Symposium
In recent years there has been growing interest in the subject of cosmetic genital surgery, which parallels the ever-increasing public awareness of cosmetic surgery generally. Despite the large number of articles in the popular press on this subject, there is very little evidence in the peer-reviewed medical literature to guide surgeons on possible surgical procedures and their outcomes. A wide variety of procedures can be included in the term ‘cosmetic genital surgery’ ranging from purely aesthetic operations such as labiaplasty, hymenoplasty and ‘vaginal rejuvenation’ to the more conventional gynaecological reconstructive procedures like vaginal pelvic floor repair, which aim to restore function as well as enhance appearance. Many of the claims made by surgeons who advocate this type of surgery are unsubstantiated by clinical trial evidence. As well as purporting to restore normal anatomical relationships following the effects of childbirth and ageing, some surgeons promise enhanced sexual gratification and improvement in urinary incontience. Other than testimonials from ‘satisfied clients’; there is currently little objective evidence to back this up. Indeed, most of the published literature on reconstructive pelvic surgery suggests that repeated vaginal surgery risks causing scarring, loss of sensation and impaired sexual function. If sexual dysfunction is the primary reason for seeking surgical intervention, then it is often more appropriate to consider other avenues of treatment first, including psychosexual counselling and pelvic floor physiotherapy. Appropriate pre-operative assessment of pelvic floor function and the degree to which normal pelvic floor support has been lost is important in planning surgery. As well as the traditional methods of ‘doctor-centred’ assessment, there is currently an increased awareness of the need to formally evaluate the mental and physical impact of any condition on the patient’s Quality of Life (QoL). Condition-specific genital dissatisfaction and sexual dysfunction QoL questionnaires have been designed and validated for this purpose. To provide women with realistic expectations, a thorough pre-operative discussion about the aims and likely outcomes of any planned urethral or vaginal surgery is invaluable. This may sometimes need to include a careful psychological assessment of their motivations in requesting surgery over more conservative treatments.