Reply: Psychological Outcomes of Labiaplasty

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We thank Dr. Oranges et al. for their thoughtful commentary on our prospective controlled study of the psychological outcomes of labiaplasty.1 Although we did find improvements in genital appearance satisfaction, we did not find significant improvements in women’s broader intimate relationship quality and psychological well-being from before to after labiaplasty. This differs from some other research findings. However, all studies included in Oranges et al.’s comprehensive review of labia minora reduction techniques were retrospective case series or case reports.2 In our recent retrospective study, women also reported increases in psychological well-being and sexual satisfaction at the time of completing the questionnaire compared with their recalled levels before labiaplasty.3 However, our study was prospective in design, which we think contributes to the difference in observed results on general well-being.
Although prospective studies by Goodman et al. and Placik and Arkins have found improvements in psychosexual outcomes,4,5 Veale et al. reported that increases in overall sexual function at 3 months after labiaplasty returned to prelabiaplasty levels at 11 to 42 months after labiaplasty.6 Notably, Veale et al.’s study and our own included only women undergoing labiaplasty,1,6 whereas the studies by Goodman et al. and Placik and Arkins included women undergoing other genital operations in combination with labiaplasty, such as vaginoplasty and clitoral hood reduction.4,5 Although we did not find improvements in women’s overall intimate relationship quality in our study, there was an increase in the percentage of women involved in an intimate relationship from before to after labiaplasty, potentially indicating that women felt more confident to enter into a relationship after surgery. Clearly, further prospective studies are needed to provide greater clarity surrounding the psychological effects of labiaplasty.
As noted by Goodman in his commentary on one of our articles, a strength of our research is that it is conducted independently of the medical practitioners performing the labiaplasty operations.7 Our study aimed to provide a broad “snapshot” of labiaplasty outcomes and thus involved the patients of all types of medical professionals who perform labiaplasty within Australia (i.e., plastic surgeons, cosmetic surgeons, and gynecologists). Although we agree that the complication rate in our sample (34 percent) was higher than in some other studies,2 an important consideration is that these complications were nominated by the patients themselves rather than their treating practitioner. Veale et al. reported a similarly high complication rate (26 percent) when using the same nomination strategy in their prospective controlled study.6 Nevertheless, we strongly agree that all medical professionals performing labiaplasty procedures should be competent in their surgical technique to ensure the safety of each patient and achieve the best possible outcomes.
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