Leading Expert Says Claims About Cosmetic Vaginal Surgery Not Substantiated
Linda Cardozo, Professor of Urogynaecology and Consultant Gynaecologist for Women's Health at King's College London, was speaking at the Royal College of Obstetricians and Gynaecologists 7th International Scientific Meeting (RCOG2008) in Montreal, Canada, that was held from 17th to 20th September.
Cardozo talked about the growing interest that cosmetic vaginal surgery has attracted in recent years, and that despite the voluminous popular press coverage, there exists little clinical or scientific evidence to guide gynaecological surgeons as to the safety and effectiveness of different procedures.
A recent search on Google for "cosmetic vaginal surgery" yielded over 45,000 references, compared with fewer than 100 on medical literature databases like PubMed and Medline. What scientific literature there is deals mostly with the correction of birth defects or intersex conditions, said Cardozo, and very little with cosmetic surgery done mainly for aesthetic reasons.
Examples of cosmetic vaginal surgery range from the purely aesthetic labiaplasty (reduces the size of the labia), hymenoplasty (restores the hymen) and "vaginal rejuvenation" to vaginal pelvic floor repair, a gynaecological reconstruction which is done partly to restore function and partly to enhance appearance.
Apart from testimonials from "satisfied clients" there is very little objective scientific evidence to support the claims of many surgeons who recommend cosmetic vaginal surgery; claims such as the procedure "restores normal anatomical relationships", for example after the effects of childbirth or ageing. Some surgeons even suggest that the procedure "enhances sexual gratification", said Cardozo.
In fact, if women seeking this type of cosmetic surgery were to be made aware of the medical literature that does exist, they might think twice about having it. For example, some literature on reconstructive pelvic surgery suggests that repeated surgery on the vagina increases the risk of scarring, loss of sensation and decreased sexual function: the opposite of what many clients want.
Cardozo suggests women considering cosmetic vaginal surgery as a way to restore sexual dysfunction should seriously consider other less physiologically invasive options first, such as psychosexual counselling and physiotherapy for the pelvic floor. Also, restoring normal pelvic function and anatomy has to consider three organ systems: the urinary organs, the sexual organs and the gastrointestinal organs.
Before choosing the most appropriate type of surgery, there needs to be a thorough assessment of function and the extent to which normal pelvic floor support has been lost, said Cardozo. It is not only a case of taking into account the doctor's professional view, but also of assessing how each surgical option may affect the patient's mental and physical state.
Specially designed and validated quality of life survey tools for condition-specific sexual dysfunction should be routinely administered as part of pre-operative assessment and discussion of aims and potential outcomes of any vaginal surgery, said Cardozo. The doctor should also think about whether a psychological assessment might also be beneficial, and perhaps do more careful probing to establish why the patient has asked for surgery over the more conventional treatment.
"Cosmetic vaginal surgery."
Invited Speaker session: S4.14, RCOG2008
Published in special issue of BJOG, Volume 115 Issue s1 , Pages 5 - 31 (September 2008).
Click here to view the RCOG2008 Speaker Session Abstracts (PDF).
Source: RCOG2008 Abstract.
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