Discussion: Why Women Request Labiaplasty

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Excerpt

I would like to commend the authors on exploring the complex issues that prompt women to seek surgical reduction of the labia minora. As these requests and procedures continue to increase, it is important to develop a metric by which surgical procedures can be compared in outcome studies. Eleven psychological and physiologic symptoms were incorporated into a preoperative questionnaire that was given to 50 patients seeking labiaplasty.
The pool of questions was derived from patient interviews, expert opinion, and an extensive literature review. Because the patients were instructed to answer all applicable questions, there may have been an element of suggestive bias created by viewing a list of potential symptoms. Perhaps an open-ended questionnaire with tabulation of the common responses would have reduced the suggestion bias.
The authors explore patient access to qualified surgeons willing to perform labiaplasty. Gynecologists logically would be the first resource explored by women who question the normalcy of their genitalia. As shown by Reitsma et al.,1 gynecologists are more likely than plastic surgeons to discourage patients from undergoing labiaplasty. Patients deterred by their gynecologist now must choose between accepting their anatomical variation as normal or persisting in seeking out an expert to comply with their aesthetic desires.
The 50 study participants presented to a plastic surgeon’s office with the intent of undergoing surgery. Some of these patients may have been discouraged and denied labiaplasty by their gynecologist. One would have to ask whether this subset of patients perhaps checked off more symptoms than truly experienced to justify the surgery not only in their minds but also in the mind of the plastic surgeon. A questionnaire given to patients presenting to gynecologists might have resulted in different answers from those given by plastic surgery patients.
In conclusion, the authors were able to determine that the most frequent physical complaints of prospective labiaplasty patients were tugging of labia with intercourse (74 percent) and in tight pants (72 percent). From an aesthetic standpoint, 94 percent were self-conscious about the appearance of their labia, which resulted in poor self-image and an avoidance of intimacy. These results are consistent with those obtained with validated questionnaires such as the Female Genital Self-Image Scale, the Index of Sexual Satisfaction, and the Body Esteem Scale,2 where body dissatisfaction and negative genital self-image were found to be the primary drivers to seek labiaplasty.
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