We are the correct physicians to treat women requesting labiaplasty

"Normal vulva" based on the first national Labiagram design in adult Iranian women not seeking female genital cosmetic surgery: a pilot study

Background

Several studies have been published to present normal values of female genitalia in different age and racial groups.

Aim

The primary objective of our study was to measure the parameters of the external genitalia in adult Iranian women, record the data using the Labiagram system (the first national Labiagram design in Iran), and establish a preliminary database.

Methods

A descriptive study was conducted from March 2022 to December 2022, involving 220 nonpregnant adult women who presented to the gynecology clinic. Women who met the inclusion criteria for the study underwent a comprehensive examination of the external genitalia. The data collected during the examinations were recorded in electronic files and the Labiagram system.

Outcomes

The data showed the diversity of external genital parameters of nonpregnant adult Iranian women.

Results

In this descriptive study, the mean ± SD age of the participants was 51.5 ± 13.44 years, ranging from 15 to 84 years. A total of 192 women (87.3%) had a history of vaginal delivery. There was no statistically significant difference observed in the average measurements of the vulva among the 4 age groups (P < .05). The Pearson correlation coefficient test indicated a statistically weak correlation between body mass index and perineum length (r = 0.174, P = .010). Additionally, a weak correlation was found between body mass index and the width of the labia minora at the left-lower point (r = 0.143, P = .030) and the right-middle point (r = 0.146, P = .031). Furthermore, the results demonstrated that women with a history of vaginal delivery had a significantly longer introitus (49.3 vs 44.3 mm, P = .037), longer labia majora (91.3 vs 87.3 mm, P = .046), and longer labia minora (56.8 vs 50.9 mm, P = .008) when compared with women without prior labor experience.

Clinical Implications

The data will be used as a basis for future studies.

Strengths and Limitations

The use of simple tools for the measuring, data recording, and digital drawing of female external genital anatomy, along with privacy protection, is one of the strengths of this research. The weakness is the small sample size, which is the reason for piloting the Labiagram chart for more extensive studies.

Conclusion

Increasing age and the number of births had no statistically significant effect on the size of external genital parameters among Iranian women. Despite the considerable diversity in these parameters, it has not resulted in a significant demand among Iranian women for female cosmetic surgery.

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.

Outcomes of labiaplasty in women with labial hypertrophy

INTRODUCTION AND HYPOTHESIS

High-quality data are lacking to understand outcomes in women who undergo labiaplasty for labial hypertrophy and whether there is an association with body dismorphic disorder (BDD).

METHODS

This was a cross-sectional study of a retrospective cohort of women who underwent labiaplasty for labial hypertrophy at a tertiary care referral center. Women were identified by CPT codes and were included if the procedure was performed by a urogynecologist. The health record was queried for demographic, pre-, intra-, and postoperative data. For the cross-sectional component of the study, participants were contacted to complete a survey.

RESULTS

Thirty-six women met study inclusion criteria; 21 participated in the survey, and retrospective data were available for 20. At the time of labiaplasty, the women had a mean age of 30 ± 12 years and mean BMI of 23.9 ± 4.4 kg/m². The most common preoperative motivation for undergoing labiaplasty, based on the medical record, was pain (85.0% 17/20). Complications were uncommon and minor. No women met criteria for BDD. Participant survey-reported primary motivation for undergoing partial simple vulvectomy was "pinching" in 10 (47.6%), "pain" in 4 (19.0%), and "appearance" in 7 (33.3%). The majority of women reported that labiaplasty achieved their preoperative goal (20/21, 95.2%).

CONCLUSIONS

Women who underwent labiaplasty were primarily motivated by functional concerns, and outcomes indicate a high satisfaction with genital appearance postoperatively as well as a positive effect on body image and quality of life. We recommend that surgeons work to understand what motivates women to pursue surgical intervention by asking about cosmetic concerns.

Individualized Surgical Treatment of Different Types of Labia Minora Hypertrophy

Objective To explore an optimal surgical approach for different types of labia minora hypertrophy and to design a better personalized surgical treatment plan for patients. Methods Forty-five patients with labia minora treated in our department from January 2014 to January 2019 were the study participants. Depending upon the appearance of the labia minora, they were divided into length labia minora hypertrophy, width labia minora hypertrophy, overall labia minora hypertrophy, and labia hypertrophy combined with clitoris foreskin. By combining the characteristics of the patient's labia minora hypertrophy and the aesthetic requirements for postoperative appearance, we designed a personalized treatment plan for each group of patients. The surgical approaches include upper pedicle flap wedge resection, upper and lower pedicle flap similar to wedge resection, lower pedicle flap pedicle wedge resection, and labia minora combined with clitoris foreskin surgery. We followed up the postoperative results, recovery, and complication rates for a period of 3 months. Results All patients who underwent surgery had good wound healing. The labia minora had good bilateral symmetry, moderate size, and desired appearance. The scar of the surgical incision was also not obvious. The postoperative labia minora felt normal without any serious complications. Overall, the treatment effect was satisfactory. Conclusion There are many surgical methods for the reduction in the labia minora. Our findings suggest that in order to achieve better results, a personalized surgical plan should be designed considering the patient's unique type of hypertrophy and the individual aesthetic requirements. 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.

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

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.

Labia minora reduction techniques: a comprehensive literature review

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.