Children's Bioethics Centre, Royal Children's Hospital (Melbourne), Flemington Road, Parkville, Victoria, 3052, Australia.
Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia.
J Bioeth Inq. 2018 Dec;15(4):535-548. doi: 10.1007/s11673-018-9878-1. Epub 2018 Oct 19.
Labiaplasty is a form of genital surgery to reduce large or protruding labia minora. Internationally, the rates of this surgery among women and girls is increasing and is viewed as a worrying trend. Currently, the main clinical strategy is to reassure adolescents that they are normal by talking about the variation of labia size and appearance and showing pictures demonstrating the wide range of normal female genital appearance. For the most part, policy documents recommend against labiaplasty in adolescents, claiming that it is medically non-essential surgery. In this paper, we contrast findings from our interviews with clinicians with the existing literature and policy documents and we point out areas needing more thought. This is qualitative research using semi-structured interviews. We set out to find out on what basis clinicians decide how to treat or manage adolescent patients seeking labiaplasty. We interviewed clinicians who are likely to be approached by under-eighteens requesting labiaplasty. We use interpretive content analysis and thematic analysis to analyse the data. Our findings support the emphasis on education and reassurance as the first step for all patients, but other issues that have not figured previously in the literature that would alter clinical strategies for managing patients emerge as well. Key findings are that reassurance does not always work and that the distinction between functional and appearance concerns is not a solid foundation in itself for deciding whether surgery is ethically appropriate. We conclude that the distinction between functional and appearance concerns is not ethically relevant. It is open to different interpretations and is not regarded by all clinicians as the definitive factor in relation to surgery. The focus of clinicians should be on relieving distress whatever the cause. Appearance reasons may sometimes justify surgery but, also, functional reasons may sometimes not be sufficient justification for surgery.
阴唇整形术是一种缩小或突出的小阴唇的生殖器手术。在国际上，这种手术在女性和女孩中的比例正在增加，被视为一种令人担忧的趋势。目前，主要的临床策略是通过谈论阴唇大小和外观的变化，并展示展示正常女性生殖器外观的广泛范围的图片，来安慰青少年，让她们知道自己是正常的。在大多数情况下，政策文件都反对青少年进行阴唇整形术，称其为非必要的医疗手术。在本文中，我们将临床医生的发现与现有文献和政策文件进行对比，并指出需要进一步思考的领域。这是一项使用半结构化访谈的定性研究。我们旨在了解临床医生如何根据什么来决定如何治疗或管理寻求阴唇整形术的青少年患者。我们采访了那些可能会被 18 岁以下要求进行阴唇整形术的青少年患者寻求治疗的临床医生。我们使用解释性内容分析和主题分析来分析数据。我们的研究结果支持对所有患者首先进行教育和安慰的强调，但也出现了一些以前在文献中没有出现过的其他问题，这些问题会改变管理患者的临床策略。主要发现是，安慰并不总是有效，而且功能和外观问题之间的区别本身并不是决定手术是否符合伦理的坚实基础。我们的结论是，功能和外观问题之间的区别在伦理上并不相关。它可以有不同的解释，并不是所有临床医生都认为这是与手术相关的决定性因素。无论原因是什么，临床医生的重点都应该是缓解痛苦。外观原因有时可能证明手术是合理的，但功能原因有时也不足以证明手术是合理的。
