Female Genital Cosmetic Surgery Research Articles

Spanish Translation, Transcultural Adaptation, Validation and Clinical Applicability of Female Genital-Self Image Scale (FGSIS).

BackgroundAs female genital cosmetic surgeries have significantly increased, appropriate tools to evaluate self-esteem about women's own genitalia are necessary.Aimto translate, culturally adapt to Spanish women and to evaluate the psychometric properties of the Female Genital Self-Image Scale (FGSIS).MethodsFGSIS was forward and backward translated, culturally adapted into Spanish and its content evaluated through Delphi consensus. One item from the original scale was discarded after expert panel evaluation, developing the final Spanish scale (FGSIS-S) consisting of 6 items. Its psychometric properties were evaluated among 202 women attending gynecological consults through an online survey. The survey included socio-demographic data and FGSIS-S.Main Outcome MeasureSocio-demographic items, psychometric characteristics of the FGSIS-S (construct evaluation, internal consistency and test-retest reliability) were assessed.ResultsFGSIS-S proved to relate appropriately with the proposed construct (sum-content validity index 0.9, and significant inverse correlation with women concerned about their genital appearance or considering cosmetic surgery) with a 1-factor solution on exploratory factor analysis. The test proved good internal consistency (McDonald's omega 0.86) and test-retest reliability (intraclass correlation 0.86, P < .001). In 41.1% of cases, women referred concern about their genital's self-image and in 12.4% had considered undergoing cosmetic surgery.Clinical TranslationThe validated version of FGSIS-S can help both professionals and patients, and its implementation can be easily made in gynecological consults.Strengths and LimitationsThe main limitation is a self-selection bias in women attending gynecological consults, who may be more worried about their gynecological/sexual health. The sample is also a relatively homogeneous Caucasian population, with medium-high educational level, coming from gynecological consults. Strengths include the large sample size and the demographic survey that permitted evaluating the performance of FGSIS-S in the context of concern about genitals or consideration of cosmetic surgery.ConclusionFGSIS-S is an adequate scale to measure women's genital image self-perception in Spanish-speaking population of Spain.Bartolomé A, Villalaín C, Bermejo R, et al. Spanish Translation, Transcultural Adaptation, Validation and Clinical Applicability of Female Genital-Self Image Scale (FGSIS). Sex Med 2022;10:100558.

Women’s experience and perspectives toward genital cosmetic surgery in Erbil city/Iraq: a qualitative study

BackgroundNowadays, Female Genital Cosmetic Surgery is quite prevalent, resulting in a wide range of medical and cultural implications. The majority of women who undergo this operation suffer from anxiety, depression, and other emotional symptoms. The present study was carried out in order to explore women’s perspective on and experience of genital cosmetic surgery given their special context and cultural aspects.MethodsThe qualitative study applying content analysis examined the experiences of nine women who received genital cosmetic surgery in Erbil, Kurdistan-Iraq, between 2021 and 2022. Each of the semi-in-depth face-to-face interviews lasted between 40 and 60 min and was conducted at the physician's clinics.ResultsSemi-structured interviews led to emergence of two main themes, namely “husband satisfaction” and “self-confidence”. Interpreting the participants’ stories resulted in some relevant subthemes and meaning units like “ugly appearance”, “anxiety related to husband undesirable intercourse”, and “dyspareunia”. Finally, the related conclusions of each theme were explored.ConclusionAs suggested by the study findings, female genital cosmetic surgery improves the women’s body image and sexual function and the couples’ sexual satisfaction, especially that of husbands. Because of the people’s sociocultural aspects in Kurdistan region, their awareness of female sexual needs and marital relationship needs to be raised.

The Attitude of Physicians Towards Female Genital Cosmetic Surgery.

IntroductionFemale genital cosmetic surgery (FGCS) is a trending topic in the field of gynecology practice. It is defined as any genital procedure that is not medically indicated but is designed to improve the appearance of the genitals. With the increasing demand for FGCS, little is known about the attitudes of physicians, especially gynecologists, toward FGCS. The study objective is to assess physicians' attitudes towards female genital cosmetic surgeries in Jeddah, Saudi Arabia.MethodsA cross-sectional survey was done among physicians in Jeddah, Saudi Arabia. Four-sectioned questionnaires were distributed to physicians. All board-certified consultants and registrars of obstetrics and gynecology, plastic, and reconstructive surgery in private/public hospitals were included in the study. Data management was done using the SPSS program version 19 (IBM Corp., Armonk, NY, USA).ResultsOut of 165 physicians, 40 were practicing physicians (female genital cosmetic surgery) (24.2%) while 125 were non-practicing physicians (75.8%). The age of practicing and non-practicing respondents ranges from 26 to 60 with a mean and standard deviation (42.6±8.6) and 24 to 60 (40.1±8.9) years old. Our study showed that there were females under 18 years old requesting FGCS from all physicians. Results of attitude towards FGCS showed that the majority of non-practicing physicians were more comfortable in providing advice about FGCS (N=53) and very confident about female anatomy (N=65). Non-practicing physicians also knew a lot more about the long and short-term risks of FGCS and discussed them all the time with their patients. In terms of giving advice on labiaplasty, clitoral hood reduction, perineoplasty, hymenoplasty, and G-spot augmentation procedures, practicing physicians were more confident compared to non-practicing physicians. Statistical analysis showed a significant difference between practicing and non-practicing physicians in terms of gender (p=0.001), career level (p=0.005) and type of work (p=0.006), giving advice on labiaplasty (p=0.001), clitoral hood reduction (p=0.001), perineoplasty (p=0.016) and G-spot augmentation (p=0.001), the number of patients per month, patients seeking advice about FGCS, knowledge about short-term and long-term risks and possible risks of FGCS, vaginal examination, offering referral/counseling and confidence in assessing female anatomy (all, p=0.001). ConclusionPhysicians in Jeddah, Saudi Arabia showed an overall positive attitude towards FGCS. The study suggests that with enough training and knowledge about FGCS, physicians could exhibit a more positive attitude towards FGCS.

Female cosmetic genital surgery: Complications

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.

New context, new content-Rethinking genital anatomy in textbooks.

It has been widely claimed that reductions in allocated teaching time and the widespread implementation of short‐cut teaching methodologies have led to a shortfall in anatomy knowledge among graduating doctors. This decline in knowledge is evident in the failure of anatomy content to prepare graduates for contemporary clinical practice. The implications for postgraduate surgical training are addressed in the numerous extracurricular anatomy courses available to surgical candidates. This paper focuses on genital diversity and its relevance to non‐surgical graduates, thus highlighting another potential impact of this knowledge shortfall on frontline clinic consultations. As the gender revolution and female genital cosmetic surgery industry flourish, nothing in contemporary anatomy textbooks addresses issues of diversification of female genitalia nor gives medical graduates a realistic view of what is normal regarding female genital appearance.

Social and structural factors influencing women’s agency regarding female genital mutilation/cutting: an intersectional analysis – a reply to ‘The prosecution of Dawoodi Bohra women’ by Richard Shweder

Countries around the world have passed laws specifically banning female genital mutilation/cutting. Legal restrictions vary as to whether they apply to both girls and adult women or to minors only, and few address a second set of genital cutting procedures known as ‘female genital cosmetic surgeries’. Different legal framings reflect variation in views regarding women’s autonomy and their ability to provide meaningful consent. Social norms theory has drawn attention to the fact that in societies where customary female genital mutilation/cutting is common, women can be under intense pressure to conform lest risking social inclusion, support and possibly marriage prospects. Hence, protectionist measures by the state have been invited. Much less attention has been directed towards the broader circumstances that can shape and constrain women’s autonomy, including economic instability, limited access to resources and services, political marginalisation and discrimination, and global factors such as climate change. In this article, I highlight the promise of intersectional analyses of factors influencing female genital mutilation/cutting and suggest that in moving beyond the problematic distinction of ‘modern’ and ‘traditional’ societies, it is more fruitful to understand the multiple and combined factors that influence women’s empowerment. Drawing on case studies from Senegal, Kenya and the US, I illustrate that the logic to perform female genital mutilation/cutting or to resist engaging in community outreach on female genital mutilation/cutting may not only emanate from community norms, but also include broader conditions that influence people’s ability to cope with precarious livelihoods. A more comprehensive understanding of spheres of influence on women’s choices can be gained by examining how structural, material, social and individual domains overlap in a woman’s life. Programmes that aim to address female genital mutilation/cutting may be enhanced by expanding beyond a focus on legal reform and social norms to also address the broader structural and global factors that influence women’s agency.

Cosmetic surgical procedures on the vulva and vagina - an overview.

Cosmetic surgery is defined as any procedure involving a change in the appearance or aesthetics of a normal anatomy where there are no congenital or acquired pathologies. The procedures that can be included under female cosmetic genital surgery are the following: reduction labiaplasty, vaginoplasty, hymenoplasty, "G-Spot amplification", and miscellaneous. Those who support these procedures could argue that women undergo such procedures as a matter of choice, whereas those opposed could argue that this choice is made because of society's fascination with physical appearance and feeling young. Prima facie these procedures appear to contradict the Hippocratic principle of "primum non nocere". There has been an increase in the marketing and conduct of the above mentioned procedures. Practitioners need to be both sceptical and cautious while performing these surgeries. Patients requesting them need to be counseled regarding the lack of data supporting their efficacy, and the potential complications of the procedures.

Body Image, Sexual Function, and Sexual Satisfaction Among Couples Before and After Gynecologic Cosmetic Surgery.

Objective: This study aimed to compare women’s body image, sexual function and satisfaction before and after gynecologic cosmetic surgery. The study also aimed to assess women husband’s sexual satisfaction. Materials and methods: This was a pretest-posttest study. A sample of 50 women attending the pelvic floor clinic of Tehran University of Medical Sciences for gynecologic cosmetic surgery was entered into the study. Surgeries included labiaplasty, clitoral hoodectomy, vaginoplasty, vaginal rejuvenation, anterior and posterior colporrhaphy, perineoplasty, and perineorrhaphy. Women were assessed for the Body Image Quality of Life Inventory (BIQLI), the Larson Sexual Satisfaction Questionnaire (LSSQ-F), and Female Sexual Function Inventory (FSFI-6) at two points in time: baseline (one week before surgery) and 3 months after surgery. Similarly, the male partners were assed for sexual satisfaction using the Larson Sexual Satisfaction Questionnaire (LSSQ-M). To analyze the data paired samples t-test was applied. Results: The mean (SD) age of women was 43.36 (8.6) years and the mean (SD) duration of marriage was 22.18 (9.7) years. Ninety-four percent had history of vaginal delivery and 58.7 percent attend surgery due to husband’s sexual dissatisfaction. The results showed that women’s body image, sexual function and couples’ sexual satisfaction improved significantly after gynecologic cosmetic surgery (p ≤ 0.001). Conclusion: The findings suggest that female genital cosmetic surgery improved the body image and sexual function of women and sexual satisfaction in couples that might lead to a more pleasurable and healthier marital relationship.

Discussion: Mapping a Danger Zone of the Dorsal Nerve of the Clitoris: Implications in Female Cosmetic Genital Surgery.

Discussion: Mapping a Danger Zone of the Dorsal Nerve of the Clitoris: Implications in Female Cosmetic Genital Surgery.

Mapping a Danger Zone of the Dorsal Nerve of the Clitoris: Implications in Female Cosmetic Genital Surgery.

The literature regarding the route of the dorsal nerve of the clitoris is sparse and lacks surgical focus. With an increasing number of procedures being performed on the labia, it is important to elucidate the route and note any variation from normal of the nerve. Fifty-one cadavers were dissected to yield 97 dorsal nerve of the clitoris samples. Measurements were taken from (1) the dorsal nerve of the clitoris penetration point of the perineal membrane to the urethra, (2) the nerve's penetration point of the perineal membrane to the pubic bone, (3) the angle of the clitoris to the branch point of the dorsal nerve of the clitoris, and (4) the branch point of the nerve to the distalmost point of the glans clitoris. Any anomalous branching patterns of the dorsal nerve of the clitoris were recorded and classified. The means and standard deviations of each measurement were used to create a surgical danger zone. The mean of each measurement was (1) 34.63 mm, (2) 5.74 mm, (3) -3.07 mm, and (4) 30.40 mm, respectively. In addition, six distinct branching patterns were observed, organized, and classified based on the location and number of branches observed. The dorsal nerve of the clitoris has multiple branching patterns and typically travels along the same course in most women. Further investigation of the course and three-dimensional position of the dorsal nerve of the clitoris is warranted to preserve sexual sensation as the frequency of procedures involving the female pudendum increases.

Cosmetic labiaplasty on minors: a review of current trends and evidence.

Cosmetic labiaplasty is a form of Female Genital Cosmetic Surgery (FGCS) that is performed with the deliberate intent to alter the appearance and morphology of the external genitalia in the absence of medical concerns. Over the last decade, there is an increasing demand for FGCS and the industry behind it is constantly growing. Adolescents comprise an extremely vulnerable population, with labiaplasties in this particular age group having also increased. However, labiaplasty has been widely contested due to the irrevocable alteration of a psychosexually significant body part on minors too young to consent. Besides, the changes that occur during pubertal development in the genital area can significantly alter pediatric surgical results. Genital anatomy is more diverse than we previously thought and there is evidence to suggest that the labia minora with their rich innervation play an important role in sexual arousal and pleasure. Education regarding the wide range of normal genital appearance suffices in most cases to dissolve concerns regarding body self-image. Mental health issues should always be explored and, if identified, the girl should be referred to an experienced professional for their resolution. Postponing labiaplasty until adulthood is strongly recommended to help adolescents achieve a well-informed decision regarding an irreversible procedure with possible adverse esthetic and functional outcomes.

The anatomical measurements of vulva in Indian women: A cross-sectional prospective study.

To measure the anatomical dimensions of the vulva in adult Indian women. To analyze their correlations with age, body mass index (BMI), parity, and mode of delivery. This cross-sectional study was conducted in a tertiary care university hospital in India, among 400 women aged 18years and above. Various vulval measurements were taken, and Pearson's correction was applied to variables like age, BMI, parity, and mode of delivery. Mean length of glans of clitoris was 5.2±1.43mm, the labia minora width was 2.6±0.74cm, length of introitus was 1.3±0.59cm, and perineal body length was 2.3±0.60cm. The range of some measurements was extensive, for example labia minora width ranged from 0.7 to 4.9cm. Normal centile curves were constructed for vulval measurements according to age groups. Statistically significant positive correlations of age, BMI, and obstetrical history were seen with labia minora width (r=0.165, P=0.001; r=0.284, P<0.001; r=0.246, P<0.001, respectively). The centile curves can be used as a reference for the Indian population of different ages. These can be used when counseling women coming for female genital cosmetic surgery.

Office Procedures in Cosmetic Gynaecology

Female genital cosmetic surgery is a set of multiple procedures focused on improving genital appearance, structure, and function. Sexual dysfunction affects a large proportion of the female population and appears to be associated with distorted genital anatomy although what women perceive as normal varies vastly depending on cultural and social beliefs. Cosmetic gynaecology office procedures are simple, quick, and effective solutions to improve sexual function as well as body image with minimal interventions and minimal side-effects. In this narrative review, we present these widely used minimally invasive aesthetic gynaecology interventions, focusing on their efficacy, and reported complications. Recommendations regarding heath professionals’ approach and ethical issues arising are also discussed.

Female Genital Cosmetic Surgery: Legitimate Refinement or Illegal Mutilation?

The aim of this article is to assess whether Female Genital Cosmetic Surgery (FGCS), which refers to procedures which change the structure and appearance of healthy female genitalia for non-medical reasons, violates the Female Genital Mutilation Act 2003, in the light of CPS guidance issued in 2019 and literature regarding the motivations of women seeking FGCS and its effectiveness. The paper concludes that FGCS does, prima facie, constitute FGM and argues that the medical exception contained in the legislation should seldom be available - but based on CPS guidance, a criminal prosecution will rarely be in the public interest. The article ends by asserting that the distinction drawn in practice (if not in law) between the treatment of western and non-western women is problematic, not only because it is discriminatory, but because tolerating FGCS may serve to legitimise FGM and result in the circumvention of the FGM Act 2003.

Anatomy Textbooks ‐ Mind the Gap

Introduction and objective The aim of this study was to determine if and how diversity and variation are represented in iconic, authoritative anatomy texts used to prepare students for contemporary clinical practice.The contemporary issue of labiaplasty, a new and increasingly commonly performed cosmetic surgery procedure, provided a focal point for this study. The anatomical criteria behind this surgery are problematic because of confusion between “normal labia” and “idealised labia”.1 Valid and accurate information about normal labial diversity is critical to referring practitioners and the gynaecologists and plastic surgeons performing these procedures. Materials and method A sample of historic, multiple edition and popular contemporary textbooks as well as the peer-reviewed literature were examined for a specific set of features to determine similarities and differences in descriptions and depictions of the labia (including information about normal structural variation and function). Results 39 of 41 editions of Gray's Anatomy, 4 of 8 editions of Buchanan's Manual of Anatomy and contemporary editions of Moore's Clinical Anatomy, Last's Anatomy and Gray's Anatomy for Students, together with over 100 peer reviewed journal articles were examined. Despite expectations that the anatomy textbooks used in medical training would be authoritative and supportive of contemporary clinical practice, they covered basic anatomy of the vulva only, and information on function, normal diversity and changes with sexual activity, childbirth and aging is not included. They do not reflect recent population data and have remained rigid and unresponsive to the concurrent proliferation of social polemics.2 Conclusion Contemporary anatomy courses using popular contemporary anatomy texts may be graduating doctors with a knowledge gap about normal genital diversity. This gap would have been less problematic in the pre-labiaplasty era but now leaves the practitioners insufficiently informed about normal female genital anatomy to competently assess and advise the increasing number of women and girls requesting labiaplasty.3 Anatomical texts and resources need to recognise normal variation and represent new evidence base so that anatomy courses support our clinical colleagues and are not merely hurdles for students to pass. References Clerico, C., Lari, A., Mojallal, A., & Boucher, F. (2017). “Anatomy and aesthetics of the labia minora: the ideal vulva?” Aesthetic Plastic Surgery, 41(3), 714-719. Hayes, J. A., & Temple-Smith, M. J. (2020). “What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy.” Australian and New Zealand Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/ajo.13298 Simonis, M., Manocha, R., & Ong, J. J. (2016). “Female genital cosmetic surgery: a cross-sectional survey exploring knowledge, attitude and practice of general practitioners.” BMJ open, 6(9).

A Cadaveric Study of the Dorsal Nerve of the Clitoris: Mapping a 3D Danger Zone for Female Cosmetic Genital Surgery

Introduction The Dorsal Nerve of the Clitoris (DNC) innervates the clitoris and plays a major role in female sexual arousal. However, little research investigating the location of its terminal branches places them at risk of being severed during surgical procedures. For instance, the most common labiaplasty approach begins with an incision into the prepuce surrounding the glans clitoris. This area may house terminal branches of the DNC, leading to damage if severed. In this study we measured the distances of distal DNC branches from important surgical landmarks, as well as created a three-dimensional “danger zone,” which can be used by surgeons performing female cosmetic genital surgery. Methods A total of 19 female preserved cadavers were examined, yielding 38 DNC. The DNC was located by first making a shallow vertical incision from the pudendal cleft superiorly through the mons pubis. The body of the clitoris was located and the fascia surrounding the crura within the labia minora was carefully dissected to expose the DNC. The DNC was followed to its deepest point at the penetration of the perineal membrane, and was also followed superficially over the angle of the clitoris and toward the glans. The distal branches were carefully dissected to reveal the location at which the nerves penetrate the clitoris. Care was taken to not disturb the natural position and course of the nerves. Photographic evidence of each nerve was obtained, and various depth measurements were taken with Mitutoyo Absolute IP-67 digital calipers. Statistical analysis was conducted in Microsoft Excel. Results The distance from the distal-most DNC branch to the edge of the prepuce surrounding the clitoris was the most important and surprising measurement we obtained in this study. The mean distance was 10.80 mm (SD 5.31 mm). These terminal branches extend into the subcutaneous tissue of the prepuce (Figure 1), which serves as the initial incision point in the most common approach to the labiaplasty procedure. Without the ability to visualize the small distal DNC branches, surgeons operating in this area have a high risk of severing the nerves that provide sensation to the clitoris. As such, this reveals that surgeons performing surgeries in this region should avoid techniques involving excision of the clitoral hood. Another important measurement was the mean distance of the DNC as it passed over the angle of the clitoris to the edge of the labia minora, which was 30.35 mm (SD 6.44 mm). This measurement provides an understanding of the depth that the DNC travels within the labia minora, which is also relevant to labia excision in the labiaplasty procedure. Conclusion This study demonstrates that the most distal branches of the DNC extend further than expected, and terminate subcutaneously within the prepuce of the clitoris. This study also reveals the depth at which the DNC travels compared to the labia minora, which is an important depth for surgeons performing procedures in this region. While there is still much to be understood about the course of the DNC, these measurements are an important beginning to increasing the awareness of this region for female sexual health.

Female genital cosmetic surgery (FGCS): Evaluation of YouTube videos

ObjectivesThe purpose of our study is to evaluate the information available on YouTube regarding FGCS procedures in terms of content, accuracy, reliability and quality. MethodsVideos were listed on YouTube on 01.10.2020 by searching the terms "plastic surgery for female genital", "vaginoplasty", "labiaplasty" and selecting their relevance from the filtering options. Among these listed videos, the 50 most watched videos were listed and recorded excluding commercials, repeating videos, those shorter than 60s and non-English ones. The videos were scored by two researchers using DISCERN and JAMA scales. The DISCERN scale varies between 0−75 points and according to the scores obtained from the scale, videos are classified as 63–75: (excellent); as 51–62: (good); as 39–50: (moderate) as 28- 38: poor and as <28 very poor. JAMA scale is a scale that evaluates the accuracy, usefulness and reliability of video sources between 0−4. Insufficient data on 1 point video source obtained from the scale, refers to. 2–3 (partially sufficient data) and 4: (completely sufficient data). ResultsThe evaluation on DISCERN scores given to the videos revealed that the average DISCERN score of the first researcher was 45.65±13.271 and the average of the second researcher’s DISCERN score was 44.65±14.235. The average of JAMA scores was 2.67±0.826 for the first researcher and 2.49±0.845 for the second researcher. Accordingly, a statistically significant linear relationship was found between DISCERN (r=0.812) scores and JAMA (r=0.622) scores by the researchers. ConclusionWe found that YouTube has the potential to provide patients with easy access to a large amount of information on FGCS, although almost all of the videos we included in the study were uploaded by health professionals, the overall quality of the content on the subject was moderate. We strongly suggest that any videos on health should be uploaded by experts and these videos should definitely be reviewed by a referee.

What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy.

Despite increasing numbers of labiaplasties being performed, there is little quantitative information on normal labial diversity to guide medical education, patient education and surgical treatment. This scoping review will determine what is known in the published literature about the anatomical basis of normal for labia and female genital cosmetic surgery (FCGS). The scoping review identified ten population-based studies that recorded labial dimensions by searching three electronic databases utilising a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search strategy. Strict inclusion and exclusion criteria were applied and then reference lists were scrutinised until no further articles that met the criteria were located. These studies showed significant variation in labial length (range 5-100mm) and width (range 1-60mm). Labia minora were wider in pre-menopausal women than in post-menopausal women, protruding labia minora were more common than not, and asymmetry between right and left labia was common. Variation in recruitment, inclusion and exclusion criteria, and measurement did not allow for summation of the data sets. This information could usefully be added to medical textbooks and teaching to ensure that medical graduates are sufficiently informed about normal variation in female genital anatomy to assess and advise women seeking FGCS.

Mapping a Danger Zone of the Dorsal Nerve of the Clitoris: Implications in Female Cosmetic Genital Surgery

OBJECTIVE: Complications following labiaplasty procedures are understudied and underreported1 and could possibly include loss of sensation in the female pudendum.2 As the number of procedures each year increase,3 it is important to continue to explore ways to ensure positive outcomes for patients. The aim of this study was to determine variability in the course and branching of the dorsal nerve of the clitoris (DNC) and to generate a surgical safe zone. METHODS: Ninety-seven Cadavers from the University of Nebraska Medical Center, Creighton University, and Kansas City University anatomy labs were examined for this study. A shallow vertical incision was made from the pudendal cleft superiorly through the mons pubis. The glans clitoris was identified and used as a landmark while the fascia surrounding the body of the clitoris was carefully removed. The DNC was located where it pierces the perineal membrane and traced distally. The following measurements were taken: (1) from the point where the DNC pierces the perineal membrane to the urethra, (2) from the point where the DNC pierces the perineal membrane to the pubic bone, (3) from the angle of the clitoris to where the nerve branches on the dorsum of the body of the clitoris, and (4) from that branch point to the distal most portion of the glans clitoris. A subset of the population (n = 72) cadavers were examined for abnormal branching patterns, which were noted and characterized. All statistical data analyses were conducted through IBM SPSS. RESULTS: Thirty-five DNCs were characterized as anomalous in the branching pattern analysis. Type 1 was the typical DNC branching pattern (splits once into two terminal branches). Type 2 was distinguished by the presence of an early branch near where the DNC pierces the perineal membrane. Types 3–6 corresponded to the number of branches the DNC had (type 3 had 3 branches, etc). Finally, the measurements that were taken were used to generate a surgical safe zone, which can be used to avoid injury to the DNC during procedures involving the female pudendum. CONCLUSIONS: The findings of this study allowed the investigators to map out a surgical safe zone for procedures involving the female pudendum to avoid injury to the DNC and identify and classify anomalous branching patterns. This information should be useful to physicians performing procedures near the DNC to increase patient satisfaction and safety. Further research should be done into the DNC and outcomes of labiaplasties and other surgeries that could impact this nerve. REFERENCES: 1. Goodman MP. Outcomes. In: Goodman MP, ed. Female Genital Plastic and Cosmetic Surgery. First. John Wiley & Sons, Ltd.; 2016:206–211. 2. Runacres SA, Wood PL. Cosmetic labiaplasty in an adolescent population. J Pediatr Adolesc Gynecol. 2016;29:218–222. 3. Vieira-Baptista P, Almeida G, Bogliatto F, et al. International Society for the study of vulvovaginal disease recommendations regarding female cosmetic genital surgery. J Low Genit Tract Dis. 2018;22:415–434.

Conceptualising the continuum of female genital fashioning practices

ABSTRACT Genital fashioning practices, such as Brazilian waxing and female genital cosmetic surgery, have become increasingly prevalent within contemporary western societies. This paper explores the role of genital fashioning in the construction of contemporary femininity. It uses in-depth interviews and focus groups with Australian women aged 18–30 to investigate female genitalia as a site of alteration. Drawing on broader understandings of the body as socially mediated, this paper contends that multiple modification practices are employed to produce genital appearance. It departs from previous investigations which consider genital fashioning practices in isolation. In identifying the scope of genital fashioning, this research reveals a continuum of genital fashioning practices, both physically and discursively mobilised by women to negotiate their identity, sexuality, and femininity.