Analysis

Requests for cosmetic genitoplasty: how should healthcare providers respond?

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39206.422269.BE (Published 24 May 2007) Cite this as: BMJ 2007;334:1090
  1. Lih Mei Liao, consultant clinical psychologist,
  2. Sarah M Creighton, consultant gynaecologist
  1. Middlesex Centre, UCL Institute for Women's Health, Elizabeth Garrett Anderson and Obstetric Hospital, London WC1E 6DH
  1. Correspondence to: L M Liao lih-mei.liao{at}uclh.nhs.uk

    Demand for cosmetic genitoplasty is increasing. Lih Mei Liao and Sarah M Creighton argue that surgery carries risks and that alternative solutions to women's concerns about the appearance of their genitals should be developed

    Women's concerns about their appearance, fuelled by commercial pressure for surgical fixes, now include the genitalia. A share of this consumer demand is being absorbed by National Health Service specialists. This article was prompted by the increased numbers of women asking for labial reduction and the concerns of clinicians about the rising number of referrals for cosmetic genital surgery.

    A new complaint

    More and more women are said to be troubled by the shape, size, or proportions of their vulvas, so that elective genitoplasty is apparently a “booming business.”1 Advertisements for cosmetic genitoplasty are common, often including before and after images and life changing narratives.2 Google produced around 490 000 results when we entered “labial reduction”. Forty seven of the first 50 results were advertisements from clinics in the United Kingdom and United States offering cosmetic genital surgery. Television programmes and articles in women's magazines on “designer vaginas” may also fuel desire for surgery, especially with the rising popularity of cosmetic surgery in general. The latest survey by the British Association of Aesthetic Plastic Surgeons reported a staggering 31% increase in uptake of cosmetic surgery in the UK3; women accounted for 92% of this uptake.

    Decisions about surgically altering the genitalia may be based on misguided assumptions about normal dimensions. Recently, we reported dimensions of female genitals based on 50 premenopausal women.4 Labial and clitoral size and shape, vaginal length, urethral position, colour, rugosity, and symmetry varied greatly. These findings bring into question assumptions about “normal” genital appearances.

    NHS stakeholders are unlikely to encourage demand for cosmetic genitoplasty, but availability in the private sector could …

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