[Cosmetic surgery of the female genitalia].

INTRODUCTION

This review studies rationale and outcome of vulvovaginal aesthetic surgery.

METHOD

Medline search of the existing literature utilizing terms labiaplasty, clitoral hood reduction, hymenoplasty, vaginoplasty, perineoplasty, female genital surgery, sexual satisfaction/body image, and anterior/posterior colporrhaphy; references from bibliographies of papers found through the literature search and in the author's reading of available literature until January 2012. Clinicians who receive requests from patients for such procedures should discuss with the patient the reason for request and perform an evaluation for any physical signs or symptoms that may indicate the need for surgical intervention.

RESULTS

A physical psychological and sexological evaluation is mandatory before a procedure of female cosmetic genital surgery. Perineoplasties in wide vagina sensations should be proposed after careful evaluation of patients, by trained surgeons, in part of a multidisciplinary approach especially sexologic, after attempt of conservative treatments (pelvic floor rehabilitation). Patients should be informed of results and complications. Female genital mutilation repair with surgery is possible and improve majority of patients. Improvement mechanism is complex and clinical trials are ongoing. Asking for this surgery, is more often result of a deep reflexion for patient who integrate his own story and those of her family. She should be listened to, respected and managed in a reference center. Sexotherapy should be systematically proposed. Concerning hymenoplasty, the procedure is considered as "legally" by medical doctors. Several techniques are available, few described, and there is no evidence-based publication. Labioplasty is a procedure whose patient expectations should be properly evaluated by surgeon and benefits risks should be informed. A preliminary discussion around "normality" and a psychotherapy should be tried, in order to not treat a dysmorphobia by surgery. Vaginal "rejuvenation" and G spot ampliation principles and techniques are very controversial and there is no evidence-based study.

CONCLUSION

Cosmetic surgery of the female genitalia covers a variety of techniques corresponding to extremely diverse situations. It requires careful and multidisciplinary evaluation as well as clear and honest information of patients. Reconstructive surgery of female genital mutilation and sexual crimes does not pose a real problem in term of indication or justification.