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New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology reviews the available literature on cosmetic labial surgery and underlines the striking lack of evidence on the safety and long-term consequences of such procedures. The authors caution that medically nonessential surgery to the labia is being promoted to women, while no data on clinical effectiveness exist.
Increasing numbers of healthy women are seeking surgery to change the shape and size of their normal vulva. Once considered the special domain of glamour models, female genital cosmetic surgery is becoming more common in economically affluent nations. Many procedures exist in the medical and marketing literature, including vaginal rejuvenation, designer vaginoplasty, G spot amplification and revirginisation. A popular request is partial excision of the labia minora.
In this study, the researchers sought to investigate the quality and content of published reports relating to labial surgery for healthy women. Electronic databases were searched for relevant articles between 1950 and April 2009. Forty articles were identified, 18 of which identified patient data. Of these 18 papers, 15 did not specify study design, and 15 did not address gynaecologic or obstetric problems. No prospective, randomised or controlled studies were found.
While sexual difficulties are often cited as a reason for surgery, the authors caution that research is needed on long-term sexual function, as surgery may damage the nerve supply and is associated with impaired sensitivity and impaired sexual function.
Research to investigate the potential increase in obstetric complications is also needed. The amount of genital tissue removed in cosmetic labial surgery is comparable with types I and II female genital mutilation, which are associated with perineal trauma, postpartum haemorrhage and increased neonatal death. While planned caesarean section may circumvent these risks, young women seeking labial surgery should be informed of potential implications for future pregnancies.
Co-author, Lih-Mei Liao, consultant psychologist at University College London, said "Healthy women are commercially targeted for invasive and irrevocable surgery to the labia minora. Advertisements promote labial surgery as easy answers to women's insecurities about their genital appearances - insecurities that are fuelled by the very advertisements that prescribe a homogenized prepubescent genital appearance standard for all women."
Co-author, Sarah Creighton, consultant gynaecologist at University College Hospital, said "This paper offers a critical review of available scientific knowledge on labial surgery and identifies a shocking lack of solid evidence. Some studies have laid claims to 'successes' despite suspect methodology, and some have not bothered to define how the conclusions had been derived. Anecdotes proliferate in the literature. Risks and complications are rarely documented.
"Labial surgery needs to be rigorously evaluated in future, and for longer term. Furthermore, quality research is needed to improve our understanding of the psychological drivers behind women's decision to sacrifice sexually sensitive tissue that contribute to erotic experiences, for a certain genital appearance that used to be an obligation only for some glamour models. Alternative solutions, such as counselling and support, should be developed for women and girls."
Prof. Philip Steer, BJOG editor-in-chief, said "Commercial images and social pressures often serve to distort public perceptions about what is physically normal.
Healthy messaging about the normal variation in female genitalia, as well as body shape and size more generally, is needed and important.
"This study underlines the need for multidisciplinary research to investigate the range of factors that affect women's sexual function and wellbeing. Reliable information on the risks and benefits of labial surgery, as well as alternative approaches, is vital to ensuring informed choice for women."
Notes
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal and include the website: bjog as a hidden link online.
Reference
Liao L, Michala L, Creighton S. Labial surgery for well women: a review of the literature. BJOG; DOI: 10.1111/j.1471-0528.2009.02426.x.
To view an abstract of the paper, click here.
Source
Royal College of Obstetricians and Gynaecologists
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