Shaw Dorothy, Allen Lisa, Chan Cynthia, Kives Sari, Popadiuk Catherine, Robertson Deborah, Shapiro Jodi
Vancouver, BC.
Toronto, ON.
J Obstet Gynaecol Can. 2022 Feb;44(2):204-214.e1. doi: 10.1016/j.jogc.2021.11.001.
To provide Canadian surgeons and other providers who offer female genital cosmetic surgery (FGCS) and procedures, and their referring practitioners, with evidence-based direction in response to increasing requests for, and availability of, vaginal and vulvar surgeries and procedures that fall outside the traditional realm of medically indicated reconstructions.
Women of all ages seeking FGCS or procedures.
BENEFITS, HARMS, AND COSTS: Health care providers play an important role in educating women about their anatomy and helping them appreciate individual variations. Most women requesting FGCS and procedures have normal genitalia, and up to 87% are reassured by counselling. At this time, due to lack of rigorous clinical or scientific evidence of short- and long-term efficacy and safety, FGCS and procedures for non-medical indications cannot be supported. FGCS and procedures are typically provided in the private sector, where costs are borne by the patient.
Literature was retrieved through searches of MEDLINE, Scopus, and The Cochrane Library using appropriate controlled vocabulary and keywords. The selected search terms represented keywords for FGCS (labiaplasty, surgery, vaginal laser therapy, laser vaginal tightening, vaginal laser, vaginal rejuvenation, vaginal relaxation syndrome, hymenoplasty, vaginal cosmetic procedures) combined with female genital counselling, consent, satisfaction, follow-up, adolescent, and body dysmorphic or body dysmorphia. The search was restricted to publications after 2012 in order to update the literature since the previous guideline on this topic. Results were restricted to systematic reviews, randomized controlled trials, and observational studies. Studies were restricted to those involving humans, and no language restrictions were applied. The search was completed on May 20, 2020, and updated on November 10, 2020.
The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).
Gynaecologists, primary care providers, surgeons performing FGCS and/or procedures.
鉴于对传统医学适应证以外的阴道和外阴手术及操作的需求不断增加且此类手术日益普及，为加拿大开展女性生殖器美容手术（FGCS）及相关操作的外科医生和其他医疗服务提供者及其转诊医生提供循证指导。
寻求FGCS或相关操作的所有年龄段女性。
益处、危害及成本：医疗服务提供者在向女性讲解其解剖结构并帮助她们认识个体差异方面发挥着重要作用。大多数寻求FGCS及相关操作的女性生殖器正常，高达87%的女性通过咨询得到了安抚。目前，由于缺乏关于短期和长期疗效及安全性的严格临床或科学证据，不支持针对非医学适应证的FGCS及相关操作。FGCS及相关操作通常在私立机构进行，费用由患者承担。
通过使用适当的受控词汇和关键词检索MEDLINE、Scopus和Cochrane图书馆获取文献。所选检索词代表FGCS的关键词（阴唇整形术、手术、阴道激光治疗、激光阴道紧缩术、阴道激光、阴道年轻化、阴道松弛综合征、处女膜修复术、阴道美容操作），并结合女性生殖器咨询、同意、满意度、随访、青少年以及身体变形或身体变形障碍。检索限于2012年以后的出版物，以便更新自上次关于该主题的指南以来的文献。结果限于系统评价、随机对照试验和观察性研究。研究限于涉及人类的研究，不设语言限制。检索于2020年5月20日完成，并于2020年11月10日更新。
作者使用推荐分级评估、制定和评价（GRADE）方法对证据质量和推荐强度进行评级。见在线附录A（表A1为定义，表A2为强弱推荐的解释）。
妇科医生、初级保健提供者、实施FGCS和/或相关操作的外科医生。
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