The Safe Practice of Female Genital Plastic Surgery

Heather J. Furnas, MD; Francisco L. Canales, MD; Rachel A. Pedreira, MD; Carly Comer, MD; Samuel J. Lin, MD, MBA; Paul E. Banwell, BSc (Hons), MBBS, FRCS (Eng), FRCS (Plast)


Plast Reconstr Surg Glob Open. 2021;9(7):e3660 

In This Article

The Controversy

In 2019, the American College of Obstetricians and Gynecologists reaffirmed their 2007 Committee Opinion 378, calling these procedures "untenable" due to the absence of established safety and efficacy.[129] In January 2020, Committee Opinion 795 replaced 378 with softer language that still maintains that vulvovaginal surgery for appearance and sexual function reasons is not medically indicated and poses substantial risk, and women interested in surgery should instead be reassured of the normalcy of their anatomy. The opinion further states that studies demonstrating patient satisfaction with these procedures "should not serve as evidence that these procedures are clinically effective."[130,131] This recommendation ignores the negative impact of not performing a cosmetic procedure that can improve quality of life.

Unlike gynecologists, plastic surgeons perform cosmetic procedures on normal anatomic structures and regard a patient's satisfaction to be an important measure of success.[132] Committee position statements published by the American College of Obstetricians and Gynecologists have indicated that physicians who perform cosmetic gynecological procedures are pathologizing the normal vulva and vagina, contributing to women's sexual dysfunction and distress.[133] The stance that women seeking these procedures are victims of a patriarchal ideal is unique among cosmetic procedures.[134] The surgeon performing any cosmetic procedure must ensure that the patient is internally motivated to have surgery. Physicians listening to patient requests for female genital cosmetic surgery may themselves be unaware of their own cultural biases.[19,47,135–141]

Teaching these procedures in training programs will help reduce the complications that the American College of Obstetricians and Gynecologists' opinion warns of, and developing more validated questionnaires specifically for female genital cosmetic surgery will expand our understanding of the impact these procedures have on women's lives. When practiced safely, female genital plastic surgery can improve the quality of life for women seeking relief.