Outcomes of labiaplasty in women with labial hypertrophy

Motivational Factors for Labiaplasty: A Systematic Review of Medical Research

Background/Objectives: Labiaplasty is an increasingly popular female genital plastic surgery; however, the motivational factors for women who undergo this procedure are controversial and not fully understood. This review aims to analyze the current medical research addressing the motivational factors behind the increasing prevalence of this procedure. Methods: Included studies met the following components: Population (women of any age who have undergone labiaplasty), Exposure of Interest (labiaplasty), and Outcome (motivational factors). The following databases were screened to identify relevant studies: PubMed, Scopus, and Web of Science, using the search strategy (Motivation OR Rationale OR Motive OR Reason OR Incentive) AND Labiaplasty. After analyzing the retrieved studies (n = 221), two studies (n = 2) strictly met the established eligibility criteria and were included in the results section. One additional study was incorporated after reviewing the reference lists of eligible studies. Results: The observed motivations for labiaplasty included purely aesthetic reasons, purely functional impairment, and a combination of both. However, when both factors were considered, functional impairment was typically identified as the primary reason, while concerns about appearance were considered secondary. From a more concrete perspective, it has been noted that negative comments and experiences contribute to the distress surrounding labial appearance. Conclusions: The majority of patients undergoing labiaplasty do so for a combination of functional impairment and aesthetic reasons. These motivations may be influenced by external factors. Additionally, there is a scarcity of studies focusing solely on women who have undergone labiaplasty within the broader context of genital cosmetic surgeries.

Long-term Functional and Aesthetic Outcomes of Labiaplasty: A Review of the Literature

The incidence of female genital cosmetic surgery (FGCS), and specifically labiaplasty, is on the rise. Common motivators for labiaplasty include hygiene concerns, functional impairment, difficulties with physical or sexual activity, and dissatisfaction with genital appearance, among others. However, there have been few reports on long-term functional and aesthetic outcomes and complications of labiaplasty. The aim of this literature review was to report on long-term outcomes of labiaplasty, defined as ≥1 year postoperatively, to inform safety and efficacy recommendations for the procedure. A comprehensive literature review was conducted on PubMed (National Institutes of Health, Bethesda, MD) and Embase (Elsevier, Amsterdam, the Netherlands) from inception to December 1, 2023, following PRISMA guidelines. Articles were selected according to predetermined eligibility criteria. A manual search was performed to identify additional relevant studies. Nine studies reported on the long-term postoperative complications associated with labiaplasty, with a cumulative total of 748 patients. The most commonly reported complications included postoperative asymmetry (n = 45, 6.02%), scarring (n = 14, 1.87%), and the need for revisional surgery (n = 42, 5.61%). Of note, the majority of patients (n = 621 of 748) were reported to not have any postoperative complications. In the 7 studies that reported on psychological outcomes associated with labiaplasty, all reported sustained improvement in genital appearance scores as well as aesthetic and sexual satisfaction over the long term.

LEVEL OF EVIDENCE: 3 (THERAPEUTIC)

Comprehensive Assessment of Labiaplasty Techniques and Tools, Satisfaction Rates, and Risk Factors: A Systematic Review and Meta-analysis

BACKGROUND

Various surgical techniques have been devised for the surgical cosmetic enhancement of female outer genitalia. The selection of an optimal method should be based on satisfaction rates and safety; however, comprehensive, contemporary systematic assessment of these factors has been limited in the literature.

OBJECTIVES

Our aim was to conduct a comprehensive systematic review and meta-analysis to evaluate the overall satisfaction rates and risk factors associated with various labiaplasty techniques and tools.

METHODS

The authors performed a systematic literature search in 3 medical databases: PubMed, Elsevier, and Cochrane (Central) with the closing date of October 2023. Original articles with quantitative satisfaction rates and frequencies of the most common complications (hematoma, dehiscence, swelling, bleeding, and infection) were included.

RESULTS

Systematic search provided a total of 3954 records. After selection and review of the articles, 86 eligible, peer-reviewed studies were identified, of which 53 provided quantitative data. High overall satisfaction rate was found for all methods (proportion [prop] 94%; confidence interval [CI] 93%-95%), with highest satisfaction for deepithelialization (prop 97%; CI, 85%-99%). Complications were generally rare, with elevated incidences for some techniques (wedge resection: dehiscence, prop, 8%, CI 5%-13%; and composite reduction: swelling, prop 13%, CI 2%-54%). Scalpel technique had significantly higher incidence of complications than laser, namely for bleeding, swelling, and hematoma.

CONCLUSIONS

Labiaplasty can be considered a generally effective approach to outer female genitalia beautification, with low associated risks. Surgeons must tailor their approach to the patients' needs and anatomy to achieve maximal satisfaction, given the differences in the frequency of complications for each method.

LEVEL OF EVIDENCE: 3

Labiaplasty in Asian women: Motivation, technique feasibility, and patient reported outcomes

Labiaplasty is an increasingly popular aesthetic procedure. However, there is a lack of information regarding different surgical procedures and Asian patients' motivations and outcomes. This study aimed to understand patients' motivations for seeking labiaplasty and to examine surgical outcomes of different procedures. This retrospective study enroled patients between August 2016 and May 2021. Patient demographics, surgical procedures, complications, and revision surgeries were reviewed. Responses to questionnaires regarding patient motivations for undergoing labiaplasty, pre- and postoperative discomfort and aesthetics, Rosen's Self-Esteem Scale (RSES) scores, and Female Genital Self-Image Scale (FGSIS) scores were recorded. One hundred thirty-one patients were included, with an average age of 30.3 ± 7.78 years. Eighty-seven (66.4%) patients underwent bilateral labiaplasty, and 44 (33.6%) underwent unilateral labiaplasty. The surgical techniques included 61 (46.6%) direct resections, 50 (38.2%) wedge resections, and 20 (15.3%) "hockey stick" procedures. Wound dehiscence occurred in 37 (28.2%) patients. A significant increase in complications occurred after the hockey stick procedure and wedge resection. Patients' motivation for surgery included aesthetic reasons in 62.0%, symptom relief in 91.5%, and repeated infection in 4.2%. There was a significant difference between pre- and postoperative genital aesthetics (p 0.001) and discomfort symptoms (p 0.001). The average RSES score was 19.68 ± 4.03, and the average FGSIS score was 20.77 ± 3.20. Pain and discomfort remained the most important motivations for Asian women to seek labiaplasty, followed by aesthetic reasons. With good preoperative consultation and surgical planning, satisfaction can be achieved concerning functional and aesthetic aspects.

The Effect of Female Genital Cosmetic and Reconstructive Procedures on Body and Genital Self-Image: A Systematic Review and Meta-Analysis

Performance of female genital cosmetic and reconstructive procedures (FGCRP) has been increasing over past decades. Appearance and functional concerns are the most common reasons for seeking FGCRP. Poor body and genital self-image may contribute to the increase in demand for surgery. The aim of this systematic review is to explore outcomes of FGCRP in the domains of body and genital self-image. A systematic literature review of PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library was conducted to identify articles that measured body and genital self-image in females after FGCRP. The authors identified 5 articles for a systematic review of body image and 8 studies for a systematic review of genital self-image. The most common procedure performed was labia minora labiaplasty. Instruments for body image evaluation were the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder and the Body Image Quality of Life Inventory. Genital image was assessed with the Female Genital Self-Image Scale and Genital Appearance Satisfaction (GAS) scale. Most of the studies indicated that FGCRP can improve both body image and genital self-image; meta-analysis revealed that FGCRP improved GAS scores by 17.96 (range: 0-33; P < .001). It appears that FGCRP leads to improvements in females' body and genital self-image. Inconsistencies in study design and measures, however, limit this conclusion. Future research should involve more rigorous study designs (for example randomized clinical trials with large sample sizes) for a more accurate assessment of FGCRP's consequences.

LEVEL OF EVIDENCE: 4

Joint Report on Terminology for Cosmetic Gynecology

INTRODUCTION AND HYPOTHESIS

The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties.

METHODS

This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus.

RESULTS

A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field.

CONCLUSIONS

A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.

Joint Report on Terminology for Cosmetic Gynecology

INTRODUCTION AND HYPOTHESIS

The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties.

METHODS

This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus.

RESULTS

A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field.

CONCLUSIONS

A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.

Developing Core Outcome Sets (COS) and Core Outcome Measures Sets (COMS) in Cosmetic Gynecological Interventions: Protocol for a Development and Usability Study

Background

Studies evaluating cosmetic gynecological interventions have followed variable methodology and reported a diversity of outcomes. Such variations limit the comparability of studies and the value of research-based evidence. The development of core outcome sets (COS) and core outcome measures sets (COMS) would help address these issues, ensuring a minimum of outcomes important to all stakeholders, primarily women requesting or having experienced cosmetic gynecological interventions.

Objective

This protocol describes the methods used in developing a COS and COMS for cosmetic gynecological interventions.

Methods

An international steering group within CHORUS, including health care professionals, researchers, and women with experience in cosmetic gynecological interventions from 4 continents, will guide the development of COS and COMS. Potential outcome measures and outcomes will be identified through comprehensive literature reviews. These potential COS and COMS will be entered into an international, multi-perspective web-based Delphi survey where Delphi participants judge which domains will be core. A priori thresholds for consensus will get established before each Delphi round. The Delphi survey results will be evaluated quantitatively and qualitatively in subsequent stakeholder group consensus meetings in the process of establishing “core” outcomes.

Results

Dissemination and implementation of the resulting COS and COMS within an international context will be promoted and reviewed.

Conclusions

This protocol presents the steps in developing a COS and COMS for cosmetic gynecological interventions. Embedding the COS and COMS for cosmetic gynecological interventions within future clinical trials, systematic reviews, and practice guidelines could contribute to enhancing the value of research and improving overall patient care.

Trial Registration

Core Outcome Measures in Effectiveness Trials (COMET) 1592; https://tinyurl.com/n8faysuh

International Registered Report Identifier (IRRID)

PRR1-10.2196/28032