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Genital surgery in NHS rises fivefold in a decade

Offer advice on normal anatomy and psychological assessment – not surgery

Louise Prime

Friday, 15 November 2013

Doctors should offer women who ask for genital cosmetic surgery an accurate explanation of normal variation in genital anatomy, and psychological counselling for body image problems, advise the Royal College of Obstetricians and Gynaecologists and the British Society for Paediatric and Adolescent Gynaecology (BritSPAG). They also say that female genital cosmetic surgery (FGCS) should not normally be carried out on girls under the age of 18 years.

The College’s ethics committee has issued its ethical opinion paper in response to a fivefold rise in the number of labial reduction procedures carried out by the NHS, in just a decade – more than 2000 operations were performed in 2010. It points out that there are few data on either the risks or the effectiveness of FCGS, which includes hymenoplasty and vaginoplasty (vaginal reconstruction and vaginal rejuvenation) as well as labiaplasty. The committee reported that although concerns with hygiene, difficulties during sexual intercourse, and discomfort when wearing tight clothes may lead to a request for surgery, “for some women, the main reason for requesting labiaplasty can be concern about genital appearance. In extreme cases this concern is an aspect of body dysmorphic disorder.”

BritSPAG’s position statement focuses specifically on adolescents undergoing labiaplasty, and explores reasons why girls under 18 years may be dissatisfied with vulval appearance. These include accessibility to unrealistic and narrow representations of vulval appearance in popular culture; and intensive marketing of labiaplasty as an unproblematic lifestyle choice.

The RCOG and BritSPAG make several recommendations for best practice, including:

  • Women should be provided with accurate information about the normal variations in female genitalia and offered counselling and other psychological treatments for problems such as body image distress
  • Women must be informed about the risks of the procedure, the lack of reliable evidence concerning its positive effects
  • As full genital development is not normally achieved before 18, FGCS should not normally be carried out on girls under 18 years
  • Surgeons who undertake FGCS should keep written records of the physical and mental health reasons why the procedure was carried out
  • Advertising of FGCS should not mislead people on  what is deemed to be normal or what is possible with surgery
  • In general, FGCS should not be undertaken within the NHS unless medically indicated.

Dame Suzi Leather, chair of the RCOG’s ethics committee, said: “Some women are requesting [surgery] solely for cosmetic reasons and these decisions are not always being made on informed understanding of the normal variations that exist but influenced by images from popular culture and the pornography industry. We need to inform women that everyone is unique and that variation in appearance is normal in the vast majority of cases.”

Consultant obstetrician and gynaecologist and BritSPAG Chair Mr Paul Wood, added: “Girls should be aware of distortions in popular culture, the unknown risks and efficacy of procedures and ways to manage labial discomfort. When significant distress is detected, these girls should receive a psychological assessment.”

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