According to the American Society of Plastic Surgeons there is an increasing demand for genital cosmetic surgery for women and men. Labiaplasty, clitoral hood reduction, reduction in the size of the mons pubis, and vaginal tightening are the more frequently requested procedures by women. Other requests include hymen reconstruction surgery, platelet rich plasma injection into the clitoral area and into the site of the controversial G-spot in the vaginal wall. Some men request elongation and girth enhancement of their genitalia. Other procedures available for men include scrotal reduction and testicular implant.[1]

A controversy has developed lately over the laser treatment of vaginal laxity and vaginal atrophy, a procedure sometimes referred to as vaginal rejuvenation.  In July of 2018 Dr Scott Gottlieb, commissionaire of the US Food & Drug Administration, announced that “we are deeply concerned [that] women are being harmed” by the laser caused vaginal burns, scarring, dyspareunia, and recurrent internal or external genital pain. The FDA is particularly concerned about deceptive marketing of energy-based devices to women in vulnerable health conditions.[2] Beyond the FDA’s concern over safety, there is a need for robust evidence for the effectiveness and the safety of genital cosmetic procedures.[3]

When a patient first brings up her sexual dissatisfaction at the family practice level, asking about possible genital surgery, and a discussion of the realities of “good enough” sex life may be helpful.[4] Single or married, children or no, working or not, work fatigue or not, young or old, privacy or no, pets in the house or not, it is the unique life situation of people that sets up or delays the mood or the opportunities for sexual interactions. Most couples in reasonable relationship accept that the quality of their sexual interaction may vary with the circumstances and they are open about that. Couples intimate with each other may be reaching out for pleasure, stress relief, playfulness, wanting to gift each other, or to say I love you without the words. The act of coitus need not be the objective: self or partner stimulation may be more relaxing and pleasurable. 

For more specific dysfunctions, referral may be advisable to sex therapy or to the more recent mindfulness approach to sexual disinterest, genital pain, or the aftermath of sexual trauma. 

Psychiatric evaluation along with gynecological consultation would be indicated when encountering  patients who insist on cosmetic genital surgery in the absence of actual body flaws. They may not be able to acknowledge the possibility that their sexual distress might be of psychological origin.
—George Szasz, CM, MD

References

1.    Giussy B. Vaginal rejuvenation: Current perspectives. Int J Womens Health 2017;9:5113-5119.

2.    Scott E. The FDA is warning against vaginal rejuvenation treatments. Metro. 31 July 2018. Accessed 22 October 2018. https://metro.co.uk/2018/07/31/fda-warning-vaginal-rejuvenation-treatments-7779919/.

3.    Zeidler M. Embodying Barbie: Cosmetic gynecology on the rise in Canada. CBC News. Last updated 17 July 2017. Accessed 22 October 2018. www.cbc.ca/news/canada/british-columbia/embodying-barbie-cosmetic-gynecology-on-the-rise-in-canada-1.4176187.

4.    Metz MW. The good enough sex–Model for couple sexual satisfaction. Sex Rel Ther 2007; 22:351-362.