229 Female Cosmetic Genital Surgery: Complications
Authors: Laskowska A , Gronowski P 
Published: May 2022

ABSTRACT

Introduction
Female cosmetic genital surgery is rapidly gaining popularity and acceptance as both the aesthetic and functional benefits of these procedures are becoming more and more appreciated and reachable. World Health Organization (WHO) defines health as „a state of complete physical, mental and social well-being and not merely absence of disease or infirmity”. Plastic surgeons and doctors of aesthetic medicine noticed that self-perception of the body image, beauty and physique strongly influences a woman's mental and social well-being. Cosmetic surgery is considered ethical and beneficial when intervention is able to improve the quality of life (QoL) and well-being of the patient. In recent years, however, a new aesthetic medicine concept has been developed into gynecological practice: correction and/or modifying the genital anatomy in the absence of a specific organic problem or disease with the objective of improving a woman's health perception.

Objective
Female cosmetic genital surgery refers to non-medically indicated cosmetic surgical procedures which change the structure and appearance of the healthy female genitalia. There are a number of procedures including: labiaplasty, vaginoplasty, perineoplasty, clitoral hood reduction, hymenoplasty and G-spot bulking.
Complications of cosmetic female cosmetic surgeries are low, estimated between 2-4% and they vary depending on the procedure.

Methods
This systematic review will provide an assessment of complications associated with female cosmetic genital surgeries. The following databases has been searched from the study inception to July 2021: the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, MEDLINE, Embase, Scopus, Web Of Science, ProQuest, ScienceDirect, UpToDate, Polish Medical Bibliography and consultations of Polish specialists and discussion forums of patients have been used.

Results
Woman's search for a „perfect” vagina and vulva is very often stimulated via the Internet promotional articles and advertisements offering and promising extraordinary cosmetic and functional improvements that are supposed to be achieved due to female cosmetic surgery. Many of these procedures, while elective, are not limited to aesthetic goal alone, e.g. the majority of women seeking labiaplasty also have a concomitant functional issue, whether it is discomfort from clothing or dyspareunia. Women should be carefully advised and screened pre-operatively for underlying psychological problems and sexual dysfunction. Female cosmetic genital surgeries should ideally be provided by a multidisciplinary team of healthcare professionals, including: surgeons, psychologists, psychosexual therapists, physiotherapists, with relevant training, demonstrated competence and with the required clinical governance arrangements in place.

Conclusions
Female cosmetic genital surgery is a rapidly expanding and poorly regulated field of cosmetic surgery. Despite the controversies, the relevant professional bodies should attempt to regulate training and standardize terminology. Well-designed prospective studies with long-term follow-up are needed. Patients should be carefully counselled and selected pre-operatively ideally by a multidisciplinary team. The request for female cosmetic genital surgery may be reasonable and whilst we respect an individual's right to choose, there needs to be increased regulation in this controversial area of medicine.

Disclosure
Work supported by industry: no.