Concerns about female genital cosmetic surgery, especially cosmetic vaginoplasty, in South Korea

Abstract

Concerns about female genital cosmetic surgery, especially cosmetic vaginoplasty, in South Korea Sir,We read the commentary of Barbara et al.(1) on female genital cosmetic surgery (FGCS) and the anatomical and biomechanical views of Petros (2). We would like to comment on FGCS in South Korea. As in many Western countries, FGCS is very popular in South Korea. The most common procedures are vaginoplasty and labia minora labiaplasty (3). Importantly, there is no definitive evidence that cosmetic genital surgery is beneficial; the genitals differ from the skin, face and breasts from a cosmetic viewpoint. The most popular FGCS in postpartum women is vaginoplasty; this is plastic surgery of the vaginal opening, canal and epithelium. Many women seek to tighten a vagina loosened by parity, aging and frequent coitus, to increase both their own sexual pleasure and that of their partners. Such surgery is common and the available techniques include anterior colporrhaphy, high-posterior colporrhaphy, excision of the lateral vaginal mucosa, and combinations of these procedures (4). Laser vaginoplastic surgery is also popular, and a ring or fillers can be used in the vagina. Advertisements promoting cosmetic surgery are common in South Korea, and FGCS is also promoted actively on the internet and in magazines. The procedures are described as "easy," "effective" and "satisfactory." However, there is no proof that FGCS effectively improves female sexual functioning in terms of any of desire, arousal or orgasm; rather increasing dyspareunia (5). A simple cut can eliminate the vaginal elasticity that maintains vaginal tension during coitus (2). Many postmenopausal women who have undergone such surgery suffer from severe vaginal atrophy; shrinkage causes dyspareunia (6). Laser or filler procedures are also of doubtful utility; long-term follow-up data are lacking. Vaginoplasty has become popular in South Korea, as the female genitalia have become increasingly viewed as a cosmetic organ. However, most women lack information on female sexual function and the long-term effects of FGCS. In Korea, attitudes toward FGCS are conservative and reflect cultural notions. Sex is regarded as a male realm and an intact hymen reflecting virginity indicates that a woman is virtuous. Hymen reconstruction, also called revirgination when the hymen has been torn during sexual intercourse, is achieved by approximating the free borders of the hymen remnants, using fine absorbable sutures to achieve partial occlusion of the introitus (7). Often a patient's hair is used as thread because when the thread is released, it is readily passed off as simply a pubic hair. Requests for other types of FGCS are also affected by cultural considerations. Cosmetic vaginoplasty to ensure partner satisfaction is more common in South Korea than in other countries. Few relevant studies have appeared; most FGCS procedures are performed in private hospitals and are not discussed publicly.

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“…Although there is no scientific evidence demonstrating that female genital cosmetic surgery (FGCS) is beneficial, it has gained popularity in Korea as in many western countries [ 1 ]. The proper role of obstetrician-gynecologists should be established in this evolving field, as they have a professional and ethical responsibility to counsel patients about complications and obtain informed consent.…”