Semin Plast Surg. 2011 May; 25(2): 130–141.

Aesthetic and Functional Genital and Perineal Surgery: Female

Guest EditorsChristopher J. Salgado, M.D.Stan J. Monstrey, M.D., Ph.D.

Aesthetic Surgery of the Female Genitalia

Julie M.L.C.L. Dobbeleir, M.D.,1 Koenraad Van Landuyt, M.D., Ph.D.,2 and Stan J. Monstrey, M.D., Ph.D.2

Aesthetic female genital surgery involves surgery on normal female external genitalia; therefore, it falls into the same category as liposuction, breast augmentation, facial rejuvenation, cosmetic dental surgery, or any other aesthetic surgery procedure to the body.

It is designed to improve the appearance subjectively, and potentially provide psychological and functional improvement in sexual stimulation and satisfaction.1

Aesthetic procedures in the genital area can resemble female cutting in terms of technique and final result, but the fundamental difference lies in the intention and the purpose never to harm the functionality of the female genitals with this surgery.9,15

Obviously, patients should be aware that this surgery carries inherent risks and complications that eventually can result in a diminished function.3

 There are no absolute medical contraindications for aesthetic genital surgery, although current gynecological disease, smoking, unrealistic expectations, and sexual dysfunction are relative contraindications.1,6

Indications:

1. Perceived genital hypertrophy or significant discrepancy
2. Discomfort with sports activities or clothing, or vaginal entrapment with coitus
3. Genital changes due to childbearing or obstetrical injury affecting beauty or gripability and pleasurable coital sensation. 

LABIOPLASTY

Labioplasty refers to reduction of the labia minora (mostly) or majora, as well as to augmentation through injection of bulking agents or autologous fat transfer.1

Women will seek labioplasty for different reasons.4,16,17,19 Functional indications include: discomfort in clothing or during sports, dyspareunia due to invagination of the labia on penetration can be another functional reason but a growing number of women seek this kind of surgery purely for aesthetic reasons.

VAGINAL TIGHTENING PROCEDURE

During life, up to 76% of women experience decreased vaginal sensation, most commonly with a feeling of a widened vagina.

The goal of these procedures is to reconstruct (or to narrow) the lower third of the vagina, which includes “the orgasmic platform, internal and external vaginal diameter (introitus) and the perineal body.”24 The procedure enhances vaginal muscle tone strength and control, and decreases internal and external vaginal diameters.

HYMENOPLASTY

The hymen is the mucous membrane that partially closes the entrance to the vagina, named after the god of marriage in classical Greek mythology, Hymenaios.

The hymenoplasty procedure consists of surgically tailoring the hymenal remnants so that they can be sutured together with absorbable interrupted sutures to narrow the vaginal orifice.27 The procedure can be repeated as many times as desired. 

Clitoral Hood Reduction

Clitoral hood reduction is designed to produce more exposure of the clitoral body (with theoretically improved sexual stimulation) and to improve the appearance of the genital area.

Clitoropexy

Clitorises viewed to be longer than usual and deemed to look more like a penis than a clitoris must be reduced to ensure social acceptance as a female

Clitoral Reduction

Clitoral hypertrophy may be primary or secondary to hormonal or genetic abnormalities such as in disorders of sex development (DSD).

Pubic Lifting

Reduction of the mons pubis for ptosis and excess tissue in this area usually requires direct wedge excision in a transverse direction. This procedure is usually combined with or part of an abdominoplasty procedure

Pubic Liposuction

Liposuction of the mons pubis is effective in patients without skin excess.

G SPOT AMPLIFICATION

The G spot or Gräfenberg spot was first described in the 1950s as a highly erogenous zone inside the vagina that enlarges when directly stimulated. The erotic zone can be found on the anterior wall of the vagina along the course of the urethra, which seems to be surrounded by erectile tissue much like the corpora cavernosa of the penis.

The amplification is performed by collagen or hyaluronan injections under local anesthetic. 

CONCLUSION

Female genital surgery mostly consists of a labioplasty or a vaginal tightening procedure. These surgical procedures seem to have acceptable complications and a reasonable cosmetic outcome.