Cosmetic vulvovaginal surgery

Abstract Cosmetic vulvovaginal surgery arouses considerable media interest. There are significant ethical and technical challenges posed by such procedures, which may not be justified on medical grounds. Many such operations are performed without adequate evidence of either safety or psychosocial benefit. The best established female genital cosmetic procedure is reduction labioplasty. Women request reduction surgery for their labia for two distinct indications: aesthetic dissatisfaction or discomfort. There are a variety of techniques, none of which has high-quality supporting evidence. Hymenoplasty is even more controversial than labioplasty, perhaps because it is seen to perpetuate misogynist myths about virginity. Despite its persistent popularity there is little evidence of successful outcomes. Vaginal laxity is a common complaint among parous women, and has a complex relationship with sexual dysfunction. When a multidisciplinary, conservative approach fails, surgical intervention, with either perineorraphy or posterior colporrhaphy may be justified. Recent publications suggest some benefits to sexual function. Throughout this area, prospective appropriately controlled studies, using validated patient-centred outcomes are needed in order to assess the benefits. Until such evidence is available, it will remain difficult appropriately to advise patients requesting surgical intervention.