Hood Reduction Research Articles

Cosmetic Gynecology: Is There Enough Exposure in the Obstetrics and Gynecology Residency?

Introduction While cosmetic gynecology has gained popularity, the training experience for obstetrics and gynecology residents in this area is limited and not standardized. The primary objective was to investigate the exposure of obstetrics and gynecology residents to cosmetic gynecologic procedures including hymenoplasty, labia majora reduction, vaginoplasty, G-spot amplification, labiaplasty, clitoral hood reduction, and vaginal laser therapy. The secondary objective was to assess their comfort in performing the procedures after graduation. Methods This is a non-validated cross-sectional survey of obstetrics and gynecology residents and their exposure to cosmetic gynecology procedures. Using the Fellowship and Residency Electronic Interactive Database Access System, the Accreditation Council for Graduate Medical Education-accredited Obstetrics and Gynecology residency programs in the United States were identified, and the residency program coordinators were asked to distribute the survey. Data regarding demographics, program-specific characteristics, and exposure to certain cosmetic gynecology procedures were obtained and reviewed. Participants' reported comfort with the independent practice of certain cosmetic gynecology procedures after graduation was also obtained. Descriptive statistics were completed. Results A total of 96 responses were received. Approximately 50% of participants were exposed to cosmetic gynecology during training. Moreover, 70.9% of residents disagreed that they would feel confident in defining the included procedures. Furthermore, 87.5% disagreed that they would feel comfortable performing the procedures independently. A minority of participants were also unsure of the indication for cosmetic gynecology procedures, with 15.4%, 7.1%, 5.7%, and 4% unaware of the surgical indication for hymenoplasty, vaginoplasty, labiaplasty, and labia majora reduction, respectively. No participant knew the indication of surgery for vaginal laser therapy or clitoral hood reduction. Conclusions In the setting of current cosmetic gynecology training, nearly 90% of residents were not comfortable with these surgeries after graduation. Exposure to cosmetic gynecology for obstetrics and gynecology residents was limited. Without adequate exposure, residents may face difficulty performing procedures and managing complications after graduation. Therefore, standardizing resident training for cosmetic gynecology should be considered.

(110) THE SURGICAL ANATOMY OF CLITORAL INNERVATION: A REVIEW OF THE CURRENT MEDICAL LITERATURE

Abstract Introduction The clitoris is a crucial structure for sexual arousal and orgasm in people with gynecological anatomy. Despite its functional importance, the innervation of the clitoris has historically been understudied. The innervation of the clitoris includes somatic afferents of the dorsal nerve of the clitoris, a branch of the pudendal nerve and sacral plexus, and autonomic afferents of the cavernous nerve, a branch of the inferior hypogastric plexus. Although we have identified these structures, there remains a paucity of research on surgical techniques to avoid clitoral innervation during pelvic surgery, despite the importance of these nerves in gynecological sexual function. Objective This paper aims to summarize the current literature on clitoral innervation with special attention paid to the anatomical locations of nervous structures within the pelvis to inform future pelvic surgeons and reduce sexual side effects related to clitoral nerve damage. Methods We performed a PubMed search from inception through June 14, 2023 utilizing the Medical Subject Headings (MeSH) search terms “(clitor*)) AND (innerv* OR nerv*) AND (surg*)” and imported this search into Covidence software. Included in the literature search were observational studies, clinical trials, review articles, correspondence, and communications, and only articles in English were included. Results An initial abstract screen of 200 articles resulted in 87 articles that were fully screened and 53 articles that were utilized as within the scope of this paper. 45 papers discussed the dorsal nerve of the clitoris, while 15 papers explored autonomic afferents via the cavernous nerve. The anatomical location of the dorsal nerve of the clitoris has been tracked in 29 papers, most of which utilize cadaver dissection, with at least six anatomic variations identified. The cavernous nerve’s exact location, however, has not been traced as extensively as has the location of the dorsal nerve of the clitoris, perhaps due to its smaller diameter and shorter length. Additional innervation to the clitoris was proposed in 12 studies as well. Many studies suggested that commonly performed procedures, including midurethral sling placement for stress urinary incontinence, labiaplasty, clitoral hood reduction, clitoroplasty, and urogenital sinus repair may interfere with clitoral innervation if not otherwise modified. Two studies discussed sensory mapping techniques prior to pelvic surgery to account for anatomic variation in clitoral innervation. Conclusions The clitoris is a vastly innervated structure with both somatic and autonomic afferents whose locations and anatomic variations should be considered when performing pelvic surgery. Failure to consider not only the dorsal nerve of the clitoris but the cavernous nerve as well may have consequences that negatively impact clitoral sensitivity, engorgement and erection, orgasmic ability, and overall sexual function. Disclosure No.

Cosmetic Gynecology

Cosmetic Gynecology (CG) is a rapidly emerging subspecialty. With the large media coverage, it had gained popularity in last few years. This review aims to provide an overview of the advancements, techniques, and considerations in aesthetic gynecology. We discuss common procedures such as labiaplasty, vaginal rejuvenation, and clitoral hood reduction, highlighting their indications, surgical techniques, outcomes, and patient satisfaction. Additionally, we explore emerging trends such as non-surgical treatments using laser therapy and Platelet-Rich Plasma (PRP) for tissue rejuvenation. Ethical considerations, patient education, and the importance of a multidisciplinary approach are also discussed. GC addresses both functional as well as aesthetic aspect of female external genitalia and is being considered as an excellent opportunity to address psychosexual issues if present. Overall, aesthetic gynecology offers valuable options to improve women’s confidence, comfort, and quality of life.

Edge Labiaplasty with Clitoral Hood Reduction: Pitfalls and Pearls.

Edge Labiaplasty with Clitoral Hood Reduction: Pitfalls and Pearls.

(265) The Surgical Anatomy of Clitoral Innervation: A Review of the Current Medical Literature

Abstract Introduction The clitoris is a crucial structure for sexual arousal and orgasm in people with gynecological anatomy. Despite its functional importance, the innervation of the clitoris has historically been understudied. The innervation of the clitoris includes somatic afferents of the dorsal nerve of the clitoris, a branch of the pudendal nerve and sacral plexus, and autonomic afferents of the cavernous nerve, a branch of the inferior hypogastric plexus. Although we have identified these structures, there remains a paucity of research on surgical techniques to avoid clitoral innervation during pelvic surgery, despite the importance of these nerves in gynecological sexual function. Objective This paper aims to summarize the current literature on clitoral innervation with special attention paid to the anatomical locations of nervous structures within the pelvis to inform future pelvic surgeons and reduce sexual side effects related to clitoral nerve damage. Methods We performed a PubMed search from inception through June 14, 2023 utilizing the Medical Subject Headings (MeSH) search terms “(clitor*)) AND (innerv* OR nerv*) AND (surg*)” and imported this search into Covidence software. Included in the literature search were observational studies, clinical trials, review articles, correspondence, and communications, and only articles in English were included. Results An initial abstract screen of 200 articles resulted in 87 articles that were fully screened and 53 articles that were utilized as within the scope of this paper. 45 papers discussed the dorsal nerve of the clitoris, while 15 papers explored autonomic afferents via the cavernous nerve. Fourteen papers discussed both somatic and autonomic innervation to the clitoris. The anatomical location of the dorsal nerve of the clitoris has been tracked in 29 papers, most of which utilize cadaver dissection, with at least six anatomic variations identified. The cavernous nerve’s exact location, however, has not been traced as extensively as has the location of the dorsal nerve of the clitoris, perhaps due to its smaller diameter and shorter length. Additional innervation to the clitoris was proposed in 12 studies as well. Many studies suggested that commonly performed procedures, including midurethral sling placement for stress urinary incontinence, labiaplasty, clitoral hood reduction, clitoroplasty, and urogenital sinus repair may interfere with clitoral innervation if not otherwise modified. Two studies discussed sensory mapping techniques prior to pelvic surgery to account for anatomic variation in clitoral innervation. Conclusions The clitoris is a vastly innervated structure with both somatic and autonomic afferents whose locations and anatomic variations should be considered when performing pelvic surgery. Failure to consider not only the dorsal nerve of the clitoris but the cavernous nerve as well may have consequences that negatively impact clitoral sensitivity, engorgement and erection, orgasmic ability, and overall sexual function. Disclosure No.

Violence against Women: Comparing Female Genital Mutilation and Female Circumcision in Malaysia

The United Nations (UN) General Assembly resolution on 20 December 2012 declared female genital mutilation (FGM) illegal and a violation of women's rights. This declaration was made following the World Health Organization's (WHO) call to eradicate FGM in 1997. The prohibition includes all forms of mutilating, harming, or causing pain to the female genitalia. The female circumcision practice in Malaysia is also categorized as FGM by the United Nations Human Rights (UNHR) at the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) in 2018. In light of these developments, this qualitative study examines and compares the true nature and concepts of FGM and the female circumcision practice from the perspective of Al-Sunnah Al-Nabawiyyah. Documentation was employed for data collection, analysis, and interpretation. The findings reveal a significant divergence between FGM and female circumcision. Female circumcision is more similar to the aesthetic surgery of the female genitalia, known as clitoral hood reduction, which can enhance women's sexuality. In conclusion, female circumcision in Malaysia is not a torturous act that violates women's rights, but rather a safe practice following Islamic law. This study also proposes a comprehensive research initiative aimed at formulating secure and Sharia-compliant protocols for female circumcision.

Women's Knowledge, Attitudes, and Practice About Female Genital Cosmetic Surgery: A Cross-Sectional Study in Saudi Arabia.

Introduction Vulvoplasty, or female genital cosmetic surgery (FGCS), refers to any surgical alteration of the vaginal or labial anatomy for aesthetic or medical reasons. It aims to restore or enhance the female genitals and can involve multiple procedures such as labiaplasty, clitoral unhooding, monsplasty, vaginoplasty, hymenoplasty, G-spot augmentation, frenuloplasty, perineoplasty, fat injections, or a combination of these. Labiaplasty is currently the most popular procedure among patients. Since the public is exploring FGCS benefits in the media, it can be foreseen that it will soon gain popularityamong the population of Saudi Arabia. As a result, the purpose of this study is to assesswomen'sattitudes and knowledge towards genital cosmetic surgeries in Saudi Arabia. Methods This correlational cross-sectional survey was conducted in Saudi Arabia among women aged 18 years and above, using an online self-structured questionnaire distributed from April 2023 to October 2023. The sample size of 594 respondents was determined based on a minimum requirement of 500 participants, with a confidence level of 95% and a study power of 95%. A convenient sampling method was employed to select participants, and data collection was carried out through a self-administered online questionnaire distributed via various social media platforms. The survey was self-structured, andCronbach's alpha values for all sections were greater than 0.7. These sections includedemographic characteristics, sexual life and obstetric history, and women's knowledge, practices, and attitudes toward FGCS. Descriptive analysis, chi-square test, and t-test were used for data analysis using SPSS software. Results A total of 589 eligible women were included in the study;284 (48.2%) were from the central region, and ages ranged from 18 to 65 years, with a mean age of 33.5 years. A total of 401 (68.1%) were married, 366 (62.1%) had a bachelor degree. Two hundred and ninety-one(49.4%) participants heard about FGCS, 165 (28%) knew that it involves surgical procedures to change the appearance of the female genitalia, 144 (24.4%) said it is also known as vaginal rejuvenation or designer vagina surgery and 200 (34%) knew it can involve procedures such as labiaplasty, clitoral hood reduction, or vaginal tightening, while 190 (32.3%) reported it is sometimes done for aesthetic reasons but may also be done for medical reasons. Only 45 (7.6%) had undergone FGCS, but 112 (19%) confirmed they consider undergoing FGCS for themselves. Four hundred and ninety-eight (84.6%) participants thought that it's important to have access to support services, such as counseling or peer support, 471 (80%) expressed that it's important that healthcare providers in Saudi Arabia are knowledgeable about FGCS, 425 (72.2%) were concerned about the potential risks and complications of FGCS. Conclusion In conclusion, the current study revealed that nearly one out of five women were knowledgeable about FGCS, mainly about the nature and types of the procedure. Higher knowledge levels about FGCS were associated with younger age, higher educational levels, and women who were more likely to consider undergoing FGCS in the future.

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.

Long-Term Follow-up in Labiaplasty in 414 Women: A Single-Center Experience in China.

Women with labial hypertrophy may opt for labiaplasty. The aim of the study was to analyze the complications, long-term follow-up of clinical outcomes and satisfaction in this population over the past 10 years.All women who underwent labiaplasty with or without clitoral hood reduction at our center between January 2008 and August 2020 were retrospectively identified. Retrospective study was conducted, recording follow-up outcomes, motivations, techniques, postoperative complications, reasons requiring reoperation, and surgical satisfaction concerned different clinical characteristics. A concrete analysis of each specific outcome and a detailed knowledge of these procedures were performed.A total of 52.41% reported functional impairment, 20.25% cited aesthetics complains, and 27.34% were motivated by both the previously mentioned reasons. Women undergoing surgical correction sometimes mixed with various psychological aspects. A total of 91.06% reported that they were moderately (6.04%) or extremely (85.02%) satisfied with the outcomes after surgery, and 37 (8.94%) reported dissatisfied. Revision surgery was needed in a small number of patients (n = 7 of 414 patients, 1.69%) because of undesirable appearance. The most common complication in our patients was asymmetry (6.28%). Women requested labiaplasty in the last 2 reasons or procedures or without psychological distress were more likely feel satisfied with the results (satisfaction rate >90%). There was a significant difference in satisfaction among the 3 concerns as well as between the 2 kinds of psychological conditions ( P < 0.05). Satisfaction of patients with aesthetic complains compared with the other 2 worries was significantly lower ( P < 0.05). There was no significant difference among the 3 procedures in this comparison group ( P > 0.05). In addition, satisfaction in labiaplasty with or without clitoral hoodoplasty, neither of which was statistically different ( P > 0.05). Patients aged 30 to 39 years reported the lowest satisfaction in comparison with the other age groups.Labiaplasty of the labia minora is the most commonly performed genital cosmetic surgery procedure. This study on 414 patients demonstrated that it is associated with a high degree of patient satisfaction and low morbidity and provided evidence of safety and effectiveness preliminary, indicating that the procedure may be regarded as safe.

Female Genitalia in Pornography: The Source of Labiaplasty Trends?

ABSTRACT Introduction Trends in appearance of female genitalia has been influenced by social media, entertainment industry, and even politics. Cosmetic labiaplasty has increased by 56% over the last decade. Wide availability and accessibility of pornography is another source where women and men learn about the anticipated normal appearance of the genitals. Objective The purpose of this review is to evaluate the current trends in appearance of female genitalia based on the most viewed pornography videos. We hypothesized that pornography may influence such trends in labiaplasty. Methods After panel of experts agreed on definitions and classifications of the different genital parts and beautification trends, we reviewed videos from the category “most viewed videos” on the most popular free pornography websites. We analyzed common representations of female genital appearance, including hair grooming (completely shaved, trimmed, natural), hyperpigmentation (natural with hyperpigmented perianal and labial skin vs. bleached with equal hyperpigmentation throughout), appearance of labia majora (thickness, length), appearance of labia minora (presence and length compared to the labia majora), clitoral hood appearance (status post clitoral hood reduction), and width of the genital hiatus. Results We reviewed the 25 most viewed videos from the five most popular free pornography websites. Among females and males, complete shaving of the pubic hair was the most common pattern, 56% (14) and 52% (13) respectively, followed by the trimmed pubic hair equally among both genders 40% (10). Only 8% of videos demonstrated labia majora resembling pre-pubertal (surgically enhanced) appearance. 44% of women had labia minora larger than labia majora, 36% had them at equal length, and 16% showed no labia minora. We did not see any dangling labia. 92% of videos demonstrated a normal appearing clitoral hood with no signs of surgical reduction. Bleaching or removal of natural hyperpigmentation was noted in 20% of videos. Wide genital hiatus consistent with vaginal delivery was identified in 16% of videos. No signs of pelvic organ prolapse, piercings, or other abnormalities were noted. Conclusions We found that the most popular pornography videos had a range of genital appearances. Pornogaphy definitely influenced hair grooming pattern. The most viewed videos on the most popular pornography sites may create expectations for both genders on the genital appearance of a partner. Disclosure No

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.

Preliminary Exploration of a New Clitoral Hood Classification System and Treatment Strategy.

Increasing attention has been given to clitoral hoods in recent years, but few studies have been conducted on the classification and treatment strategies of clitoral hood hypertrophy. The purpose of this article is to introduce a new system of clitoral hood classification based on relevant anatomy and make recommendations for clitoral hood reduction. The clitoral hood region is divided into the central zone (zone C) and the lateral zone (zone L). According to the anatomical characteristics of each zone, patients can be divided into 5 types: standard form, central hypertrophy, lateral hypertrophy, composite hypertrophy and special type. Central hypertrophy is further divided into wide and long clitoral hoods, and horizontal and vertical redundancy are addressed using bilateral clitoral hood triangular skin resection and inverted horizontal V-shaped skin resection, respectively. Lateral hypertrophy can be treated with vertically oriented excision. Composite hypertrophy is corrected by combining these methods to remove redundant tissue depending on the situation. 1135 patients were classified according to the new classification system and 789 participants were given corresponding treatment measures. Thirty-four patients (4.3%) experienced complications, and 15 (1.9%) underwent revision surgery. Six months after the procedure, clitoral hood images improved significantly without paresthesia, and the overall satisfaction rate of the patients regarding clitoral hood reduction was 95.7%. The clitoral prepuce is an important part of the aesthetic unit of female vulva. The new clitoral hood classification strategy systematically summarizes the anatomical characteristics of the clitoral hood and clearly makes recommendations for surgical options. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Female Genitalia in Pornography: The Source of Labiaplasty Trends?

ABSTRACT Introduction Trends in appearance of female genitalia has been influenced by social media, entertainment industry, and even politics. Cosmetic labiaplasty has increased by 39% over the last decade. Wide availability and accessibility of pornography is another source where women and men learn about the anticipated normal appearance of the genitals. Objective The purpose of this review is to evaluate the current trends in appearance of female genitalia based on the most viewed pornography videos. We hypothesized that pornography may influence such trends in labiaplasty. Methods After panel of experts agreed on definitions and classifications of the different genital parts and beautification trends, we reviewed videos from the category “most viewed videos” on the most popular free pornography websites. We analyzed common representations of female genital appearance, including hair grooming (completely shaved, trimmed, natural), hyperpigmentation (natural with hyperpigmented perianal and labial skin vs. bleached with equal hyperpigmentation throughout), appearance of labia majora (thickness, length), appearance of labia minora (presence and length compared to the labia majora), clitoral hood appearance (status post clitoral hood reduction), and width of the genital hiatus. Results We reviewed the 25 most viewed videos from the five most popular free pornography websites. Among females and males, complete shaving of the pubic hair was the most common pattern, 56% (14) and 52% (13) respectively, followed by the trimmed pubic hair equally among both genders 40% (10). Only 8% of videos demonstrated labia majora resembling pre-pubertal (surgically enhanced) appearance. 44% of women had labia minora larger than labia majora, 36% had them at equal length, and 16% showed no labia minora and were consistent with labiaplasty. 92% of videos demonstrated a normal appearing clitoral hood with no signs of surgical reduction. Bleaching or removal of natural hyperpigmentation was noted in 20% of videos. Wide genital hiatus consistent with vaginal delivery was identified in 16% of videos. No signs of pelvic organ prolapse, piercings, or other abnormalities were noted. Conclusions We found that the most popular pornography videos had a range of genital appearances, disproving our hypothesis that labiaplasty and bleaching are commonly seen in pornography. However, pornography likely has influenced trends in hair removal. The most viewed videos on the most popular pornography sites may nonetheless create expectations for both genders on the genital appearance of a partner. Disclosure No

Trilobal Methods for Composite Reduction Labiaplasty.

BackgroundIt is difficult to plan a simple and effective surgical strategy for patients with horizontal and vertical redundant tissue of the labia minora and clitoral hood redundancy. A single edge resection or wedge resection labiaplasty with clitoral hood reduction that simultaneously resolves these three issues has yet to be reported. This study investigated the clinical effects and safety of trilobal labiaplasty via a composite incision.MethodsThe single-center, retrospective, observational study included data from patients with hypertrophy of the labia minora and clitoral hood who underwent trilobal labiaplasty.ResultsAltogether, 136 patients (average age: 31.6 ± 8.82 years; range: 21–53 years; 224 sides) sought surgery for aesthetic (39/136, 28.7%), functional (17/136, 12.5%), or both reasons (80/136, 58.8%). Overall, 134 patients (134/136, 98.5%) were followed up for 3 months. No serious complications or malformations occurred. Three patients (2.2%) underwent secondary repair surgery due to incomplete bilateral symmetry, 122 (91.0%) scored ≥ 21 points on the Female Genital Self-Image Scale, 107 (91.5%) were satisfied with the cosmetic outcomes, and 93 (95.9%) were satisfied with the functional improvement.ConclusionsTrilobal labiaplasty performed via a composite incision using edge and wedge labiaplasty to adjust horizontal and vertical hypertrophy of the labia minora and remove lateral folds of the clitoris is a safe and effective method to improve the appearance and rearrange the position of the clitoral hood and clitoral frenulum while preserving the fine structure of the surrounding tissue. This method results in few complications and high functional and aesthetic satisfaction rates.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Three-Step Excision: An Easy Way for Composite Labia Minora and Lateral Clitoral Hood Reduction.

Hypertrophy of the labia minora with lateral clitoral hood redundancy is common, but the excess clitoral hood is often overlooked during labiaplasty, which may result in imbalanced and unsatisfactory outcomes. The purpose of this study was to present an easy method of three-step excision for composite labia minora and lateral clitoral hood reduction. The procedure was performed in three steps: the prominent clitoral hood skin parallel to the labia majora and the clitoral hood sulcus was removed first; then, the protuberant portion of the labia minora was removed by wedge resection; and finally, a triangle at the junction between the labia minora and the clitoral hood was trimmed. Patients were required to return for examination on the first day and within 14 days after surgery. Follow-ups were arranged on the Internet or at the outpatient clinic. Satisfaction questionnaires were completed during follow-up. Between January of 2016 and January of 2020, 136 patients underwent composite labia minora and lateral clitoral hood reduction. Ages ranged from 9 to 55 years. Six patients experienced complications (4.4 percent) and five underwent revision surgery (3.7 percent). The overall satisfaction rate within 14 days and after 3 months following surgery was 91.0 percent and 95.5 percent, respectively. Preoperative discomfort was resolved in 43.0 percent and significantly relieved in 54.2 percent, and sex life was improved in 70.9 percent. Three-step excision is effective and safe for composite labia minora and lateral clitoral hood reduction with very high satisfaction. Considering the advantages of easy preoperative design and controllable tissue removal, this method could be a better alternative to the present procedures. Therapeutic, IV.

The Safe Practice of Female Genital Plastic Surgery.

Summary:The purpose of this article is to guide surgeons in the safe practice of female genital plastic surgery when the number of such cases is steadily increasing. A careful review of salient things to look for in the patient’s motivation, medical history, and physical examination can help the surgeon wisely choose best candidates. The anatomy is described, with particular attention given to the variations not generally described in textbooks or articles. Descriptions are included for labiaplasty, including clitoral hood reduction, majoraplasty, monsplasty, and perineoplasty with vaginoplasty. Reduction of anesthetic risks, deep venous thromboses, and pulmonary emboli are discussed, with special consideration for avoidance of nerve injury and compartment syndrome. Postoperative care of a variety of vulvovaginal procedures is discussed. Videos showing anatomic variations and surgical techniques of common female genital procedures with recommendations to reduce the complication rate are included in the article.

Clinical and ethical perspectives of medical professionals towards female genital cosmetic procedures

Objective:To evaluate the attitudes of medical students and professionals towards female genital cosmetic procedures (FGCPs) in terms of medical justification, applicability in practical life, ethical concerns, patient autonomy, and the clinical/social/psychological benefits-harms of these procedures.Materials and Methods:A semi-structured questionnaire providing information about the attitudes of medical students and specialists (n=623) towards FGCPs including G-spot amplification, clitoral hood reduction, vaginoplasty, labia majora augmentation/reduction, labia minora augmentation/reduction, hymenoplasty, laser procedures, vulvar/perianal bleaching, and liposculpture, was completed by a target population and evaluated statistically.Results:Participants stated that FGCPs could be performed only upon patient request and there could rarely be a medical indication for their performance (p<0.05). Nearly half (44.5%) of the participants regarded hymenoplasty as controversial in terms of ethical issues, and 44.6% of participants do so for G-spot amplification. Over half (54.5%) of the participants agreed on the positive effect of FGCPs on improving the quality of life, 55.4% on improving self-esteem, and 54.1% on improving sexual functions of women. About half (49.3%) of respondents thought that the advertising and encouragement of FGCPs should be forbidden and 47% were indecisive about whether FGCPs constituted genital mutilation.Conclusion:The majority of the participants declared that FGCPs could be performed only upon patient request and improve self-esteem, quality of life, and sexual functions. The most controversial procedures in terms of ethics were hymenoplasty and G-spot amplification. Detailed guidelines for the protection of both patients and physicians are needed because the recommendations on FGCPs are insufficient to define the boundaries of medical justification, genital mutilation, advertising, and ethical concerns.

L-Shaped Incision in Composite Reduction Labiaplasty

Labia minora hypertrophy, in combination with clitoral hood protrusion, is a common deformity encountered in clinic practice and should be treated as a compound entity. Most targeted surgical procedures are too complex to understand and master. Herein, we introduce a relatively simple method to correct this deformity. In this study, we retrospectively review our experience treating patients with deformity of labia minora hypertrophy combined with clitoral hood protrusion between January 2017 and November 2019. All patients received correction surgery to repair the complex deformity. During the procedures, we divided the complex operation into two parts: clitoral hood reduction using L-shaped incision and then labiaplasty using L-shaped edge resection. We describe the details of the method step-by-step and evaluate the treatment outcomes. A total of 38 sides (14 bilateral procedures and 10 unilateral procedures) of clitoral hood reduction and labiaplasty were performed. There were no wound healing complications in any cases. One patient had a secondary corrective operation for obvious asymmetry of bilateral labia minora. Ultimately, all the patients were satisfied with the cosmetic appearance and did not have complaints. The surgical procedure we describe proved to be an effective, simple method for dealing with the complex situation of hypertrophy of labia minora combined with clitoral hood protrusion. Subsequent L-shaped edge resection of labiaplasty is appropriate for individuals with darker skin, in particular.Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Genital Surgery.

Cosmetic gynecology—a systematic review and call for standardized outcome measures

Cosmetic gynecology, a field which has garnered substantial attention over recent years, lacks a universally accepted nomenclature. The aim of this systematic review is to evaluate techniques, outcome measures reported, and adverse events in patients undergoing cosmetic gynecology procedures and offer recommendations to improve reporting metrics. A systematic literature search was performed using electronic databases from inception to April 2019. The search was based on 51 unique cosmetic gynecology keywords such as: "labiaplasty," "vaginal rejuvenation," and "liposuction mons pubis." All English full-text prospective and retrospective observational and interventional studies with at least five subjects that describe a cosmetic gynecology procedure were included. Only full-text articles were included. This protocol has been registered with PROSPERO (CRD 42019131860). A total of 1837 articles were identified from the search strategy with 42 included in the quantitative synthesis. Procedures described included: labia minora reduction with or without clitoral hood reduction, labia majora augmentation, surgical vaginal caliber reduction, mons pubis reduction/suspension, and energy-based therapy for vaginal laxity or vulvar laxity. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. Complication rates varied by procedure but were generally low and ranged between Clavien-Dindo grades I-III. Although there is a breadth of literature on cosmetic gynecology surgical techniques and short-term complication rates, the terminology and outcome measures utilized are heterogeneous. To address this, standardized terminology along with uniform cosmetic and functional endpoints must be developed.

Elective Female Genital Cosmetic Surgery: ACOG Committee Opinion Summary, Number 795.

"Female genital cosmetic surgery" is a broad term that comprises numerous procedures, including labiaplasty, clitoral hood reduction, hymenoplasty, labia majora augmentation, vaginoplasty, and G-spot amplification. Both patient interest in and performance of cosmetic genital procedures have increased during the past decade. Lack of published studies and standardized nomenclature related to female genital cosmetic surgical procedures and their outcomes translates to a lack of clear information on incidence and prevalence and limited data on risks and benefits. Women should be informed about the lack of high-quality data that support the effectiveness of genital cosmetic surgical procedures and counseled about their potential complications, including pain, bleeding, infection, scarring, adhesions, altered sensation, dyspareunia, and need for reoperation. Obstetrician-gynecologists should have sufficient training to recognize women with sexual function disorders as well as those with depression, anxiety, and other psychiatric conditions. Individuals should be assessed, if indicated, for body dysmorphic disorder. In women who have suspected psychological concerns, a referral for evaluation should occur before considering surgery. As for all procedures, obstetrician-gynecologists who perform genital cosmetic surgical procedures should inform prospective patients about their experience and surgical outcomes. Patients should be made aware that surgery or procedures to alter sexual appearance or function (excluding procedures performed for clinical indications, such as clinically diagnosed female sexual dysfunction, pain with intercourse, interference in athletic activities, previous obstetric or straddle injury, reversing female genital cutting, vaginal prolapse, incontinence, or gender affirmation surgery) are not medically indicated, pose substantial risk, and their safety and effectiveness have not been established.