Intended for healthcare professionals


Vulvovaginal surgery is being carried out without evidence of safety or benefits, gynaecologists say

BMJ 2008; 337 doi: (Published 16 September 2008) Cite this as: BMJ 2008;337:a1684
  1. Roger Dobson
  1. 1Abergavenny

    Aggressive marketing by private clinics in the United Kingdom and United States and media coverage have led to growing numbers of women asking for cosmetic genital procedures, a new report says.

    But many such procedures are being carried out without adequate evidence of either safety or psychosocial benefits, say the authors (Obstetrics, Gynaecology and Reproductive Medicine, doi:10.1016/j.ogrm.2008.07.008).

    “There are very significant gaps in our understanding of these types of procedures. Given the political and ethical controversy, the onus remains on the surgeons who perform such surgery to demonstrate both safety and efficacy,” wrote the authors, Rufus Cartwright and Linda Cardozo, from King’s College Hospital, London.

    They add, “In the absence of clear evidence, surgeons must tread cautiously, choosing to operate only as a last resort.”

    The authors say that no area of elective gynaecology is currently more controversial than cosmetic vulvovaginal surgery, which includes reduction labioplasty, augmentation labioplasty, vulvar lipoplasty, G spot amplification, and hymenorrhaphy and perineorrhaphy for vaginal laxity, also known as vaginal rejuvenation.

    They say that genital cosmetic surgery in women may represent a dangerous medicalisation of female sexuality: “A comparison can be also made with female genital mutilation. There are clear distinctions, most notably that female genital mutilation is typically performed without adequate consent upon a minor, and has clearly established physical harms.

    “However, the similarities with procedures now being performed in western nations for cosmetic reasons have led to the suggestion that any distinction is only a Eurocentrist fallacy.

    “There is a genuine concern that female genital cosmetic procedures are not justified on medical grounds, and are being performed without adequate evidence of either safety or psychosocial benefit.”

    The paper says that the best established female genital cosmetic procedure is reduction labioplasty, which women usually seek either because of aesthetic dissatisfaction or discomfort during exercise or sexual intercourse. Women, it says, may perceive their labia to be abnormal in size or shape but may be unaware of the wide range of normal sizes for labia.

    The authors say the level of evidence of success for even the most studied procedure, reduction labioplasty, is low.

    Hymenoplasty is even more controversial than labioplasty, they say, perhaps because it is seen to perpetuate misogynist myths about virginity.

    “Some women request hymenorrhaphy in order to give the appearance of virginity on their wedding night,” say the authors. “By acquiescing to perform such surgery, the doctor is perpetuating misogynist myths about virginity.”

    They add, “Despite its persistent popularity there is little evidence of successful outcomes.”

    They say the evidence that surgical repair improves any of a number of symptoms associated with vaginal laxity, including pelvic discomfort, is very limited.


    Cite this as: BMJ 2008;337:a1684

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