Cosmetic vulvar surgery including labiaplasty is a broad descriptor of numerous procedures designed to improve the appearance, function or both of the vulvar structures (Goodman et al. J Sex Med 2010;7:1565–77).
Controversy regarding this specialisation was amplified following an ACOG Committee Opinion advising caution due to a lack of data on safety and efficacy (Committee on Gynecologic Practice, ACOG. Obstet Gynecol 2007;110:737–8). ACOG mentioned many of the procedures by their marketing names only, such as ‘Laser Vaginal Rejuvenation’, ‘Labiaplasty’ and ‘G Spot Amplification’ among others, while inadequately describing the historical basis that many of these procedures have. Data contradicting this committee opinion continue to grow with quite promising results, indicating very high patient satisfaction and efficacy and low complication rates.
An important point is that many of these procedures, while elective, are not limited to aesthetic goals alone. For example, the majority of women seeking labiaplasty also have a concomitant functional issue, whether it be discomfort from clothing or dyspareunia (Miklos et al. J Sex Med 2008;5:1492–5).
Although many of these women may have labia falling within the normal range, are we to discount their concerns and fail to mention all potential treatments, even as positive and reassuring evidence continues to mount?
The focusing on marketing terminology and ignoring the surgical goals and techniques of these procedures by groups such as ACOG distracts from the important fact that many of these procedures, such as laser vaginal rejuvenation, treat symptomatic pelvic organ prolapse and can be an effective option for women wishing to forgo tension-free vaginal tapes for the treatment of stress urinary incontinence. A large amount of research exists that indicates improved sexual function with successful treatment of pelvic organ prolapse with or without stress urinary incontinence. Procedures such as laser vaginal rejuvenation are built upon a solid gynaecological surgical foundation of procedures such as anterior and posterior colporrhaphy and perineorrhaphy (Pardo et al. Acta Obstet Gynecol Scand 2006;85:1125–7).
Our traditional physician—patient roles continue to evolve. Whereas in academia we learn the importance of a functional result, we have been oblivious for far too long to the profound impact an unsightly or asymmetric scar or wound has on the wellbeing of our patients. This is undoubtedly amplified when women have these concerns in intimate areas. This will often negatively impact a woman's self-confidence. We have to treat each patient as a whole, not merely limited to the physical characteristics, but with emotional and mental aspects as well.
One of the interesting points to cosmetic vulvar surgery such as the labiaplasty procedure is that women can have the best of both worlds; improvement in presenting symptoms as well as an aesthetically pleasing look. Women have always had the good sense to look at form and function; perhaps it is time we all follow their lead and continue to provide them with knowledge, choice and alternatives.