This is a rapidly progressing subspecialty that is increasingly requested by the patients and also attracted the attention of many Gynecologist, plastic surgeon and beauticians. This new subspecialty of Gynecology appeared at the end of the first decade of the 21st century (exactly in the year 2007 when the issue was first addressed by American College of Obstetricians and Gynecologist (ACOG)). At first the value and importance of Cosmetic and Reconstructive Gynecology Procedures were questionable. However, four years later, in the year 2011, an extensive evidence-based work on the effectiveness and reliability of these procedures was published. Also, in 2013, Canada’s Society of Obstetricians and Gynecologists’ policy statement recommended that the medical, sexual, and gynecologic histories be reviewed with patients requesting genital cosmetic and/or reconstructive surgery. They also recommended that the patient be informed of the normal variations in genital appearance; the physiologic changes that developed with aging, and the unpredictability of changes that might occur during pregnancy and menopause. In 2013, the Royal College of Obstetricians and Gynecologists published ethical considerations in relation to female genital cosmetic surgery and recommended that “female genital cosmetic surgeries shouldn’t be carried out before 18 years of age, the patient must be fully concerned about the procedures, and any advertising of these procedures conforms to good medical practice”.. In 2015, the International Federation of Gynecology and Obstetrics Committee for the Ethical Aspects of Human Reproduction published a report supporting that patients requesting cosmetic gynecologic procedures and surgeons must be aware of the differences between therapeutic surgical procedures and surgical procedures without medical indications, that normal anatomy and variations must be explained so that patients have a good understanding of them, that patients should be evaluated, especially for body dysmorphic disorder and other mental problems, and that the operating surgeons must have competent skills in this field.
In 2017 ACOG published a new committee statement recommending that in the case of requests for labiaplasty, patients, especially adolescents, and their families be informed about normal variations and physical changes, that the patient’s physical and emotional development had to be evaluated, and that consultation about non-surgical techniques should be provided.
According to the World Health Organization, the definition of female genital mutilation ( Female Circumcision) refers to all procedures involving partial or total removal of external genitalia. It has no health benefit and it is a human rights violation. However, this description is totally different from female genital cosmetic surgery relating to genital destruction and the lack of patient consent in mutilation.
In conclusion, the lines between medically necessary operations such as vaginal/pelvic reconstructive surgery and elective surgeries such as vaginoplasty and labiaplasty are blurring and can now be performed at the same time. Both function and beauty are becoming addressed together and not separately. Minimal complication rates and maximum patient satisfaction can be achieved if experienced, trained physicians are involved. To achieve the best outcomes in both functionality and appearance, surgeons must inform patients about normal variations, perform psychological evaluations, and discuss realistic expectations. The technique of surgery to be used should be individualized with great consideration of the patient’s preferred goals and with realistic expectations. The surgeon’s training and skills and comfort level with the various techniques must be considered fully. As is clearly seen, more academic training in this branch of gynecology must be given. Moreover, further studies are needed on the long-term efficacy, safety and reliability of non-surgical techniques, especially those that do not require hospitalization and can be performed in an office environment.
The following is a list of some Cosmetic and Reconstructive Gynecology procedures: -
* Vaginal tightening, or vaginoplasty.
* Labia majoraplasty and augmentation.
* Labia minoraplasty.
* Clitoral hood reduction (hoodoplasty) .
* Mons Pubis Liposuction and Lifting.
* Vulvar lightening.
* Fillers injection.
* G-Spot amplification.
* Treatment of Vulvar Varicosities.
* Vaginal Thread lifting.
Dr. Hisham Hussein Imam, MD.