osgood G (1991) Complications of laser therapy in the gynecological patient: a review of four patients. Ann Plast Surg 27(4):364–367

    PubMed  Article  CAS  Google Scholar 

  40. Davison SP, West JE, Caputy G, Talavera F, Stadelmann WK, Slenkovich NG (2011) Labiaplasty and Labia Minora Reduction. eMedicine.com. http://emedicine.medscape.com/article/1372175-overview

  41. Giraldo F, Gonzalez C, de Haro F (2004) Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora. Plast Reconstr Surg 113(6):1820–1825

    PubMed  Article  Google Scholar 

  42. Tepper OM, Wulkan M, Matarasso A (2011) Labioplasty: anatomy, etiology, and a new surgical approach. Aesthet Surg J 31(5):511–518

    PubMed  Article  Google Scholar 

  43. Lloyd J, Crouch NS, Minto CL et al (2005) Female genital appearance: “normality” unfolds. BJOG 112(5):643–646

    PubMed  Article  Google Scholar 

  44. Rezai A, Jansson P (2007) Clinical techniques: evaluation and result of reduction labioplasty. The American Journal of Cosmetic Surgery. 24(2): http://www.cosmeticsurgeryspecialists.co.uk/wp-content/uploads/Article2.pdf

  45. Alter G (1998) A new technique for aesthetic labia minora reduction. Ann Plast Surg 40:287–290

    PubMed  Article  CAS  Google Scholar 

  46. Munhoz AM, Filassi JR, Ricci MD, Aldrighi C, Correia LD, Aldrighi JM et al (2006) Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast Reconstr Surg 118(5):1237–1247

    PubMed  Article  CAS  Google Scholar 

  47. Alter GJ (2011) Labia minora reconstruction using clitoral hood flaps, wedge excisions, and YV advancement flaps. Plast Reconstr Surg 127(6):2356–2363

    PubMed  Article  CAS  Google Scholar 

  48. Cao YJ, Li FY, Li SK, Zhou CD, Hu JT, Ding J, Xie LH, Li Q (2012) A modified method of labia minora reduction: the de-epithelialised reduction of the central and posterior labia minora. J Plast Reconstr Aesthet Surg 65(8):1096–1102

    PubMed  Article  CAS  Google Scholar 

  49. Choi HY, Kim KT (2000) A new method for aesthetic reduction of labia minora (the deepithelialized reduction of labioplasty). Plast Reconstr Surg 105(1):419–422, discussion 423–424

    PubMed  Article  CAS  Google Scholar 

  50. Solanki NS, Tejero-Trujeque R, Stevens-King A, Malata CM (2010) Aesthetic and functional reduction of the labia minora using the Maas and Hage technique. J Plast Reconstr Aesthet Surg 63(7):1181–1185

    PubMed  Article  CAS  Google Scholar 

  51. Alter GJ (2008) Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg 122(6):1780–1789

    PubMed  Article  CAS  Google Scholar 

  52. Maas SM, Hage JJ (2000) Functional and aesthetic labia minora reduction. Plast Reconstr Surg 105(4):1453–1456

    PubMed  CAS  Google Scholar 

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

    PubMed  Article  CAS  Google Scholar 

  54. Felicio YA (2007) Labial surgery. Aesthet Surg J 27(3):322–328

    Article  CAS  Google Scholar 

  55. Di Saia JP (2008) An unusual staged labial rejuvenation. J Sex Med 5(5):1263–1267, discussion 1263–1267

    PubMed  Article  Google Scholar 

  56. Trichot C, Thubert T, Faivre E, Fernandez H, Deffieux X (2011) Surgical reduction of hypertrophy of the labia minora. Int J Gynaecol Obstet 115(1):40–43

    PubMed  Article  Google Scholar 

  57. Ellsworth WA, Rizvi M, Lypka M, Gaon M, Smith B, Cohen B, Dinh T (2010) Techniques for labia minora reduction: an algorithmic approach. Aesthetic Plast Surg 34(1):105–110

    PubMed  Article  Google Scholar 

  58. Baskin LS, Erol A, Li YW, Liu WH, Kurzrock E, Cunha GR (1999) Anatomical studies of the human clitoris. J Urol 162(3 Pt 2):1015–1020

    PubMed  CAS  Google Scholar 

  59. Hunter JG (2008) Considerations in female external genital aesthetic surgery techniques. Aesthet Surg J 28(1):106–107, author reply 107

    PubMed  Article  CAS  Google Scholar 

  60. Salgado CJ, Tang JC, Desrosiers AE 3rd (2012) Use of dermal fat graft for augmentation of the labia majora. J Plast Reconstr Aesthet Surg 65(2):267–270

    PubMed  Article  Google Scholar 

  61. Blugerman G, Amar R, Schavelzon D, et al. (2011) Advanced lipotransfer techniques. In: Serdev N (Ed.), Advanced techniques in liposuction and fat transfer. Rijeka, Croatia: InTech, http://www.intechopen.com/books/advanced-techniques-in-liposuction-and-fat-transfer/advanced-lipotransfer-techniques. Accessed 19 August 2012

  62. Vogt PM, Herold C, Rennekampff HO (2011) Autologous fat transplantation for labia majora reconstruction. Aesthetic Plast Surg 35(5):913–915

    PubMed  Article  CAS  Google Scholar 

  63. Triana L, Robledo AM (2012) Refreshing labioplasty techniques for plastic surgeons. Aesth Plast Surg. doi:10.1007/s00266-012-9916-z

    Google Scholar 

  64. Kilchevsky A, Vardi Y, Lowenstein L, Gruenwald I (2012) Is the female G-spot a distinct anatomic entity? J Sex 9:719–726

    Article  Google Scholar 

  65. Grafenberg E (1950) The role of the urethra in female orgasm. Int J Sexol 3:145–148

    Google Scholar 

  66. Puppo V, Gruenwald I (2012) Does the G-spot exist? A review of the current literature. Int Urogynecol J 23:1665–1669

    PubMed  Article  Google Scholar 

  67. Rabinerson D, Horowitz E (2007) G-spot and female ejaculation: fiction or reality. Harefuah 146:145–147

    PubMed  Google Scholar 

  68. Ostrzenski A (2012) G-spot anatomy: a new discovery. J Sex Med 9(5):1355–1359

    PubMed  Article  Google Scholar 

  69. Park HJ, Jung KH, Kim SY, Lee JH, Jeong JY, Kim JH (2010) Hyaluronic acid pulmonary embolism: a critical consequence of an illegal cosmetic vaginal procedure. Thorax 65(4):360–361

    PubMed  Article  Google Scholar 

  70. Marchitelli CE, Sluga MC, Perrotta M, Testa R (2010) Initial experience in vulvovaginal aesthetic surgery unit within a general gynecology department. J Low Genit Tract Dis 14(4):295–300

    PubMed  Article  Google Scholar 

  71. Pardo J, Sola V, Ricci P, Guilloff E (2006) Laser labioplasty for labia minora. International J of Gyn Obst 93:38–43

    Article  CAS  Google Scholar 

  72. Oxman AD (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490–1494

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

Dr Alinsod: Consultant Coloplast, Ellman International, Cooper Surgical, Monarch Medical Products. None for Drs Iglesia and Yurteri-Kaplan.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cheryl B. Iglesia.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Iglesia, C.B., Yurteri-Kaplan, L. & Alinsod, R. Female genital cosmetic surgery: a review of techniques and outcomes. Int Urogynecol J 24, 1997–2009 (2013). https://doi.org/10.1007/s00192-013-2117-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-013-2117-8

Keyword

  • Female genital cosmetic surgery
  • Cosmetic gynecology
  • Vaginal rejuvenation
  • Labiaplasty
  • Vaginoplasty