Genital Cosmetic Surgery and Sexuality: Mini-Review

Body image is a concept that includes individuals’ health status, physical appearance and skills, attitudes and perceptions about their sexuality and constitutes the physical quality of the self [1]. It is known that body image is related to sexual functions [2,3]. When considered in this context, it can be said that body image is a factor affecting genital aesthetic operations. Genital aesthetics is the general name of surgical or non-surgical procedures performed to improve the appearance or functionality of the external genital area of women. These procedures are performed to address aesthetic concerns or, in some cases, to solve functional problems in the inner or outer parts of the vagina. Vaginal aesthetic procedures may include G-spot amplification, clitoral hood reduction, labia majora augmentation, labia majora reduction, labia minora augmentation, labia majora reduction, laser vaginal tightening, laser for genitourinary syndrome of menopause, vaginoplasty, vulvar/perianal bleaching, liposculpture, and hymenoplasty [4].

The convergence of genital cosmetic surgery and sexuality is a complicated subject that includes both personal goals for physical change and cultural conventions about sexual attractiveness [5]. As the demand for genital cosmetic operations grows, it is critical to investigate the underlying motives, psychological ramifications, and ethical features of these interventions [6]. This essay seeks to clarify the complicated link between genital aesthetics and sexuality by investigating the mechanisms that drive this phenomenon and its implications for sexual well-being and identity. The concept of body image encompasses not only individuals’ physical health and appearance but also their skills, attitudes, and perceptions regarding sexuality, constituting a tangible manifestation of self. Indeed, studies have shown a correlation between body image and sexual functioning. Thus, it can be inferred that body image plays a pivotal role in influencing decisions regarding genital aesthetic procedures [7].

Genital aesthetics, a broad category encompassing both surgical and non-surgical interventions, seeks to enhance the appearance and functionality of the external genital area in women. These procedures address aesthetic concerns or resolve functional issues affecting the inner or outer aspects of the vagina. Examples include labiaplasty (reduction of the labia minora), labia majora augmentation, clitoral hood correction, vaginoplasty (vaginal tightening), G-spot enhancement, perineoplasty (reshaping of the perineal region), and hymenoplasty (reconstruction of the hymen) [8].

The proliferation of surgical interventions targeting female genitalia in recent years has been notable. Several factors contribute to this surge in demand, including misinformation about normal genital appearance, the pervasive influence of social media and the internet, and the spotlight placed on anatomical variances due to widespread pubic hair removal practices. Exposure to digitally altered images of the vulva, particularly on social media platforms, can distort women’s perceptions of normalcy and desirability, potentially swaying their decision to undergo labiaplasty. Often, such procedures are sought by individuals grappling with aesthetic or psychological concerns [9]. (Gomes et al., 2019).

Based on the literature about cosmetic surgery and genital esthetic, this review aims to determine the prevalence of female genital cosmetic surgery, investigate the recommendations of associations, and review the literature on this subject. This paper also investigates the complicated link between genital cosmetic surgery and sexuality, looking at the reasons for such surgeries, their influence on sexual well-being, and the ethical issues surrounding this emerging profession.

Women may seek vaginal aesthetic procedures due to various conditions, such as irregularities in labial shape or size, laxity or prominence of the labia majora, or sexual dysfunctions like difficulty achieving orgasm or experiencing pain during intercourse [10]. However, influenced by societal standards perpetuated by the media, many now aspire to achieve an idealized notion of beauty even in their genital region. Yet, the next four questions arise that will be discussed below.

The first question: What are the motivations for genital cosmetic surgery?

Individuals are motivated to undertake genital cosmetic surgery for a variety of reasons, including self-image, sexual confidence, and social expectations. While some people seek these treatments to treat practical issues like discomfort or pain, others are motivated by aesthetic preferences or a desire to conform to perceived cultural beauty standards. According to research, dissatisfaction with genital appearance may have a significant impact on self-esteem and sexual happiness, leading people to seek surgical procedures to improve their perceived beauty and sexual confidence [11].

The second question: What is the impact of cosmetic surgery on sexual well-being?

The link between genital cosmetic surgery and sexual wellbeing is complicated and varied, with results that vary greatly across people. While some people report increased sexual pleasure and better body image after surgery, others may feel disappointed or dissatisfied if their expectations are not realized. Furthermore, the psychological impacts of genital cosmetic surgery can impair sexual performance and intimacy, demanding extensive prior counseling and aftercare. It is critical to remember that sexual wellbeing includes not just physical satisfaction but also emotional and psychological dimensions, emphasizing the necessity for comprehensive methods to address genital aesthetic problems [12].

The third question: What are the ethical considerations of cosmetic surgery?

The ethical considerations for genital cosmetic surgery include informed consent, patient autonomy, and cultural pressures. Critics claim that medicalizing genital appearance reinforces unattainable beauty standards and pathologizes natural variances, potentially leading to unneeded procedures and mental damage. Furthermore, concerns have been expressed about the monetization of sexuality and the reinforcement of gender standards through cosmetic operations. As a result, ethical principles and professional standards must promote patient well-being while ensuring that procedures are based on true therapeutic necessity rather than cosmetic improvement [13].

The fourth question: Should every woman desiring genital aesthetics undergo surgery?

In response to this question the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Royal College of Obstetricians and Gynaecologists (RCOG) have issued various recommendations, which are outlined in (Table 1) [14]. Surgical procedures for the female genital area have been increasing rapidly in recent years. Many factors may play a role in the increasing demand, including a lack of accurate information about normal genital appearance, the proliferation of misinformation on social media and the internet, and anatomical differences emphasized by the increasing practice of pubic hair removal. However, exposure to images of altered vulva, especially on social media, can change women’s perceptions of what is normal or desirable and may influence women’s decision to undergo labiaplasty. Such operations are often favored by women with aesthetic or psychological concerns. Individuals may apply for vaginal aesthetic procedures due to conditions such as an abnormal labia shape or size, sagging or voluminous labia majora, orgasm problems or pain during sexual intercourse. However, with the influence of the media, many women now want their genital area to be beautiful. Should every woman who wants to have genital aesthetics be operated on? There are various recommendations published by the Society of Obstetricians and Gynecologists of Canada (SOGC) (Table 1).

Table 1:Recommendations RCOG and SOGC.

The motivations underlying genital aesthetic procedures are intricately linked to perceptions of sexuality among adults. Surgical interventions targeting the genital area are meticulously tailored to enhance both sexual satisfaction and perceived attractiveness. Women who harbor dissatisfaction with the appearance of their genitalia often grapple with feelings of shame, diminished selfconfidence during sexual encounters, and heightened anxiety stemming from apprehensions regarding their partner’s potential negative perceptions [15]. Furthermore, for some individuals, sexual intercourse may engender physical discomfort and irritation, rendering it an undesirable experience. Consequently, a considerable subset of women unable to attain sexual fulfillment turn to genital plastic surgery as a recourse [16].

Initially conceived to address medical concerns such as the repair of episiotomy scars, excision of tumors, and urinary incontinence, the practice of genital aesthetics has evolved into a distinct surgical discipline known as genioplasty [16]. Gynecologists, obstetricians, and plastic surgeons collaborate in the provision of procedures aimed at rectifying perceived defects or dissatisfactions concerning the genital region, particularly in the aftermath of vaginal childbirth.

What are the rates of genital cosmetic surgery in the world?

The term aesthetics within the medical domain pertains to methodologies employed for rectifying or enhancing a deficient organ [16]. Global statistics indicate a notable escalation in the prevalence of aesthetic procedures, with a 5.4% surge observed in 2018 compared to the preceding year, culminating in an overall prevalence rate of 18.7%. Leading the charge in this domain are the United States of America, with 4,361,867 individuals, and Brazil, with 2,267,405 individuals, representing the countries where aesthetic procedures are most extensively practiced [17]. In Turkey, the prevalence of aesthetic procedures, encompassing both surgical and non-surgical modalities, stands at three out of every 100 individuals [17]. Notably, a gender-based analysis reveals a pronounced predominance of aesthetic procedures among women, accounting for 87.4% of the total procedures conducted [18].

Within the purview of genital aesthetics, the British Pediatric and Adolescent Gynecology Association reports a total of 266 genital aesthetic interventions conducted between 2008 and 2012, with a notable proportion being performed on individuals below the age of 14. Moreover, data from the National Health Service (NHS) in the United Kingdom evinces a fivefold increase in labiaplasty procedures over a span of nine years, spanning from 2001 to 2010. Concurrently, the American Society of Plastic Surgeons documents a substantial surge in vaginal rejuvenation procedures, with a notable 30% increase observed from 793 procedures in 2005 to 1030 procedures in 2006 [19]. These statistics underscore a growing trend in the realm of genital cosmetic surgery, shedding light on evolving societal perceptions and preferences regarding genital aesthetics. Further research is warranted to comprehensively elucidate the underlying factors driving this phenomenon and its potential implications on individual well-being and societal dynamics.

Genital aesthetic surgery is primarily aimed at enhancing individuals’ sexual well-being. The correlation between body satisfaction and sexual behaviors underscores the significance of addressing dissatisfaction with one’s body, as individuals harboring such sentiments tend to exhibit heightened self-consciousness during sexual encounters, potentially diminishing their sexual interest [2]. Research indicates that individuals with greater body satisfaction report more frequent sexual experiences, encounter fewer sexual difficulties, and perceive themselves as more sexually appealing compared to those with lower levels of satisfaction [3,20]. For instance, Træen et al. (2016) conducted a cross-sectional investigation among Norwegian young adults aged 18-29 years, revealing a significant association between body image and sexual satisfaction, particularly among women. Genital surgery may thus be considered in addressing sexual dysfunctions experienced by individuals with negative body image perceptions, especially about genital appearance.

Psychosocial factors, alongside mental health considerations, play a pivotal role in individuals’ decisions regarding aesthetic surgery. Hence, thorough psychosocial assessment of female applicants is deemed essential alongside physical evaluation [21]. As with any surgical intervention, genital aesthetic surgery entails psychological stress. Thus, providing evidence-based information concerning normal genital anatomy, the surgical procedure, anticipated postoperative anatomical outcomes, as well as potential complications is imperative for informed decision-making, involving both the woman and her partner [21]. It is noteworthy that genital aesthetic surgery is not advocated for adolescents. In a study involving 136 adolescent female students, educational interventions utilizing videos and photographs were implemented to enhance understanding of the variations in normal genital morphology and foster positive attitudes towards genital appearance. The findings suggest that educational interventions, such as informative videos, can positively influence adolescents’ perceptions regarding genital aesthetics [22]. Consequently, it is recommended that adolescents expressing interest in genital aesthetic procedures receive comprehensive education and counseling before pursuing such interventions.

Web of Science search of the existing literature utilizing three terms labiaplasty, female genital surgery, and sexuality the top ten papers cited highest found through the literature search are listed in (Table 1). The citations of the ten top papers in WoS were also checked in Scholar Google database [23]. (Table 2) shows that the paper titled “A Large Multicenter Outcome Study of Female Genital Plastic Surgery” studied by Goodman et al. has the highest citation both in WoS and Scholar Google.

Table 2:The top Ten Research about genital Cosmetic Surgery and sexuality.

In conclusion, the relationship between genital cosmetic surgery and sexuality is a multifaceted tapestry woven with threads of individual aspirations, societal norms, and ethical considerations. At its core, this link is deeply intertwined with the complex interplay of personal identity and societal expectations regarding physical appearance and sexual desirability. For some individuals, genital cosmetic surgery represents an opportunity to address physical discomfort, enhance sexual satisfaction, or align their bodies with their gender identity. However, these procedures also raise profound questions about the influence of cultural ideals on body image and the extent to which individuals feel pressured to conform to narrow standards of beauty.

Moreover, the connection between genital cosmetic surgery and sexuality underscores broader issues surrounding bodily autonomy and the medicalization of human sexuality. As these procedures become more commonplace, there is a risk of reducing diverse expressions of sexuality to a set of standardized aesthetic norms, potentially overshadowing the importance of individual experiences and preferences. Additionally, the commercialization of genital cosmetic surgery raises concerns about the ethical implications of treating intimate aspects of human anatomy as marketable commodities, potentially exploiting individuals’ insecurities for financial gain [26-28].

Moving forward, it is imperative to approach the intersection of genital cosmetic surgery and sexuality with sensitivity, empathy, and a commitment to ethical practice. This necessitates acknowledging the diverse motivations and experiences of individuals seeking these procedures, as well as the broader societal forces that shape their decisions. A patient-centered approach that prioritizes informed consent, psychological well-being, and comprehensive sexual health is essential in navigating this complex terrain [29- 31]. By fostering open dialogue, promoting diversity, and upholding ethical standards, we can strive to create a more inclusive and supportive environment in which individuals are empowered to make decisions about their bodies and sexualities on their own terms.

None.

No conflict of interest.

1. Hamurcu P, Öner C, Telatar B, Yeşildağ Ş (2015) Obezitenin benlik saygısı ve beden algısı üzerine etkisi. 19(3): 122-129.
2. Woertman L, Van den Brink F (2012) Body image and female sexual functioning and behavior: A review. Journal of Sex Research 49(2-3): 184-211.
3. van den Brink F, Vollmann M, Smeets MA, Hessen DJ, Woertman L (2018) Relationships between body image, sexual satisfaction, and relationship quality in romantic couples. Journal of Family Psychology 32(4): 466-474.
4. Wiśniewska-Ślepaczuk K, Pieczykolan A, Grzesik-Gąsior J, Wdowiak A (2021) A review of aesthetic gynecologic procedures for women. Plastic and Aesthetic Nursing 41(4): 191-202.
5. Roche NA (2020) Unruly Labia: Female Genital Cosmetic Surgery and the Production of Normality. University of California, Santa Cruz.
6. McDougall L (2021)The perfect vagina: cosmetic surgery in the twenty-first century. Indiana University Press: 276.
7. Goodman MP, Placik OJ, Matlock DL, Simopoulos AF, Dalton TA, et al. (2016) Evaluation of body image and sexual satisfaction in women undergoing female genital plastic/cosmetic surgery. Aesthetic surgery journal 36(9): 1048-1057.
8. Alavi-Arjas F, Goodman MP, Simbar M, Majd HA, Sharp G, et al. (2023) The effect of female genital cosmetic and reconstructive procedures on body and genital self-image: a systematic review and meta-analysis. Aesthetic Surgery Journal 43(10): 1161-1173.
9. Gomes TBS, Brasil CA, Barreto APP, Ferreira RS, Berghmans B, et al. (2019) Female genital image: is there a relationship with body image? Turkish journal of obstetrics and gynecology 16(2): 84-90.
10. Goodman MP (2009) Female cosmetic genital surgery. Obstetrics & gynecology 113(1): 154-159.
11. Eftekhar T, Hajibabaei M, Deldar Pesikhani M, Rahnama P, Montazeri A (2019) Sexual quality of life, female sexual function, female genital self-and body image among women requesting genital cosmetic surgery: a comparative study. Psychology & Sexuality 10(2): 94-100.
12. Applebaum SA, Placik OJ (2022) Genital self-image and esthetic genital surgery. Clinics in Plastic Surgery 49(4): 509-516.
13. Yeğin GF, Kılıç G, Seçen Eİ, Bahadır İB, Taş EE, et al. (2021) Clinical and ethical perspectives of medical professionals towards female genital cosmetic procedures. Turkish Journal of Obstetrics and Gynecology 18(2): 131-138.
14. Shaw D, Allen L, Chan C, Kives S, Popadiuk C, et al. (2022) Guideline No. 423: Female genital cosmetic surgery and procedures. Journal of Obstetrics and Gynaecology Canada 44(2): 204-214.
15. Kingsberg SA, Althof S, Simon JA, Bradford A, Bitzer J, et al. (2017) Female sexual dysfunction - medical and psychological treatments, committee 14. The journal of sexual medicine 14(12): 1463-1491.
16. Beşen MA (2014) Cinsellik ve estetik. Duzce Medical Journal 16(1): 70-72.
17. ISAPS (2016) https://www.isaps.org/discover/about-isaps/global-statistics/reports-and-press-releases/global-survey-2016-full-report-and-press-releases-english/
18. ISAPS (2018) https://www.nygart.dk/wp-content/uploads/2019/12/ISAPS-Global-Survey-Results-2018-new.pdf
19. Barbara G, Facchin F, Meschia M, Vercellini P (2015) “The first cut is the deepest”: a psychological, sexological and gynecological perspective on female genital cosmetic surgery. Acta obstetricia et gynecologica Scandinavica 94(9): 915-920.
20. Træen B, Markovic A, Kvalem IL (2016) Sexual satisfaction and body image: A cross-sectional study among Norwegian young adults. Sexual and Relationship Therapy 31(2): 1-15.
21. Daşıkan Z, Kıratlı D, Erdoğan M (2019) Kadınların genital görünüm memnuniyeti: Genital kozmetik cerrahi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi 16(4): 238-243.
22. Sharp G, Tiggemann M (2016) Educating women about normal female genital appearance variation. Body image 16: 70-78.
23. (2024) Scholar Google database/ https://scholar.google.com
24. Alter GJ (2008) Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plastic and reconstructive surgery 122(6): 1780-1789.
25. Braun V (2010) Female genital cosmetic surgery: a critical review of current knowledge and contemporary debates. Journal of Women's Health 19(7): 1393-1407.
26. Choi HY, Kim KT (2000) A new method for aesthetic reduction of labia minora (the deepithelialized reduction labioplasty). Plastic and reconstructive surgery 105(1): 419-422.
27. Hodgkinson DJ, Hait G (1984) Aesthetic vaginal labioplasty. Plastic and reconstructive surgery 74(3): 414-416.
28. Goodman MP (2011) Female genital cosmetic and plastic surgery: a review. The journal of sexual medicine 8(6): 1813-1825.
29. Goodman MP, Placik OJ, Benson RH, Miklos JR, Moore RD, et al. (2010) A large multicenter outcome study of female genital plastic surgery. The journal of sexual medicine 7(4_Part_1): 1565-1577.
30. Puppo V (2013) Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction. Clinical Anatomy 26(1): 134-152.
31. Tiefer L (2008) Female genital cosmetic surgery: Freakish or inevitable? Analysis from medical marketing, bioethics, and feminist theory. Feminism & Psychology 18(4): 466-479.