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Köle E, Doğan O, Arslan G, Köle MÇ, Aslan E, Çalışkan E. Labiaplasty Outcomes and Complications in Turkish Women: A Multicentric Study. Int Urogynecol J 2024; 35:1045-1050. [PMID: 38635038 DOI: 10.1007/s00192-024-05777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to evaluate the outcomes, complication rates, and complication types of different labiaplasty techniques. METHODS In this cross-sectional retrospective study, a total of 2,594 patients who underwent surgery owing to hypertrophy or asymmetry of the labium minus were retrospectively analyzed. Data were collected by individual interviews with 43 experts from different centers. The patients were between 18 and 50 years of age. During the interview information about the presence and nature of complications, and about concomitant or revision surgeries, were gathered. The surgeons who performed these surgeries were also questioned about their training and surgical experience. RESULTS The most frequently observed complication was complete dehiscence, accounting for 29% of all complications. Complete dehiscence was most commonly seen after wedge resection (16 cases). The second most common complication was labium majus hematoma, accounting for 12.5% of all cases. Among the labiaplasty techniques, wedge resection had the highest complication rate at 3% (26 cases out of 753 patients). This was followed by composite labiaplasty at 1.2% (5 cases out of 395 patients), Z-plasty at 0.8% (1 case out of 123 patients), and trimming labiaplasty at 0.5% (7 cases out of 1,323 patients). CONCLUSION Considering the heterogeneity and low quality of the existing studies on this subject, this study provides valuable information for surgeons practicing in this field. However, further research is clearly warranted as female genital aesthetic procedures are being performed with a steadily increasing trend.
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Affiliation(s)
- Emre Köle
- Department of Obstetrics and Gynecology, Alanya Alaaddin Keykubat University School of Medicine, Kestel, Karapınar Caddesi, 07450, Antalya, Turkey.
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Private Practice, Harbiye, Lal Apartmanı, Mim Kemal Öke Cd. No:23, 34367, Istanbul, Turkey
| | - Gaye Arslan
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İçmeler Mah, Aydınlı Yolu Cd. No:2, 34947, Istanbul, Turkey
| | - Merve Çakır Köle
- Department of Obstetrics and Gynecology, Alanya Alaaddin Keykubat University School of Medicine, Kestel, Karapınar Caddesi, 07450, Antalya, Turkey
| | - Erdoğan Aslan
- Department of Obstetrics and Gynecology, Alanya Alaaddin Keykubat University School of Medicine, Kestel, Karapınar Caddesi, 07450, Antalya, Turkey
| | - Eray Çalışkan
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İçmeler Mah, Aydınlı Yolu Cd. No:2, 34947, Istanbul, Turkey
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Eftekhar T, Ghaemi M, Shabannejad Z, Mansouri Z, Hantoushzadeh S, Bazmi E, Foroozesh M, Mohammadi I, Eshraghi N. A Decade of Lawsuits Against Surgeons Performing Female Genital Cosmetic Surgery (FGCS) in Tehran, Iran. Aesthetic Plast Surg 2024:10.1007/s00266-024-03980-9. [PMID: 38512408 DOI: 10.1007/s00266-024-03980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The objective of this study is to evaluate the legal proceedings that arise from Female Genital Cosmetic Surgeries (FGCS) and analyze the reasons why women file complaints against their surgeons. Additionally, we examined the outcomes of the legal decisions associated with these complaints. METHODS This descriptive cross-sectional study was conducted in Tehran province, Iran, from 2012 to 2021. The primary data source for this study was forensic medical records, which were reviewed to gather relevant information. The collected data included the characteristics of the participants, the reasons for lawsuits, the procedure setting, and the outcomes of the legal decisions. RESULTS A total of 121 patients were examined in the study, revealing that Labiaplasty was the most prevalent procedure (49.6%), followed by vaginoplasty (19.8%) and perineoplasty (13.2%). The most common complaints were related to cosmetic concerns (57%), lack of recovery (26.4%), and sexual dysfunctions (22.3%). Healthcare providers were found liable for malpractice in 52.1% of cases. Additionally, having the surgery performed by a gynecologist decreased the risk of malpractice (β = 0.21, p= 0.034), while procedures in private clinics increased the risk (β = 2.95, p = 0.040). CONCLUSION The study's findings emphasized the importance of providing women with comprehensive education and consultations to ensure they are well-informed about the potential outcomes and risks of FGCS. Furthermore, the study highlighted the significance of having these surgical procedures performed by skilled and experienced surgeons. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Tahereh Eftekhar
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Imam Complex, East Bagherkhan Ave., Tehran, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Imam Complex, East Bagherkhan Ave., Tehran, Iran
| | - Zahra Shabannejad
- Legal Medicine Research Center, Iranian Legal Medicine Organization, Tehran, Iran
| | - Zeinab Mansouri
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Imam Complex, East Bagherkhan Ave., Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Imam Complex, East Bagherkhan Ave., Tehran, Iran
| | - Elham Bazmi
- Legal Medicine Research Center, Iranian Legal Medicine Organization, Tehran, Iran
| | - Mehdi Foroozesh
- Legal Medicine Research Center, Iranian Legal Medicine Organization, Tehran, Iran
| | - Ilnaz Mohammadi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Imam Complex, East Bagherkhan Ave., Tehran, Iran
| | - Nasim Eshraghi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Imam Complex, East Bagherkhan Ave., Tehran, Iran.
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Shen SH, Chen JW, Liu MZ, Peng L, Chen YZ, Shen H, Luo DY. Modified posterior colporrhaphy: A better technique to improve sexual function in women with vaginal laxity. Int J Surg 2024; 110:01279778-990000000-00946. [PMID: 38215253 PMCID: PMC11019970 DOI: 10.1097/js9.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Si-hong Shen
- Department of Urology, Institute of Urology, West China Hospital
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jia-wei Chen
- Department of Urology, Institute of Urology, West China Hospital
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Meng-zhu Liu
- Department of Urology, Institute of Urology, West China Hospital
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuan-zhuo Chen
- Department of Urology, Institute of Urology, West China Hospital
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Hong Shen
- Department of Urology, Institute of Urology, West China Hospital
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - De-yi Luo
- Department of Urology, Institute of Urology, West China Hospital
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Che K, Wang K, Yuan Y, Li F, Li Q. The 50 most cited articles and science mapping analysis of vaginal tightening. Int Urogynecol J 2023; 34:1607-1617. [PMID: 36645444 DOI: 10.1007/s00192-022-05436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/29/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The study was aimed at exploring the 50 most cited articles related to vaginal tightening. METHODS The papers were searched through the Thomson Reuters Web of Science on 30 July 2022, and were ranked by the total number of citations. The included articles were analyzed for author, journal, country, number of citations, keywords, subject matter, and level of evidence. The search output was also imported into VOSviewer. RESULTS The 50 most cited articles were cited a combined total of 2,558 times. The papers were published between 1990 and 2020, of which 86% were published between 2010 and 2020. They included 38 original articles, 8 reviews, 3 editorial articles, and 1 letter. Most articles were published in gynecology-related journals (n=30, 60%). The articles covered a wide range of topics, the most common being laser/radiofrequency treatment, vaginal tightening procedures, and urinary incontinence. The majority presented findings supported by level IV or V evidence. Through co-occurrence analysis, high-frequency words and countries were displayed well. CONCLUSIONS The study shed light on frequently read articles and influential topics about vaginal tightening. The highly cited literature mainly focused on laser or radiofrequency treatments and gynecologists currently dominate the highly cited literature on vaginal tightening. The articles related to surgical treatments are low in number and evidence level so far. The co-occurrence analysis reveals the hot research content and active countries in the field. In general, the study provides useful evidence for future research and educational materials.
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Affiliation(s)
- Kexin Che
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keke Wang
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Yuan
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengyong Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Hayes JA, Temple-Smith MJ. Teaching vulval anatomy in the twenty-first century: The Australian experience. ANATOMICAL SCIENCES EDUCATION 2023. [PMID: 36807881 DOI: 10.1002/ase.2264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/12/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Anatomy has often been regarded as an immutable discipline where everything that needs to be known is known. This article focuses on the teaching of vulval anatomy, the diversification of gender in contemporary society, and the increasing popularity of the Female Genital Cosmetic Surgery (FGCS) industry. The binary language and singular structural arrangements contained in lectures and chapters on "female genital anatomy" are nowadays rendered exclusive and incomplete. A series of 31 semi-structured interviews with Australian anatomy teachers identified barriers and facilitators for teaching vulval anatomy to contemporary student cohorts. Barriers included lack of connection to contemporary clinical practice, time and technical difficulty involved in regularly updating online presentations, the crowded curriculum, personal sensitivity to teaching vulval anatomy, and reluctance to introduce inclusive terminology. Facilitators included lived experience, regular use of social media, and institutional initiatives toward inclusivity including the support of queer colleagues.
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Affiliation(s)
- Jennifer A Hayes
- Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
- Department of Anatomy and Physiology, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Meredith J Temple-Smith
- Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
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Dubinskaya A, Anger JT. Female genitalia in pornography: a source of labiaplasty trends? J Sex Med 2023; 20:124-125. [PMID: 36763915 DOI: 10.1093/jsxmed/qdac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Alexandra Dubinskaya
- Division of Urology, Cedars Sinai Medical Center, Los Angeles, CA 90211, United States
| | - Jennifer T Anger
- Department of Urology, UC San Diego, La Jolla, CA 92093, United States
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Wang HC, Long X. Filler-induced non-thrombotic pulmonary embolism after genital aesthetic injection. J COSMET LASER THER 2022; 24:66-72. [PMID: 35969584 DOI: 10.1080/14764172.2022.2112231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Genital aesthetic procedures have increased in popularity among women and men. Many clinicians tried to expand the application of fill injection by using it for genital aesthetic injection. However, this procedure is not so safe as imagined and may lead to a fatal complication of pulmonary embolism. This article summarizes the clinical manifestations and proposed mechanism of the filler-induced non-thrombotic pulmonary embolism (FINTPE) cases. A literature review was performed with the search keywords including "genital aesthetic injection, vaginal injection, vaginoplasty, vaginal tightening, penile augmentation, penis injection, hyaluronic acid, fat grafting, pulmonary embolism, alveolar hemorrhage, hypoxemia, and dyspnea." Among the 14 cases from 11 articles enrolled, 12 patients were female, and two were male. Eight patients received silicone injection, followed by two received fat grafting and hyaluronic acid injection, respectively. All the female patients had one single injection site, including 11 cases for the vaginal wall and one for G-spot, while all the male patients received injections into the penis and scrotum. The main symptoms were dyspnea and chest pain. Almost 60% of FINTPE patients presented respiratory disorders within 12 hours post-operation. Treatment includes oxygen therapy, corticosteroids, and anticoagulation. Five patients improved with an average of 14.6-day treatment, and seven died due to organ failures. Genital aesthetic filler injections are experimental procedures without being strictly reviewed or approved. As a severe complication following these procedures, FINTPE requires cautious performance, careful prevention, timely identification, and treatment to decrease its incidence and mortality.
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Affiliation(s)
- Hayson Chenyu Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Cihantimur B, Aglamis O, Ozsular Y. 360 Genital Fat Transfer. Aesthetic Plast Surg 2021; 45:2996-3002. [PMID: 34373975 DOI: 10.1007/s00266-021-02488-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/18/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study was designed to evaluate utility of transferring autologous adipose-derived mesenchymal stem cells with high regenerative capacity and adipose tissue derived-stromal vascular fraction, so-called 360 Vaginal Beautification technique, in labia majora augmentation and vaginal tightening operation. METHODS A total of 97 female patients who underwent labia majora augmentation and vaginal tightening operation with 360 Vaginal Beautification technique were included. Post-discharge early (3rd and 7th postoperative day) and late (1st and 3rd postoperative month) surgical complications were assessed , while the Female Genital Self-Image Scale (FGSIS) was applied before surgery and also during postoperative 6-12 months. RESULTS All complications noted on postoperative 3rd day (ecchymosis of labia majus, ecchymosis of clitoral hood, tenderness in the pubic area and pain at the vaginal entrance points) regressed on postoperative 7th day with no infection, edema, lipoma or granuloma formation in any patient. Total mean FGSIS score was 17.7 ± 1.6 in the pre-operative period, and increased significantly to 20.9 ± 1.4 and 22.2 ± 1.8 in the postoperative 6th month (p < 0.001) and 12th month (p = 0.013), respectively. CONCLUSIONS The use of autologous fat, called 360 vaginal beautification, in the labia majora augmentation and vaginal tightening appears to be a safe technique due to use of autologous tissue transfer and to be associated with high satisfaction rate and an advantage of being more minimally invasive than surgical labia majora augmentation and vaginal tightening. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bulent Cihantimur
- Estetik International Quasar Clinic, Fulya Mahallesi, 34394, Sisli, Istanbul, Turkey.
| | - Ozgur Aglamis
- Estetik International Quasar Clinic, Fulya Mahallesi, 34394, Sisli, Istanbul, Turkey
| | - Yavuz Ozsular
- Estetik International Quasar Clinic, Fulya Mahallesi, 34394, Sisli, Istanbul, Turkey
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Skoda K, Oswald FE, Shorter L, Pedersen CL. Perceptions of Female Genitalia Following Labiaplasty. JOURNAL OF SEX RESEARCH 2021; 58:943-950. [PMID: 32852222 DOI: 10.1080/00224499.2020.1808563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Labiaplasty - a common form of female genital cosmetic surgery involving the removal of portions of the labia minora - is becoming increasingly popular, yet little research has examined perceptions of postoperative labia relative to perceptions of unaltered labia. The purpose of this study was therefore to examine perceptions of preoperative and postoperative labia. A sample of 4513 participants - 42% women, 56% men, and 3% non-binary (Mage 27.01, SDage = 9.97) - was shown a randomized series of "before-and-after" images of labiaplasty procedures. Participants rated each image on how well it matched societal ideals, their personal ideal, and perceived normalcy in appearance. Our hypothesis that postoperative labia would be evaluated more favorably than preoperative labia on these constructs was supported. Individuals who specified their gender outside of the binary rated labia more positively overall; women rated labia more negatively than participants of other genders. Ratings were consistently low overall for both pre- and postoperative labia, suggesting critically negative perceptions of female genitalia. Our findings highlight a need for interventions and education to encourage more positive and accurate views of women's bodies.
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Affiliation(s)
- Kaylee Skoda
- Department of Psychology, Kwantlen Polytechnic University
| | - Flora E Oswald
- Departments of Psychology and Women's, Gender, & Sexuality Studies, Pennsylvania State University
| | - Lacey Shorter
- Department of Psychology, Kwantlen Polytechnic University
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The Safe Practice of Female Genital Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3660. [PMID: 34249585 PMCID: PMC8263325 DOI: 10.1097/gox.0000000000003660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 01/11/2023]
Abstract
The purpose of this article is to guide surgeons in the safe practice of female genital plastic surgery when the number of such cases is steadily increasing. A careful review of salient things to look for in the patient’s motivation, medical history, and physical examination can help the surgeon wisely choose best candidates. The anatomy is described, with particular attention given to the variations not generally described in textbooks or articles. Descriptions are included for labiaplasty, including clitoral hood reduction, majoraplasty, monsplasty, and perineoplasty with vaginoplasty. Reduction of anesthetic risks, deep venous thromboses, and pulmonary emboli are discussed, with special consideration for avoidance of nerve injury and compartment syndrome. Postoperative care of a variety of vulvovaginal procedures is discussed. Videos showing anatomic variations and surgical techniques of common female genital procedures with recommendations to reduce the complication rate are included in the article.
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Zheng Z, Yin J, Cheng B, Huang W. Materials Selection for the Injection into Vaginal Wall for Treatment of Vaginal Atrophy. Aesthetic Plast Surg 2021; 45:1231-1241. [PMID: 33649927 DOI: 10.1007/s00266-020-02054-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
Vaginal atrophy caused by the aging process and perineal trauma has a negative impact on women. A new vaginal atrophy treatment is injection of materials into the vaginal wall, including platelet-rich plasma (PRP), autogenous fat graft (AFG), hyaluronic acid (HA), botulinum toxin (BTX), and collagen, but to date their efficacy has not been reviewed. Vaginal wall injection is available only for mild cases of vaginal atrophy or as an adjunct to vaginal surgery. PRP is used mainly to restore vaginal function, and multiple injections are needed to achieve good results in vaginal atrophy. HA, AFG, and collagen are used mainly to augment the vaginal wall. BTX injection can inhibit vaginal muscle spasm and reduce pain during sexual intercourse in patients with vaginismus. Injection of most of these materials into vaginal wall is effective and relatively safe. Vascular embolisms are the most serious complication of vaginal injection and should be prevented. In addition, there has been no randomized double-blind placebo-controlled trial or discussion of methods to avoid serious complications resulting from vaginal injection. Therefore, further studies of the injection of materials into the vaginal wall to treat vaginal atrophy are required, and the procedures should be standardized to benefit more patients.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Zhifang Zheng
- Department of Anatomy, School of Basic Medicine Sciences, Southern Medical University, No. 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, China
| | - Junfeiyang Yin
- Department of Anatomy, School of Basic Medicine Sciences, Southern Medical University, No. 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, China
| | - Biao Cheng
- Department of Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, 510010, China
| | - Wenhua Huang
- Department of Anatomy, School of Basic Medicine Sciences, Southern Medical University, No. 1023 Shatai South Road, Baiyun District, Guangzhou, 510515, China.
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Evaluating the Quality and Readability of Online Resources for Labiaplasty. Female Pelvic Med Reconstr Surg 2021; 27:63-67. [PMID: 30998540 DOI: 10.1097/spv.0000000000000725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the quality, readability, and accuracy of Web-based information regarding labiaplasty and to characterize the types of Web sites providing this information. METHODS Investigators used 3 major search engines to query the internet using the search terms labiaplasty, labia reduction, and vaginal rejuvenation. Two validated tools were used to evaluate Web sites: the JAMA benchmark tool and the DISCERN instrument. Three physicians independently reviewed each Web site. Interrater agreement was assessed, and reviewer scores were averaged. Flesch-Kincaid reading ease and Flesch-Kincaid grade level of each site were assessed. Data were analyzed using Stata 14.0 (College Station, TX). RESULTS Of the 112 Web sites reviewed, 100 Web sites were from North America, 9 from Europe, 2 from Australia, and 1 from Asia. The median score using the JAMA tool was 1.0 (0.33-4.0), indicating low accountability, whereas the median score using the DISCERN tool was 28 (18.7-77) of 80 with higher scores indicating higher quality. Cohen's weighted κ statistic (0.81) demonstrated near perfect agreement among reviewers for DISCERN scores. The median reading level was 11.9 (6.4-19.5). A majority of the Web sites (92) were for-profit businesses or blogs. CONCLUSIONS The internet enables patients to research sensitive topics and seek answers without worry of social stigma. Online health-related information is a widely used yet poorly studied source of medical information. The majority of Web sites reviewed lack balanced, evidence-based information. Given the wide variation in the quality of information, physicians should guide patients to reputable online resources.
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Hayes JA, Temple-Smith MJ. What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy. Aust N Z J Obstet Gynaecol 2020; 61:331-338. [PMID: 33382090 DOI: 10.1111/ajo.13298] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite increasing numbers of labiaplasties being performed, there is little quantitative information on normal labial diversity to guide medical education, patient education and surgical treatment. AIM This scoping review will determine what is known in the published literature about the anatomical basis of normal for labia and female genital cosmetic surgery (FCGS). MATERIALS AND METHODS The scoping review identified ten population-based studies that recorded labial dimensions by searching three electronic databases utilising a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search strategy. Strict inclusion and exclusion criteria were applied and then reference lists were scrutinised until no further articles that met the criteria were located. RESULTS These studies showed significant variation in labial length (range 5-100 mm) and width (range 1-60 mm). Labia minora were wider in pre-menopausal women than in post-menopausal women, protruding labia minora were more common than not, and asymmetry between right and left labia was common. Variation in recruitment, inclusion and exclusion criteria, and measurement did not allow for summation of the data sets. CONCLUSION This information could usefully be added to medical textbooks and teaching to ensure that medical graduates are sufficiently informed about normal variation in female genital anatomy to assess and advise women seeking FGCS.
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Affiliation(s)
- Jennifer A Hayes
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.,Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
LEARNING OBJECTIVES After studying this article, participants should be able to: (1) Identify the most appropriate type of anesthesia for the female genital plastic surgical patient and minimize risks of nerve injury and thromboembolic event through proper preoperative evaluation and knowledge of positioning. (2) Define the vulvovaginal anatomy, including common variants, and assess vulvovaginal tissues after childbirth and menopause. (3) Apply surgical techniques to minimize complications in female genital plastic surgery. (4) Classify the types of female genital mutilation/cutting and design methods of reconstruction after female genital mutilation/cutting. SUMMARY Female genital plastic surgery is growing in popularity and in numbers performed. This CME article covers several aspects of safety in the performance of these procedures. In choosing the best candidates, the impact of patient motivation, body mass index, parity, menopause and estrogen therapy is discussed. Under anesthesia, consideration for the risks associated with the dorsal lithotomy position and avoidance of compartment syndrome, nerve injury, deep venous thromboses, and pulmonary embolus are covered. Anatomical variations are discussed, as is the impact of childbirth on tissues and muscles. Surgical safety, avoidance of complications, and postoperative care of a variety of vulvovaginal procedures are discussed. Videos showing anatomical variations and surgical techniques of the most common female genital procedures with recommendations to reduce the complication rate are included in the article. Finally, female genital mutilation/cutting is defined, and treatment, avoidance of complications, and postoperative care are discussed.
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Li F, Li Q, Zhou Y, Li S, Cao Y, Liu M, Qiang S, Yuan Y, Zhang Z. L-Shaped Incision in Composite Reduction Labiaplasty. Aesthetic Plast Surg 2020; 44:1854-1858. [PMID: 32676901 DOI: 10.1007/s00266-020-01867-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
Labia minora hypertrophy, in combination with clitoral hood protrusion, is a common deformity encountered in clinic practice and should be treated as a compound entity. Most targeted surgical procedures are too complex to understand and master. Herein, we introduce a relatively simple method to correct this deformity. In this study, we retrospectively review our experience treating patients with deformity of labia minora hypertrophy combined with clitoral hood protrusion between January 2017 and November 2019. All patients received correction surgery to repair the complex deformity. During the procedures, we divided the complex operation into two parts: clitoral hood reduction using L-shaped incision and then labiaplasty using L-shaped edge resection. We describe the details of the method step-by-step and evaluate the treatment outcomes. A total of 38 sides (14 bilateral procedures and 10 unilateral procedures) of clitoral hood reduction and labiaplasty were performed. There were no wound healing complications in any cases. One patient had a secondary corrective operation for obvious asymmetry of bilateral labia minora. Ultimately, all the patients were satisfied with the cosmetic appearance and did not have complaints. The surgical procedure we describe proved to be an effective, simple method for dealing with the complex situation of hypertrophy of labia minora combined with clitoral hood protrusion. Subsequent L-shaped edge resection of labiaplasty is appropriate for individuals with darker skin, in particular.Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Genital Surgery.
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Srinivasan V, Sundaram H. Commentary on: Death Caused by Vaginal Injection of Hyaluronic Acid and Collagen: A Case Report. Aesthet Surg J 2020; 40:NP269-NP272. [PMID: 32101276 DOI: 10.1093/asj/sjaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Female genital cosmetic surgery (FGCS) aims to alter the structure and appearance of female genitalia to attain the desired shape, size or look, or to decrease labial interference during intercourse, relieve pain and discomfort with clothing and exercise or decrease vaginal caliber and laxity. In the last 5 years, the number of labiaplasty surgeries performed in the United States rose by 53%. Despite the increasing popularity of FGCS, several divergent opinions regarding the ethics, safety, and efficacy of these procedures exist. Here we provide a brief overview of the terminology and techniques for FGCS and summarize current controversies.
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Anatomy, histology, and nerve density of clitoris and associated structures: clinical applications to vulvar surgery. Am J Obstet Gynecol 2019; 221:519.e1-519.e9. [PMID: 31254525 DOI: 10.1016/j.ajog.2019.06.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/04/2019] [Accepted: 06/20/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND A precise understanding of structures comprising the female external genitalia is essential in obstetric and gynecologic practice. OBJECTIVE To further characterize the anatomy, histology, and nerve density of the clitoris and associated structures, and to provide clinical correlations to vulvar surgery. MATERIALS AND METHODS Unembalmed female cadavers were examined. The length and width of the body, glans, and crura of the clitoris were measured. Distances from the glans to the urethra and from the dorsal surface of the clitoral body to the mid pubic arch were recorded. The path of the dorsal nerve of the clitoris was examined, and the nerve width was measured as it emerged from the lateral surface of crura and at the distal clitoral body. Distances from where the dorsal nerve emerged from the perineal membrane to the posterior surface of the membrane and to mid pubic arch were measured. Connective tissue layers associated with the clitoris were examined. Tissue was harvested from additional unembalmed cadavers, and nerve density of the labia minora, glans, and clitoral body were analyzed. Histological examination was performed on vulvar structures to clarify tissue composition. Descriptive statistics were used for data analyses. RESULTS A total of 27 cadavers (aged 48-96 years) were examined, 22 grossly and 5 histologically. The median length and width of clitoral body were 29 mm (range, 13-59 mm) and 9 mm (range, 5-14 mm), respectively. The glans was 8 mm (range, 5-12 mm) long and 4 mm (range, 3-10 mm) wide. The length of the crura was 50 mm (range, 25-68 mm), and the width at the anterior portion was 9 mm (range, 2-13 mm). The closest distance from the glans to the urethra was 25 mm (range, 14-37 mm) and from the clitoral body to the mid pubic arch was 29 mm (range, 14-46 mm). The widths of the dorsal nerve at the lateral crura and at the distal clitoral body were 3 mm (range, 2-4 mm) and 1 mm (range, 1-2 mm), respectively. The distance from the dorsal nerve as it emerged from the perineal membrane to the mid pubic arch was 34 mm (range, 20-48 mm) and to the posterior surface of the membrane was 20 mm (range, 8-31 mm). The dorsal nerve and artery of the clitoris coursed adjacent to the medial surface of the inferior pubic ramus surrounded by a dense fibrous capsule adherent to the periosteum. The nerve and artery then coursed deep to dense connective tissue layers, which were contiguous with the suspensory ligament and fascia of the clitoris. Histologic examination revealed the presence of erectile tissue in the clitoral body, crura, and vestibular bulbs, but such tissue was absent in the glans and labia minora. Nerve density analysis revealed statistically significant greater density in the dorsal compared with ventral half of the clitoral body. Although not statistically significant, there was increased nerve density in the distal compared to the proximal half of the labia minora. CONCLUSION Precise knowledge of clitoral anatomy and associated neurovascular structures is essential to safely complete partial vulvectomies, clitoral and vulvar reconstructive procedures, anti-incontinence surgeries, and repair of obstetric lacerations. Understanding the range of anatomic variations and awareness of the areas of increased nerve density is important during counseling and surgical planning. Although the dorsal nerve of the clitoris courses deep to dense connective tissue layers, inadvertent injury may occur in the setting of deep dissection or suture placement. The dorsal nerve seems most vulnerable with surgical entry or lacerations that extend from the midline of the prepuce to the inferior pubic rami.
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Austin RE, Lista F, Vastis PG, Ahmad J. Posterior Vaginoplasty With Perineoplasty: A Canadian Experience With Vaginal Tightening Surgery. Aesthet Surg J Open Forum 2019; 1:ojz030. [PMID: 33791620 PMCID: PMC7780460 DOI: 10.1093/asjof/ojz030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Following vaginal trauma, most commonly vaginal delivery, women may experience vaginal laxity as a result of local tissue stretching and separation of the pelvic floor musculature. In addition to this generalized sensation of laxity, women may complain of decreased sexual satisfaction, gaping of the perineum, and excessive vaginal secretions. Since 2014, the authors have used a posterior vaginoplasty with perineoplasty technique for the surgical management of vaginal laxity. To date, the authors have performed surgical vaginal tightening in 30 consecutive patients and found that the posterior vaginoplasty with perineoplasty technique has allowed us to achieve reproducible outcomes with no postoperative complications. This article will review the authors’ approach to patients presenting for surgical vaginal tightening and the authors’ experience to date, including our preoperative screening, perioperative management, and detailed steps of the procedure.
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Affiliation(s)
| | - Frank Lista
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto,, Toronto, Ontario, Canada
| | | | - Jamil Ahmad
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto,, Toronto, Ontario, Canada
- Corresponding Author: Dr Jamil Ahmad, The Plastic Surgery Clinic, 1421 Hurontario Street, Mississauga, ON, Canada, L5G 3H5 E-mail: ; Twitter: @DrJAhmad
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Nohales F, Calvo P, Garcia-Gamón M, Monfort R, Valle A. La escisión de la glándula de Bartholin como causa de distorsión anatómica y dolor vulvar. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2019. [DOI: 10.1016/j.gine.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eftekhar T, Hajibabaei M, Deldar Pesikhani M, Rahnama P, Montazeri A. Sexual quality of life, female sexual function, female genital self- and body image among women requesting genital cosmetic surgery: a comparative study. PSYCHOLOGY & SEXUALITY 2019. [DOI: 10.1080/19419899.2018.1552187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Tahereh Eftekhar
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pelvic Floor, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Hajibabaei
- Psychosomatic Medicine Research Center. Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Deldar Pesikhani
- Department of Pelvic Floor, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Rahnama
- Department of Midwifery, Shahed University, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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Female Cosmetic Genital Reconstruction: a Review of Current Trends, Treatments, and Techniques. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00191-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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International Society for the Study of Vulvovaginal Disease Recommendations Regarding Female Cosmetic Genital Surgery. J Low Genit Tract Dis 2018; 22:415-434. [PMID: 29994815 DOI: 10.1097/lgt.0000000000000412] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Female genital cosmetic surgeries (FGCSs) and procedures are increasingly being advertised as common, simple, and complication-free, capable of not only improving aesthetic appearance but also increasing self-esteem and sexual pleasure.Guidelines for physicians and clear, scientifically correct information for patients must be made available, to minimize the number of ineffective or deleterious procedures.The International Society for the Study of Vulvovaginal Disease positions/recommendations regarding FGCS are as follows:1. There is a wide variation regarding genital normalcy; providers must be able to explain this to women.2. There are no data supporting FGCS including, G-spot augmentation, hymenoplasty, vulvar and perianal bleaching/whitening, vaginal tightening procedures, and other procedures aimed at increasing sexual function.3. Women should not be offered FGCS before the age of 18 years.4. Women undergoing FGCS should be evaluated by a provider with expertise in vulvovaginal diseases, including attention to their psychological, social, and sexual context. Evaluation by an experienced mental health provider should be considered when the motivation for seeking surgery and/or expectations are not clear or realistic.5. Female genital cosmetic surgery is not exempt from complications.6. Informed consent must always be obtained.7. Surgeons performing FGCS should refrain from solicitous advertising or promoting procedures without scientific basis, including on Web sites.8. Surgeons should not perform surgery that they do not agree with and explain their rationale/position when pressured by patients.9. The genital surgeon must be adequately trained in performing FGCS including knowledge of the anatomy, physiology and pathophysiology of the vulva, vagina and adjacent organs.
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Müllerová J, Weiss P. Plastic surgery in gynaecology: Factors affecting women’s decision to undergo labiaplasty. Mind the risk of body dysmorphic disorder: A review. J Women Aging 2018; 32:241-258. [DOI: 10.1080/08952841.2018.1529474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jana Müllerová
- 1st Medical Faculty, Charles University, Prague, Czech Republic
- Institute of Sexology, Charles University, Prague, Czech Republic
| | - Petr Weiss
- 1st Medical Faculty, Charles University, Prague, Czech Republic
- Institute of Sexology, Charles University, Prague, Czech Republic
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Güneş A, Alinsod RM. A mini-review of aesthetic gynecology and leading gynecology associations' approaches to this issue. Turk J Obstet Gynecol 2018; 15:105-111. [PMID: 29971188 PMCID: PMC6022427 DOI: 10.4274/tjod.33407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/02/2018] [Indexed: 12/01/2022] Open
Abstract
Aesthetic gynecology has seen increasing patient and physician demand. Although this typically falls in the reign of obstetrics and gynecology, plastic surgeons and cosmetic surgeons have also developed great interest in this field. Currently, few if any obstetrics and gynecology residency or fellowship programs teach this subject matter though inroads have taken place in plastic surgery and cosmetic surgery training programs that had the foresight to include specific training in this field. Currently, many surgeons start by first training in various established certification and preceptorship programs based in the United States and the United Kingdom. New programs worldwide in 2016-2017 have also been launched to offer certification training to interested physicians in both surgical and non-surgical treatments. A steady flow of certificate programs continues to evolve in Turkey, the Middle East, Spain, and South America, as a second wave of experts emerge. We present a review of surgical and non-surgical techniques of what is presently called “aesthetic gynecology” and the approaches of prominent gynecologic societies regarding this relatively new subspecialty.
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Affiliation(s)
- Aylin Güneş
- Yeni Yüzyıl University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Red M Alinsod
- South Cost Urogynecology, Clinic of Urogynecology and Pelvic Reconstructive Surgery, Laguna Beach, California, United States of America
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Audit of Female Genital Aesthetic Surgery: Changing Trends in India. J Obstet Gynaecol India 2018; 68:214-220. [PMID: 29896002 DOI: 10.1007/s13224-018-1115-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022] Open
Abstract
Introduction Female genital cosmetic surgery (FGCS) is undoubtedly a fast-growing speciality in the world with increasing demand for a variety of procedures to beautify the female genitals. In India, over the last few years, there has been a steady growth in the interest for these procedures. Materials and Methods A variety of FGCS procedures were performed on 76 patients from January 2012 to August 2016. The procedures performed were as follows: vaginal tightening, labia minoraplasty, labia majoraplasty, clitoral hood reduction, and hymenoplasty. Discussion Based on FSFI scores, labia minoraplasty was more valuable as a cosmetic procedure and vaginal tightening was associated with better sexual function after surgery. Conclusion FGCS is no doubt in its infancy in India. However, there is a steady rise in the awareness and demand for these procedures. A combination of procedures to improve individual components leads to improved aesthetic and functional aspects of female genitalia.
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Özer M, Mortimore I, Jansma EP, Mullender MG. Labiaplasty: motivation, techniques, and ethics. Nat Rev Urol 2018; 15:175-189. [DOI: 10.1038/nrurol.2018.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Attitudes Regarding Labial Hypertrophy and Labiaplasty: A Survey of Members of the Society of Gynecologic Surgeons and the North American Society for Pediatric and Adolescent Gynecology. Female Pelvic Med Reconstr Surg 2017; 22:175-9. [PMID: 26825405 DOI: 10.1097/spv.0000000000000239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe gynecologists' attitudes toward labial hypertrophy and explore possible differences among providers for pediatric/adolescent patients. METHODS This was an institutional review board-approved, cross-sectional survey of physician attendees at 2 national meetings in 2014: the Society of Gynecologic Surgeons (SGS) and the North American Society for Pediatric and Adolescent Gynecology (NASPAG). The survey was designed to query demographics and impressions regarding labial hypertrophy and labiaplasty. RESULTS Three hundred sixty-five surveys were completed (response rate, 50%); 268 were analyzed: 55% from SGS and 45% from NASPAG. Most were older than 41 years; 170 (63%) were women, and 93 (35%) were men. More men than women attended SGS (60%); however, women were the majority at NASPAG (94%).Most respondents believed labial hypertrophy to be infrequently reported and "a condition that impacts body image." Common symptoms were "discomfort with exercise" and "dissatisfaction with appearance naked." The majority felt this to impact sexual function "in some cases," citing "self-esteem" and "comfort" most often.Concerning therapies for provided labial hypertrophy, 83% of practitioners provide reassurance, whereas 77% would offer labiaplasty. Expertise with labiaplasty varied; 28% felt "very comfortable," and 11% felt "very uncomfortable."Provider preference for treatment differed based on meeting attendance. After logistic regression controlling for sex and age, attendance at SGS remained associated with offering labiaplasty (P = 0.001; odds ratio, 4.1; 95% confidence interval, 1.8-9.3), whereas NASPAG attendance was associated with providing reassurance (P = 0.008; odds ratio, 0.30; 95% confidence interval, 0.10-0.70). CONCLUSIONS Although the majority surveyed view labial hypertrophy to be bothersome, gynecologists caring for our youngest patients are more likely to provide reassurance. Consensus guidelines are needed to aid practitioners in appropriate management of labial hypertrophy.
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Abstract
BACKGROUND Aging, childbearing, and hormonal changes can lead to vulvovaginal laxity and mucosal atrophy that negatively affect a woman's quality of life. As more minimally and noninvasive options for genital rejuvenation become available in the outpatient setting, it becomes increasingly important for the dermatologic surgeon to be familiar with these popular procedures. OBJECTIVE To familiarize dermatologists with the nonsurgical options available for female genital rejuvenation, patient motivations for pursuing these procedures, relevant anatomy, and potential adverse events. MATERIALS AND METHODS A MEDLINE search was performed on nonsurgical female genital rejuvenation from 1989 to 2015, and results are summarized. RESULTS Reports of nonsurgical female genital rejuvenation procedures using fractional carbon dioxide lasers, nonablative lasers, monopolar radiofrequency devices, hyaluronic acid fillers, and fat transfer are concisely summarized for the practicing dermatologist. CONCLUSION Review of the literature revealed expanding options for nonsurgical female genital rejuvenation.
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Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A, Calligaro A, Elias JA, Gambaciani M, Gaviria JE, Iglesia CB, Selih-Martinec K, Mwesigwa PL, Ogrinc UB, Salvatore S, Scollo P, Zerbinati N, Nelson JS. Light and energy based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers Surg Med 2017; 49:137-159. [PMID: 28220946 DOI: 10.1002/lsm.22637] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 11/09/2022]
Abstract
Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137-159, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yona Tadir
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
| | - Adrian Gaspar
- Department of Laser Surgery, Mendoza Hospital, Mendoza, Argentina
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Macrene Alexiades
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Red Alinsod
- South Coast Urogynecology, Laguna Beach, California
| | - Alex Bader
- Reconstruction & Cosmetic Gynecology, London, UK
| | - Alberto Calligaro
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Jorge A Elias
- Urogynecology and Aesthetic Gynecology Clinic, Boenos Aires, Argentina
| | - Marco Gambaciani
- Department of Obstetrics and Gynecology, University Hospital Pisa, Pisa, Italy
| | - Jorge E Gaviria
- Aesthetics and Laser Medical Educational Center, Korpo Laser, Caracas, Venezuela
| | - Cheryl B Iglesia
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Patricia L Mwesigwa
- Departments of Obstetrics and Gynecology, Georgetown University, Washington, District of Columbia
| | | | - Stefano Salvatore
- Department of Obstetrics and Gynecology, San Raffaele University, Milan, Italy
| | - Paolo Scollo
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy
| | - Nicola Zerbinati
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - John Stuart Nelson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California
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Female genital mutilation: the role of medical professional organizations. Int Urogynecol J 2016; 28:537-541. [PMID: 27858133 DOI: 10.1007/s00192-016-3202-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
Female genital mutilation (FGM) refers to alteration of the external genitalia of girls without medical benefit. It is estimated by United Nations agencies that 200 million living girls and women have been subjected to different forms of FGM worldwide. Despite the criminalization of the procedure in the vast majority of countries where it is practiced, the decline in the incidence of this ritual is far from satisfactory. Immediate and long-term ill effects are well documented. Most publications of relevance originate from countries outside the map of FGM. In addition, there are major gaps in research related to this issue, considering the magnitude of the problem. International medical organizations and societies should assume their responsibility by providing a platform to professionals engaged in the prevention and treatment of the consequences of FGM, especially those living in the communities where the practice is endemic.
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Ampt AJ, Roach V, Roberts CL. Vulvoplasty in New South Wales, 2001–2013: a population‐based record linkage study. Med J Aust 2016; 205:365-369. [DOI: 10.5694/mja16.00512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/15/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Vijay Roach
- Royal North Shore Hospital, Sydney, NSW
- North Shore Private Hospital, Sydney, NSW
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Sharp G, Tiggemann M, Mattiske J. Factors That Influence the Decision to Undergo Labiaplasty: Media, Relationships, and Psychological Well-Being. Aesthet Surg J 2016; 36:469-78. [PMID: 26893523 DOI: 10.1093/asj/sjv270] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An increasing number of women are undergoing labiaplasty procedures; however, very little is known about the psychological factors that motivate women to seek out this procedure. OBJECTIVES To investigate the factors that influence women's decisions to undergo labiaplasty. METHODS Women seeking to undergo labiaplasty (n = 35) were compared with women who were not (n = 30). Standardized measures were employed to assess the patients' media exposure (television, the Internet, advertising, pornography), relationship quality, and psychological well-being. RESULTS Women's motivations for deciding to undergo a labiaplasty procedure were characterized as "appearance," "functional," "sexual," or "psychological" motivations, with concerns about the labia's appearance being the most commonly reported motivation. Correspondingly, women seeking labiaplasty were significantly less satisfied with the appearance of their genitals than the comparison group (P < .001). These women had also experienced greater exposure to images of female genitalia on the Internet (P = .004) and in advertisements (P = .021), and had internalized these images to a greater extent (P = .010). There were no differences between the two groups on the measures of relationship quality. However, significantly fewer of the women seeking to undergo a labiaplasty procedure were involved in a romantic relationship at the time of the study (P = .039). There were also no differences between the two groups on the measures of psychological well-being, except that women seeking to undergo labiaplasty were less satisfied with their lives overall (P = .027). CONCLUSIONS The findings identified media exposure and relationship status as important factors that influence women's decisions to undergo labiaplasty. LEVEL OF EVIDENCE 3 Risk.
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Affiliation(s)
- Gemma Sharp
- From the School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Marika Tiggemann
- From the School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Julie Mattiske
- From the School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Sharp G, Tiggemann M. Educating women about normal female genital appearance variation. Body Image 2016; 16:70-8. [PMID: 26723015 DOI: 10.1016/j.bodyim.2015.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 11/24/2022]
Abstract
The study investigated the effectiveness of two online resources aimed at improving women's knowledge of the variation in normal female genital appearance and their attitudes towards their own genitals. The first consisted of a photographic array of normal female genitals and the second consisted of a video addressing digital airbrushing of women's genitals in media images. A sample of 136 female undergraduate students were randomly assigned to view the photographs, video, both the photographs and video, or neither. The video significantly increased women's perceptions of genital appearance diversity as well as awareness of digital airbrushing of genital images. Owing to relatively low levels of genital appearance concern, there was no effect of either resource on women's attitudes towards their own genitals; however, women who viewed the video indicated they would pass on their knowledge to help other women. Our results suggest that an educational video could be a useful tool.
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Affiliation(s)
- Gemma Sharp
- School of Psychology, Flinders University, Adelaide, South Australia 5001, Australia.
| | - Marika Tiggemann
- School of Psychology, Flinders University, Adelaide, South Australia 5001, Australia.
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Mowat H, McDonald K, Dobson AS, Fisher J, Kirkman M. The contribution of online content to the promotion and normalisation of female genital cosmetic surgery: a systematic review of the literature. BMC Womens Health 2015; 15:110. [PMID: 26608568 PMCID: PMC4660671 DOI: 10.1186/s12905-015-0271-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women considering female genital cosmetic surgery (FGCS) are likely to use the internet as a key source of information during the decision-making process. The aim of this systematic review was to determine what is known about the role of the internet in the promotion and normalisation of female genital cosmetic surgery and to identify areas for future research. METHODS Eight social science, medical, and communication databases and Google Scholar were searched for peer-reviewed papers published in English. Results from all papers were analysed to identify recurring and unique themes. RESULTS Five papers met inclusion criteria. Three of the papers reported investigations of website content of FGCS providers, a fourth compared motivations for labiaplasty publicised on provider websites with those disclosed by women in online communities, and the fifth analysed visual depictions of female genitalia in online pornography. Analysis yielded five significant and interrelated patterns of representation, each functioning to promote and normalise the practice of FGCS: pathologisation of genital diversity; female genital appearance as important to wellbeing; characteristics of women's genitals are important for sex life; female body as degenerative and improvable through surgery; and FGCS as safe, easy, and effective. A significant gap was identified in the literature: the ways in which user-generated content might function to perpetuate, challenge, or subvert the normative discourses prevalent in online pornography and surgical websites. CONCLUSIONS Further research is needed to contribute to knowledge of the role played by the internet in the promotion and normalisation of female genital cosmetic surgery.
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Affiliation(s)
- Hayley Mowat
- Jean Hailes Research Unit, Monash University, Melbourne, Australia.
| | - Karalyn McDonald
- Jean Hailes Research Unit, Monash University, Melbourne, Australia.
| | - Amy Shields Dobson
- Institute for Advanced Studies in the Humanities, University of Queensland, Brisbane, Australia.
| | - Jane Fisher
- Jean Hailes Research Unit, Monash University, Melbourne, Australia.
| | - Maggie Kirkman
- Jean Hailes Research Unit, Monash University, Melbourne, Australia.
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Lee JB, Choi SY. [Effects of Electric Stimulation and Biofeedback for Pelvic Floor Muscle Exercise in Women with Vaginal Rejuvenation Women]. J Korean Acad Nurs 2015; 45:713-22. [PMID: 26582116 DOI: 10.4040/jkan.2015.45.5.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/05/2015] [Accepted: 06/24/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of pelvic floor muscle exercise using electric stimulation and biofeedback on maximum pressure of vaginal contraction, vaginal contraction duration and sexual function in women who have had vaginal rejuvenation. METHODS The research design was a non-equivalent control group non-synchronized design study. Participants in this study were women who had vaginal rejuvenation at C obstetrics and gynecology hospital. The 15 participants in the experimental group were given pelvic floor muscle exercise using electric stimulation and biofeedback and the 15 participants in the control group received self pelvic floor muscle exercise. RESULTS For maximum pressure of vaginal contraction, the experimental group showed a statistically significant increase compared to than the control group (t=5.96, p<.001). For vaginal contraction duration, the experimental group also showed a statistically significant increase compared to the control group (t=3.23, p=.003). For women's sexual function, the experimental group showed a significant increase when compared to the control group in total sexual function scores (t=3.41, p=.002). CONCLUSION The results indicate that pelvic floor muscle exercise with electric stimulation and biofeedback after vaginal rejuvenation is effective in strengthening vaginal contraction pressure, vaginal contraction and that it also positively functions to increase women's sexual function.
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Affiliation(s)
| | - So Young Choi
- College of Nursing · Institute of Health Science, Gyeongsang National University, Jinju, Korea.
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Lista F, Mistry BD, Singh Y, Ahmad J. The Safety of Aesthetic Labiaplasty: A Plastic Surgery Experience. Aesthet Surg J 2015; 35:689-95. [PMID: 26082092 DOI: 10.1093/asj/sjv002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The demand for female aesthetic labiaplasty surgery continues to rapidly increase. Several questions have been raised regarding the safety and effectiveness of female aesthetic genital surgery. OBJECTIVES The purpose of this study is to review our experience with aesthetic labiaplasty and describe the type and frequency of complications that have been experienced. METHODS A retrospective chart review was performed on all patients who had primary aesthetic labia minora reduction surgery from August 2007 to April 2014. A chart review of the electronic medical record was performed to examine demographic, procedural, and outcome data. RESULTS In the study period, 113 patients underwent aesthetic labiaplasty. Of these, 29 patients (25.6%) had labiaplasty performed in combination with another procedure. A total of 15 patients (13.3%) reported transient symptoms, including swelling, bruising, and pain. There was one patient (0.8%) that experienced bleeding. Four patients (3.5%) required revision surgery. All revisions were performed to excise further tissue to address persistent redundancy or asymmetry. No major complications were reported. CONCLUSIONS In our experience, aesthetic surgery of the labia minora using an edge excision technique has a very low complication rate and provides satisfactory aesthetic outcomes for our patients. More studies examining the impact of labiaplasty on a woman's self-image and quality of life would add to our understanding of the motivations and expectations of women undergoing this aesthetic surgery. This information will allow us to help our patients make well-informed decisions when considering this aesthetic genital surgery. LEVEL OF EVIDENCE 4 Risk.
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Affiliation(s)
- Frank Lista
- Dr Lista is an Assistant Professor and Dr Ahmad is a Lecturer, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada. Mr Mistry is a Medical Student in the Faculty of Medicine, University of British Columbia, Vancouver, Canada. Ms Singh is a Medical Student in the School of Medicine at the Royal College of Surgeons in Ireland, Dublin
| | - Bhavik D Mistry
- Dr Lista is an Assistant Professor and Dr Ahmad is a Lecturer, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada. Mr Mistry is a Medical Student in the Faculty of Medicine, University of British Columbia, Vancouver, Canada. Ms Singh is a Medical Student in the School of Medicine at the Royal College of Surgeons in Ireland, Dublin
| | - Yashoda Singh
- Dr Lista is an Assistant Professor and Dr Ahmad is a Lecturer, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada. Mr Mistry is a Medical Student in the Faculty of Medicine, University of British Columbia, Vancouver, Canada. Ms Singh is a Medical Student in the School of Medicine at the Royal College of Surgeons in Ireland, Dublin
| | - Jamil Ahmad
- Dr Lista is an Assistant Professor and Dr Ahmad is a Lecturer, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada. Mr Mistry is a Medical Student in the Faculty of Medicine, University of British Columbia, Vancouver, Canada. Ms Singh is a Medical Student in the School of Medicine at the Royal College of Surgeons in Ireland, Dublin
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40
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Oranges CM, Sisti A, Sisti G. Labia minora reduction techniques: a comprehensive literature review. Aesthet Surg J 2015; 35:419-31. [PMID: 25908699 DOI: 10.1093/asj/sjv023] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Many studies of techniques to reduce the labia minora have been published in recent decades, including case reports and retrospective case series. However, to date, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques. OBJECTIVES The authors performed a comprehensive literature review to determine outcomes and complications of labiaplasty techniques, including patient satisfaction. METHODS A search on PubMed/Medline was performed with the keywords labiaplasty, labioplasty, labial hypertrophy, and techniques plus labia minora reduction. The inclusion criterion was clinical studies in which techniques of labia minora reduction were described. Excluded from the study were publications not dealing with surgical procedures and review articles. RESULTS Thirty-eight studies, published from 1971 through 2014, were included; this represented 1981 treated patients. Eight labiaplasty techniques were identified from these studies: edge resection, wedge resection, deepithelialization, W-plasty, laser labiaplasty, custom flask, fenestration, and composite reduction. Satisfactory results, judged from clinical examination, were observed with all 8 techniques. Few postoperative complications occurred. In a small number of cases, complications required surgical revision or secondary resection. CONCLUSIONS All 8 labiaplasty techniques resulted in good outcomes, including high patient satisfaction and low morbidity.
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Affiliation(s)
- Carlo Maria Oranges
- Dr Oranges is a Resident in the Plastic, Reconstructive and Aesthetic Surgery School, Marche Polytechnic University, Ancona, Italy. Dr A. Sisti is a Resident in the General and Specialist Surgery Department, Plastic Surgery Division, University of Siena, Siena, Italy. Dr G. Sisti is a Resident in the Department of Science for Woman and Child Health, University of Florence, Florence, Italy
| | - Andrea Sisti
- Dr Oranges is a Resident in the Plastic, Reconstructive and Aesthetic Surgery School, Marche Polytechnic University, Ancona, Italy. Dr A. Sisti is a Resident in the General and Specialist Surgery Department, Plastic Surgery Division, University of Siena, Siena, Italy. Dr G. Sisti is a Resident in the Department of Science for Woman and Child Health, University of Florence, Florence, Italy
| | - Giovanni Sisti
- Dr Oranges is a Resident in the Plastic, Reconstructive and Aesthetic Surgery School, Marche Polytechnic University, Ancona, Italy. Dr A. Sisti is a Resident in the General and Specialist Surgery Department, Plastic Surgery Division, University of Siena, Siena, Italy. Dr G. Sisti is a Resident in the Department of Science for Woman and Child Health, University of Florence, Florence, Italy
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Schober JM, Alguacil NM, Cooper RS, Pfaff DW, Meyer-Bahlburg HF. Self-assessment of anatomy, sexual sensitivity, and function of the labia and vagina. Clin Anat 2015; 28:355-62. [DOI: 10.1002/ca.22503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/11/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Justine M. Schober
- Pediatric Urology, UPMC Hamot; Erie Pennsylvania
- Pfaff Laboratory of Neurobiology and Behavior, Rockefeller University; New York New York
| | - Nieves Martin Alguacil
- Pfaff Laboratory of Neurobiology and Behavior, Rockefeller University; New York New York
- Department of Anatomy and Embryology; School of Veterinary Medicine, Universidad Complutense de Madrid; Spain
| | - R. Scott Cooper
- Lake Erie College of Osteopathic Medicine; Erie Pennsylvania
| | - Donald W. Pfaff
- Pfaff Laboratory of Neurobiology and Behavior, Rockefeller University; New York New York
| | - Heino F.L. Meyer-Bahlburg
- NYS Psychiatric Institute/Department of Psychiatry; College of Physicians and Surgeons of Columbia University; New York New York
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42
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Laser vaginal rejuvenation: not ready for prime time. Int Urogynecol J 2014; 26:163-4. [PMID: 25477142 DOI: 10.1007/s00192-014-2588-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
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Abstract
Our study investigated predictors of consideration of labiaplasty (the surgical reduction of the labia) using a sociocultural framework. A sample of 351 heterosexual adult Australian women aged 18–69 years completed measures of media exposure, peer influence, relationship quality, internalisation of the genital ideal, genital appearance comparison, genital appearance dissatisfaction, and consideration of labiaplasty. Almost all predictor variables were significantly correlated with consideration of labiaplasty. A structural equation model based on the Tripartite Influence Model focused on beauty ideals showed a good level of fit to the data: The effects of media exposure and peer influence on genital appearance dissatisfaction and consideration of labiaplasty were mediated by internalisation of the genital ideal and genital appearance comparison. We concluded that media exposure, peer influence, and relationship quality influenced consideration of labiaplasty both directly and indirectly. The results contribute to a greater understanding of the sociocultural motivations behind labiaplasty and also demonstrate an important extension of the Tripartite Influence Model beyond the explanation of disordered eating behaviours to the consideration of a specific form of cosmetic surgery. The development of media literacy programmes may be beneficial in addressing genital appearance concerns in young girls.
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Affiliation(s)
- Gemma Sharp
- School of Psychology, Flinders University, Adelaide, Australia
| | | | - Julie Mattiske
- School of Psychology, Flinders University, Adelaide, Australia
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Most women who undergo labiaplasty have normal anatomy; we should not perform labiaplasty. Am J Obstet Gynecol 2014; 211:218-218.e1. [PMID: 25168066 DOI: 10.1016/j.ajog.2014.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 11/21/2022]
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45
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Placik OJ, Arkins JP. Plastic surgery trends parallel Playboy magazine: the pudenda preoccupation. Aesthet Surg J 2014; 34:1083-90. [PMID: 25168807 DOI: 10.1177/1090820x14543514] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Aesthetic vulvovaginal procedures are being performed with increased frequency. Many experts have suggested that the growing demand for these procedures relates to the availability and revealing nature of nude images on the Internet and in other media. OBJECTIVES The authors examined chronologically organized nude photographs from a popular magazine and objectively measured the position of the vulva relative to the center of focus to observe trends for the past 6 decades. METHODS Playboy magazine centerfold photographs from 1954 to 2013 were analyzed and categorized. The positions of the vaginal area (V-line) and the breast area (N-line) were measured in relation to the horizontal midline of the photograph. Images also were assessed for degree of grooming and exposure of the breast and pubic areas, as well as visibility of the pudendal cleft, labia majora, and labia minora. RESULTS Four hundred ninety images met inclusion criteria for the analysis. Full exposure of the V-line increased from 0 instances in the 1950s to 78.6% of images from 2010 through 2013 (P<.001). Moreover, the V-line position became 41.0% closer to the photographic midline (P=.045). CONCLUSIONS The results demonstrate a trend toward increased visibility and prominence of the female genitalia as the focal point of popular nude photographs.
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Affiliation(s)
- Otto J Placik
- Dr Placik is an Assistant Professor of Clinical Surgery-Plastic, Northwestern University Feinberg School of Medicine, Chicago, IllinoisMr Arkins is a clinical researcher at a private plastic surgery practice in Arlington Heights, Illinois
| | - John P Arkins
- Dr Placik is an Assistant Professor of Clinical Surgery-Plastic, Northwestern University Feinberg School of Medicine, Chicago, IllinoisMr Arkins is a clinical researcher at a private plastic surgery practice in Arlington Heights, Illinois
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46
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Pauls RN. We are the correct physicians to treat women requesting labiaplasty. Am J Obstet Gynecol 2014; 211:218-218.e1. [PMID: 25168065 DOI: 10.1016/j.ajog.2014.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/05/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Rachel N Pauls
- Division of Urogynecology and Reconstructive Pelvic Surgery, Women's Center for Specialized Care, TriHealth Good Samaritan Hospital, Cincinnati, OH
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47
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48
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Park TH, Park HJ, Whang KW. Functional vaginal rejuvenation with elastic silicone threads: a 4-year experience with 180 patients. J Plast Surg Hand Surg 2014; 49:36-9. [PMID: 25141944 DOI: 10.3109/2000656x.2014.944187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, there has been growing interest in female genital plastic surgery. To the authors' knowledge, no studies have adopted elastic silicone thread for vaginal rejuvenation. This study introduces clinical experience over 4 years with vaginal rejuvenation using elastic silicone thread to specifically assess the overall patient satisfaction (sexual function and correction of the vaginal width). It is hypothesised that this novel surgical method can improve sexual function. Between 2007-2011, 180 patients underwent vaginal rejuvenation using elastic silicone thread performed by the authors at a single institution. Patients with persistent feeling of a wide vagina and/or a decreased ability to reach orgasm were included. Patients were excluded from the study if they were unavailable for follow-up, or if they had been diagnosed with any gynecologic diseases. To measure the 15 degree of improvement with regard to sexual function, this study adopted the validated system; Female Sexual Function Index (FSFI). 92.8% (167/180) of the patients were satisfied with outcome with regard to feelings of correction of vaginal width. Vaginal rejuvenation using elastic silicone thread significantly improved postoperative outcomes, resulting in improved sexual function, with a focus on improving the FSFI score. This is especially prominent in FSFI orgasm subscore. However, a prospective multicentre study would be beneficial to provide patients with the best possible management.
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Affiliation(s)
- Tae Hwan Park
- Buleun Health Care Center , Incheon , Republic of Korea
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Duan Y, Zhang L, Li S, Yang Y, Xing J, Li W, Wang X, Zhou Y. Polyacrylamide hydrogel pulmonary embolism--A fatal consequence of an illegal cosmetic vaginal tightening procedure: A case report. Forensic Sci Int 2014; 238:e6-e10. [PMID: 24656776 DOI: 10.1016/j.forsciint.2014.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/14/2014] [Accepted: 02/18/2014] [Indexed: 12/15/2022]
Abstract
Vaginal tightening is a kind of esthetic surgery aimed at enhancing sexual satisfaction during intercourse. Although the injective vaginal tightening procedure is informal, there are already some reports of its application. But pulmonary embolism is a really rare therapeutic complication of this procedure. We report a case of death due to the non-thrombotic pulmonary embolism as a consequence of illegal cosmetic vaginal-tightening procedure using polyacrylamide hydrogel. A 34-year-old woman was hospitalized with paroxysmal abdominal cramps and diarrhea as initial symptoms, while she concealed the genital cosmetic surgery history. Respiratory distress presented only 1.5h before she died. The result of autopsy revealed the cause of death as pulmonary embolism due to the hydrogel which was injected into her vaginal wall. The emboli were confirmed as polyacrylamide hydrogel by Alcian-blue stain and the Fourier transform infrared scanning. It is suggested that pulmonary embolism should not be discarded in the expertise of deaths following cosmetic implant surgeries. It broadens our understanding about death associated with esthetic genital procedures and informs clinicians and medical examiners of the potential death of this type. And detailed investigations of previous medical and surgical history will always play a critical role in the certification of cause of death.
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Affiliation(s)
- Yijie Duan
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Lin Zhang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Shangxun Li
- Department of Public Security of Hubei Province, No.181 Xiongchu Avenue, Wuhan, 430070, PR China.
| | - Yi Yang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Jingjun Xing
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Wenhe Li
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Xinmei Wang
- Central Hospital of Zibo, No. 54 Gongqingtuan West Road, Zibo, 255036, PR China.
| | - Yiwu Zhou
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
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