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Background: Labiaplasty, a surgical procedure designed to address labia minora hypertrophy, has been closely linked to the improvement of genital self-image and the alleviation of symptoms related to body dysmorphic disorder (BDD). Brazil stands as the global leader in the prevalence of labiaplasty procedures. This study aimed to assess alterations in genital self-image and symptoms of BDD in individuals with labia minora hypertrophy who underwent either wedge or trim labiaplasty., Methods: A total of 48 adult women undergoing labiaplasty were enrolled in this randomized clinical trial with 2 parallel groups. The allocation ratio was 1:1. The study group underwent wedge labiaplasty, and the control group underwent trim labiaplasty. Genital self-image and symptoms of BDD were assessed both preoperatively and 6 months postoperatively, using validated tools., Results: After a 6-month intervention period, a statistically significant improvement in genital self-image was observed ( P < 0.001), alongside a marked decrease in the score of symptoms related to BDD ( P < 0.001). There were no significant differences in outcomes between the groups. Furthermore, no statistically significant associations were noted between complications and the specific technique used., Conclusions: The study findings underscore the noteworthy improvement in genital self-image and a concurrent reduction in symptoms of BDD, evident in both the wedge and linear labiaplasty groups at the 6-month postoperative assessments. These results suggest that the choice of surgical technique does not significantly impact these outcomes., Clinical Question/level of Evidence: Therapeutic, I., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Background: The primary reasons for labiaplasty usually revolve around aesthetic, sexual, and functional concerns. Upon delving deeper into these issues, it becomes apparent that sexual partners play a controversial role in influencing women's decisions to undergo surgery., Aim: This study aimed to investigate the impact of sexual partners on women's choices to pursue labiaplasty., Methods: A comprehensive search was conducted across electronic databases covering the period from January 2000 to February 2024. After removing duplicates, a total of 931 articles were retrieved by searching keywords in titles and abstracts., Outcomes: The meta-analysis revealed that 36.7% of women who sought labiaplasty cited their partners' negative comments as a factor influencing their decision., Results: After applying the eligibility criteria and excluding irrelevant articles, a total of 12 articles involving 962 participants were included in the analysis. With the exception of 2 articles, the majority of the studies suggested a discernible influence of male partners on women's decisions to seek labiaplasty. Frequently, sexual partners are not the primary decision makers, nor do they exert significant pressure when it comes to seeking labiaplasty. In certain instances, women seeking labiaplasty acknowledged that their sexual partners did influence their decisions, either by making disparaging comments about their genitalia or by directly pressuring or requesting them to undergo labiaplasty. Additionally, women might opt for labiaplasty out of fear of their partner's negative remarks or to enhance sexual pleasure for their partners. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity., Clinical Implications: The findings of this study can be applied in prelabiaplasty counseling sessions to acknowledge and explore the role of the sexual partner in women's decision making., Strengths and Limitations: This study stands as the inaugural systematic review examining the impact of sexual partners on women seeking labiaplasty, encompassing all original studies exploring the role of the sexual partner. However, a notable limitation lies in the varied interpretations of the sexual partner's role, that the heterogeneous nature of these interpretations poses a challenge to providing a more precise answer through meta-analysis., Conclusion: Based on the findings of this systematic review, it is evident that sexual partners exert multifaceted influences on women's decisions to seek labiaplasty. While not serving as the primary decision makers, women opt for labiaplasty with the aim of enhancing attractiveness in sexual relationships and mitigating potential negative comments from their partners., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The popularity of labiaplasty has increased over the last decade and patients consistently report high levels of satisfaction with outcomes. Specifically, patients generally experience improved sexual satisfaction, but there is very limited research on the impacts on intimate relationships more broadly, even though these experiences are often crucial to women's lives., Objectives: The aim of this study was to conduct an in-depth qualitative exploration of the impacts of labiaplasty on intimate relationship quality. Qualitative semistructured telephone interviews were conducted with adult women (n = 15), who had undergone labiaplasty between 1 and 72 months previously (mean [standard deviation], 28.1 [24.3] months). Participants were asked about any perceived changes to their intimate relationships and how labiaplasty may have influenced those changes (if any). Thematic analysis of the transcribed interview data was performed., Results: The results showed that most women reported greater confidence engaging in new relationships, and partaking in subsequent sexual experiences was also commonly reported. However, other women reported no changes to their intimate relationship quality after labiaplasty. Over half of the women reported concerns that their current or a future partner may perceive their postsurgery genital appearance as not "natural.", Conclusions: The current study adds some novel depth and nuance to the impacts of labiaplasty on intimate relationship quality. Although most women experience improved sexual confidence in their intimate relationships, a proportion may also experience concerns around their partner's reactions to the surgery., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society.)

Background: The demand for labiaplasty has increased rapidly over the last 10 to 15 years. Women's reasons for pursuing the procedure have been thoroughly documented in the literature, but other preoperative aspects are less well defined. These include women's expected outcomes, concerns about having the surgery, and the impacts of support from others in their personal lives as well as their treating team., Objectives: The aim of this study was to explore women's preoperative labiaplasty experiences, particularly expectations, concerns, and interpersonal support., Methods: Semistructured interviews were completed with 15 adult women in the United States and Australia who had undergone a labia minora reduction. The women were asked about their motivations for having a labiaplasty, expected outcomes, concerns regarding surgery, and support received from family members, friends, and the treating surgeon. The interviews were audio recorded, transcribed verbatim, and analyzed thematically., Results: Two overarching themes with accompanying subthemes emerged from the analyses: (1) "motivations/influences" which included appearance concerns, physical discomfort, negative impacts on self-confidence, and negative experiences with partners and/or peers; and (2) "perceptions approaching labiaplasty procedure" where women reported concerns about recovery duration and impacts on sexual sensation as well as expectations for their postoperative vulvar appearance to be "neat," "tidy," and "natural." In addition, the women stated that they felt well supported by their surgeons prior to the procedure, but some felt too embarrassed to seek support from family members and friends., Conclusions: These new insights into women's preoperative experiences may assist clinical teams in enhancing their support and education of women seeking labiaplasty., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society.)

Aesthetic surgery of the female genitalia is on the rise. Many procedures are performed. Body dysmorphic disorder (BDD) is a psychiatric disorder and often goes unrecognized in plastic surgery. This review examines actual knowledge of plastic surgery in gynecology, knowledge of motivational factors of women, and BDD. We carried out a systematic electronic search. We used a combination of relevant keywords to construct the search strategy. Included studies were systematic reviews or primary studies published 1990-2017 and containing information about BDD. Reviewers independently assessed study eligibility, extracted data, and assessed quality, undertaking narrative synthesis. The research revealed a variety of plastic procedures available and why women consider undergoing labia reduction surgery.

Background: Influencing factors involved in the decision to undergo labiaplasty are evolving and show diversity among different settings and countries. Updated underlying motivators may assist in clinical decision-making and assessing outcomes from the patients' perspective., Objectives: Herein, the main motivators of women undergoing labiaplasty and sociodemographic features are discussed., Methods: Seventy-one patients who were scheduled for labiaplasty were assessed via an open-ended, well-detailed questionnaire to determine the main motivational factors from the patients' perspective. Validated questionnaires to measure genital self-image, self-esteem, body appreciation, attitude toward having cosmetic surgery, sexual dysfunction, and body-dysmorphic disorder were performed., Results: Half of the patients reported that they had an idea about the appearance of other women's genitalia (50.7%) and were influenced through the media (47.9%). The majority of those (71.8%) stated that they did not have normal genitalia and considered labiaplasty more than 6 months ago (88.7%). The pornography consumption rate in the last month was 19.7% and was significantly related with lower genital self-image and self-esteem. The main motivation was improvement in appearance (43.7%) and a better sexual life (26.8%). Patients reported aesthetic (52.1%), sexual (46.5%), and psychological (39.4%) reasons leading to their decision. Patient-reported 8-items of 11-item motivators for having labiaplasty were statistically consistent with validated questionnaires. The self-esteem and body appreciation of the patients were comparable to the literature. Genital self-image and sexual function were found to be impaired., Conclusions: The women's main motivator for labiaplasty was improvement in genital appearance integrated with their aesthetic and sexual demands. Eleven-item motivators derived from the statements of women seeking labiaplasty were determined in this study. Sociodemographic features and main motivators can conveniently be used as normative data for this population., (© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

The recent rise in women seeking cosmetic surgery of their genitalia (labiaplasty) coincides with the increasing number of surgeons posting videos of these operations on social media accounts and websites. Sociocultural influences significantly contribute to our ideas of what constitutes healthy and pathologic, and surgeons have historically played a role in defining "normal" and "abnormal" anatomy. In the nineteenth century, Saartjie Baartman-a woman with a large posterior and unusually long labia minora-was used by physicians to "educate" the public about these differences. We examine the parallels with the twenty-first century practice of surgeons using social media to educate patients about the operations they perform and discuss ethical and professional hazards associated with this practice., (© 2018 American Medical Association. All Rights Reserved.)

Introduction and Hypothesis: We provide a review of the literature about the onset and development of hypertrophy of the labia minora, together with some expert opinions on the appropriateness of labiaplasty., Methods: We searched PubMed and used popular search engines, with a greater emphasis on the physiology and hormone-mediated metabolism of these structures, and less emphasis on their surgical treatment., Results: We describe major embryological, cytological, and biochemical features of this anatomical part and summarize the clinical aspects of its hypertrophy, evaluating types of discomfort reported by women and the medical treatments available. Also, based on what is known about the artificial elongation and spontaneous hypertrophy of the inner labia, we illustrate and discuss the main biological factors that may trigger this medical condition. There are not enough data identifying a clear inheritance of inner labia hypertrophy in the absence of other pathological conditions; instead, we found indirect evidence for an association with transient episodes of local inflammation either before birth or during puberty. We also analyze the role played by estrogen receptors and other factors with regard to the onset of this condition and highlight the importance of their timing in determining the size of women's labia minora. Remarkably, most cases of enlarged labia minora should be considered as outliers that are within the physiological range of size variation described for these structures., Conclusions: We generally advise against surgical treatment of labia minora, especially in young, pre-pubertal girls, unless specific medical conditions are also present and/or the psychological impact on the patient is deemed particularly negative.

Background: In recent years, labiaplasty has jumped in popularity, despite opposition to the procedure. In 2007, the American College of Obstetricians and Gynecologists declared the recommendation of cosmetic vaginal procedures to be "untenable," although in 2016 they allowed consideration of labiaplasty in adolescents if symptoms persist. The reasons for labiaplasty requests are not yet fully understood, and physician opposition limits patient access to surgical relief., Methods: In this prospective study, 50 consecutive patients consulting about labiaplasty were given a questionnaire assessing 11 physical and appearance-related symptoms associated with elongated labia., Results: The mean patient age was 33.5 years (range, 17 to 51 years). Fifty-eight percent of women had given birth, 52 percent noticed that their labia had become elongated as they got older, and 93 percent had bilateral elongation. When asked about physical symptoms, over half of patients experienced tugging during intercourse, found tight pants uncomfortable, experienced twisting of the labia, and noted labia visibility in yoga pants. Nearly half experienced pain during intercourse, and 40 percent said their labia could become exposed in bathing suits. Regarding appearance, almost all patients were self-conscious and over half felt less attractive to their partner, experienced restricted clothing choice, and noted a negative impact on self-esteem and intimacy. Nearly all patients experienced at least four symptoms., Conclusions: Most patients requesting labiaplasty experience both physical and appearance-related symptoms. Understanding this patient perspective is crucial in assessing surgical outcomes. Furthermore, the better all physicians understand labia symptomatology, the better supported patients will be in seeking surgical relief.

Background: Labiaplasty has become an increasingly popular procedure. However, the psychological outcomes of this procedure, such as the effects on women’s sex lives and psychological well-being, have received little attention from researchers to date. In addition, the investigation of factors which predict satisfaction with surgical outcomes is also lacking., Objectives: To examine the effect of labiaplasty on women’s sexual satisfaction and psychological well-being. To also identify patient characteristics which predict surgical satisfaction., Methods: This retrospective study involved 48 adult women who had undergone a labiaplasty procedure between 3 and 204 months prior. These women completed an online questionnaire which contained measures of satisfaction with labiaplasty, genital appearance satisfaction, sexual satisfaction, and psychological well-being., Results: Most women were very satisfied with their labial appearance and function after surgery. The women also reported statistically significant increases in their genital appearance satisfaction (P < .001), sexual satisfaction (P = .009), and psychological well-being (P < .001) at the time of completing the questionnaire compared to their recalled levels prior to surgery. Undergoing labiaplasty to address physical/functional concerns (P = .025) as well as sexual concerns (P = .037) was associated with greater satisfaction with surgical outcomes. In contrast, experiencing post-surgery complications (P = .015) was related to lower satisfaction., Conclusions: Women appear to be very satisfied with the results of their labiaplasty and they also seem to experience improvements in their sexual satisfaction and psychological well-being. Physical/functional motivations for undergoing labiaplasty are associated with greater satisfaction with outcomes., Level of Evidence: 4, (© 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com)

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.

In the West, a specific ideal has emerged for female genitalia. The ideal is one of absence, a clean slit that can be attained through the removal of pubic hair and, increasingly, through female genital cosmetic surgery. This ideal is largely created in the media, which generates contradictory messages for women. The popular press, backed by medical opinion, explicitly acknowledges that a wide range of variation is normal--female genitals vary in appearance 'about as much as snowflakes'--but by showing only altered minimalist clean slits, it carries an implicit message that women should be worried if their genitals do not match up to this exacting ideal. Consequently, some women feel their genitals are not satisfactory and choose surgery. Using biomedicine to fix normal body parts in order to fashion desirable femininity, releases medicine from its rigid scientific underpinnings exposing it as an increasingly cultural and commercial pursuit.

Background: The central wedge excision to reduce the labia minora was reported in 1998. The purpose of this article is to present recent modifications and results of this technique., Methods: A central wedge or V is removed from the most protuberant portion of each labium minus. The outer portion of the V excision is usually curved lateral and anterior to excise redundant lateral labium and excess lateral clitoral hood. Postoperative examinations were performed when possible. Two separate mailings of questionnaires were sent, and follow-up phone calls were made to nonresponders., Results: A total of 407 patients had labia reductions from January 1, 2005, to December 31, 2006. All but 14 (3 percent) were bilateral. Ages ranged from 13 to 63 years (average, 32.4 years). Almost all patients had some lateral clitoral hood excisions with the extension of the lateral hockey-stick design. Postoperative examinations at least 2 weeks after surgery were performed on 123 patients. The total number of patients undergoing reoperation was 12 of 407 (2.9 percent). Patients responding to the questionnaire (166 of 407) were pleased with the surgery by an average score of 9.2 of 10 (where 10 = most pleased). Improvement in self-esteem (93 percent), sex life (71 percent), and discomfort (95 percent) was reported with a low significant complication rate (4 percent); 163 of the respondents (98 percent) would undergo the surgery again., Conclusion: Central wedge reduction with lateral clitoral hood reduction is a safe, effective procedure with few complications and high patient satisfaction.

Objective: To understand women's reasons for undergoing labial reduction surgery, their expectations and experiences., Design: A retrospective qualitative study., Setting: British National Health Service Hospital., Sample: Six women who had experienced surgery for labial reduction. Method Qualitative study using semi-structured interviews., Results: Results relating to 'Normality and defect', 'Sex lives' and 'The process of accessing surgery' are presented in this study. The women had seen their presurgery genital appearance as 'defective' and sought a 'normal' genital appearance. They thought that their presurgery genital appearance impacted on their sex lives, but their expectations of the effects of surgery on their sex lives were not all fulfilled. Information about labial surgery came from both the popular media and the health services. An emphasis on, for example, physical discomfort rather than appearance may have been used to legitimise a request for surgery. The process of accessing surgery had exposed them to potentially conflicting messages about their genital appearance., Conclusions: Women presenting for labial reduction may have unrealistic expectations of surgery, but their perceptions and expectations are long-standing and seem to be based on strong cultural norms. The gynaecologist is also meeting those women who have already negotiated the referral process. As demand for this surgery appears to be increasing, further research is needed. These findings may add to the case for the potential value of specialist staff to provide psychosocial interventions within gynaecology services.