Cosmetic labiaplasty on minors: a review of current trends and evidence

Abstract

Cosmetic labiaplasty is a form of Female Genital Cosmetic Surgery (FGCS) that is performed with the deliberate intent to alter the appearance and morphology of the external genitalia in the absence of medical concerns. Over the last decade, there is an increasing demand for FGCS and the industry behind it is constantly growing. Adolescents comprise an extremely vulnerable population, with labiaplasties in this particular age group having also increased. However, labiaplasty has been widely contested due to the irrevocable alteration of a psychosexually significant body part on minors too young to consent. Besides, the changes that occur during pubertal development in the genital area can significantly alter pediatric surgical results. Genital anatomy is more diverse than we previously thought and there is evidence to suggest that the labia minora with their rich innervation play an important role in sexual arousal and pleasure. Education regarding the wide range of normal genital appearance suffices in most cases to dissolve concerns regarding body self-image. Mental health issues should always be explored and, if identified, the girl should be referred to an experienced professional for their resolution. Postponing labiaplasty until adulthood is strongly recommended to help adolescents achieve a well-informed decision regarding an irreversible procedure with possible adverse esthetic and functional outcomes.

Genital Cutting as Gender Oppression: Time to Revisit the WHO Paradigm

“…intersex genital cutting, or routine penile circumcision in the Global North, although these, too, can be substantial) (Beh and Diamond, 2000;Creighton, 2001;Diamond and Garland, 2014;Darby, 2015;Fahmy, 2019;Learner et al, 2020;Gress, 2021;Kalampalikis and Michala, 2021;Schröder et al, 2021). To illustrate, health department records from the Eastern Cape region of South Africa show that more than five thousand Xhosa boys required hospitalization due to their traditional circumcisions between 2006 and 2013; there were 453 recorded deaths among initiates within this time period and 214 circumcision-related penile amputations (Meissner and Buso, 2007;Meel, 2010;Douglas and Nyembezi, 2015).…”

National Estimates of Labiaplasty Performance in the United States From 2016 to 2019

“…Additionally, diagnosis coding may limit our analysis if alternative diagnoses were provided, and the population with the highest utilization is likely not eligible for Medicare or Medicaid given age and income. Nevertheless, given the limited outcome data and potential long-term adverse events associated with this procedure, including scarring, infection, chronic sexual dysfunction, wound breakdown, and regret, 3,4,6 as well as the high rate of minors undergoing this procedure, more dedicated research assessing the prevalence and associated outcomes is warranted.…”

“…Nationwide Ambulatory Surgery Sample data do not allow us to determine whether procedures were considered medically indicated or cosmetic or the degree of patient bother, though it is notable that most cases of symptomatic labial hypertrophy can be treated with supportive measures and do not require surgical correction. 4–6…”

Understanding adolescent girls' and young women's health‐seeking for female genital cosmetic surgery: How can clinicians help their patients?

“…A study of Australian general practitioners (GPs) in 2016 found that over a third of GPs surveyed had consulted with patients aged under 18 years for FGCS 9 . International evidence also suggests that young women and girls seek these procedures 10 . A 2021 study reported a high complication rate (20.5%) of labioplasty in an adolescent population ( n = 17), with a 6.8% reoperation rate.…”

“…Regarding adolescents and FGCS, the Society of Obstetricians and Gynaecologists of Canada further contends that ‘such procedures [FGCS] should not be offered until complete maturity including genital maturity, and parental consent is not required at that time’ 22 and advise that physicians who consult adolescent patients requesting FGCS require additional expertise in adolescent health. A 2021 review of cosmetic labioplasty on minors recommends that adolescent patients with genital appearance concerns should: (i) be counselled in the first instance about the wide range of ‘normal’ genital appearance to ameliorate any body image concerns; (ii) be referred to an experienced mental health professional if mental health issues are identified; and (iii) delay labioplasty until adulthood to ensure a well‐informed decision about FGCS can be reached 10 …”