Discussion: The Impact of Labiaplasty on Sexuality

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I would like to commend the authors on their study regarding the effect of labiaplasty on patients’ quality of life, self-esteem, and sexual function. Women who request labiaplasty are often discouraged, by their family and by the medical community, from proceeding with surgery, as the potential physical and emotional benefits are poorly defined. Despite these confounding factors, women undergo labiaplasty in hopes of improving their lives. The authors seek to define the specific emotional and sexual benefits of labiaplasty.
Twenty-four sexually active patients interested in labiaplasty were enrolled in the study. It would have been interesting to see the number of non–sexually active patients that sought labiaplasty, because patients seeking improvement of the labia minora frequently avoid sex and were thus excluded. Would the results of the quality-of-life and self-esteem questionnaires be different had this abstinent population been included?
Crouch et al. have shown that 60 percent of surveyed labiaplasty patients have never been sexually active and may avoid sex because of the appearance of their labia.1 These findings are consistent with my observation that the majority of mature women seeking labiaplasty are in a sexual hiatus—either between relationships or in the process of a divorce. In addition, there is a large subset of young girls younger than 25 years who have never had sex because of the perceived abnormal appearance of their labia.
The study by da Cunha et al. showed statistical improvement in two parameters of the Sexual Function Questionnaire: less pain and more enjoyment. As one would expect, desire, arousal, sensation, and partner satisfaction were also improved but failed to reach significance, as noted by the authors, secondary to the small sample size. It is likely that most sexual parameters are improved with labiaplasty, as demonstrated by Goodman et al. in a retrospective review of 341 female genital surgery patients. They found that 67 percent of labiaplasty patients experienced an “enhancement of sexual function” as a result of their surgery.2
I agree with the authors regarding the lack of specificity of the Brazilian version of the Rosenberg Self-Esteem scale in detecting emotional changes after labiaplasty. The embarrassment in intimate settings and shame induced by disparaging remarks of a partner are harmful to female sexual identity. The questionnaire may have failed to capture improvement in these parameters after labiaplasty. Sorice et al. report that, among 50 patients seeking labiaplasty, 66 percent reported a negative effect on their self-esteem.3 The inclusion of the Female Sexual Distress Scale, a more sexually related assessment, would more likely have shown a positive correlation between labiaplasty and improved self-esteem.
In conclusion, I applaud the Brazilian authors on their insightful study exploring the effects of labiaplasty on the emotional and physical well-being of women. As shown by the authors, labiaplasty improves the sexual function of women. The relatively new field of female genital surgery is in need of studies like this one that validate the benefits of labiaplasty.
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