Genital cosmetic surgeons need greater awareness

The review is published today in The Obstetrician & Gynaecologist (TOG) and also points out that the long term risks of this kind of surgery have not been sufficiently explored.

Female genital cosmetic surgery (FGCS) is becoming increasingly prevalent and encompasses a wide range of procedures such as labia reduction, clitoral hood reduction, hymenoplasty and revirgination.

Labioplasty is the most common first-line FGCS procedure and involves reduction of the labia and sometimes reduction of the clitoral hood. Hymenoplasty involves creating scar tissue so that a woman whose hymen is no longer intact can bleed the next time she has intercourse. Other forms of FCGS, such as revirgination and G-spot amplification, are more contentious and lack reliable data on their effectiveness say the authors.

The review explores the factors which may be linked to this rise in FGCS procedures. Internet advertising has become a predominant source of information for self-comparison among women and some television programmes focussing on people's body worries may direct women away from self-acceptance, says the review.

In addition, women may request surgery because of rubbing or pain during exercise. However, negative psychological preoccupations will intensify unpleasant physical sensations and how troubled women feel about them.

Female body distress is complex and is more prevalent than male body distress. However, it is not always fully understood and healthcare professionals may be unaware of the wide variation of female genitalia. The review recommends that doctors should be wary of conducting cosmetic surgery on women whose genital dimensions are normal. Furthermore, they should seek input from a psychological practitioner trained in assessing and intervening in problems of body image, sexuality and relationships.

Looking at the long term risks, the review states that there are no well run prospective studies on this with long term follow-up. Moreover, there is no information on future obstetric performance.

The review also looks at the links with female genital mutilation (FGM) and states that many FGCS procedures compare anatomically with types of FGM.

Dr Sarah Creighton, UCL Elizabeth Garrett Anderson Institute for Women's Health says: "Gynaecologists themselves must be familiar with the wide variation of genital appearance and be able to reassure a woman of normality with confidence. Women should be made aware of the potential short and long-term risks and the absence of long-term data on clinical effectiveness.

"More guidance and training is needed in this area in particular around psychological training. More research is needed to look at why women and girls are increasingly insecure about their bodies and gynaecologists have an important role in promoting sexual wellness."

TOG's Editor-in-Chief, Jason Waugh said: "Female genital cosmetic surgery is on the rise but there is little evidence on its long term effects. Women and gynaecologists should be aware of the variation that exists in genital appearance and think carefully about exploring the idea of surgery if it is not clinically necessary."

Media contact: David Weston