As urogynecologists, we are specialists who address women’s functional and anatomical changes to the pelvic floor as a result of childbirth, aging, and other factors. Many of these women – our patients who we see daily – also complain of changes in sexual function and genital aesthetic appearance. It is our duty as pelvic floor specialists to understand these concerns and either address them or refer them to the best qualified surgeon.
Cosmetic Gynecology has become one of the fastest growing subspecialties of elective surgery for women and includes specialists in gynecology, urogynecology, urology, and plastic surgery. This area of special interest includes both cosmetic procedures to enhance the aesthetic appearance of the vulvo/vaginal region, as well as functional vaginal repairs to enhance or help restore sexual function following the changes that may occur following childbirth and/or aging.
Among the first procedures covered by this subspecialty – and the most controversial and discussed – is colloquially named Vaginal Rejuvenation (VR), which is performed to treat the vaginal laxity syndrome (VLS). For many years it has been shown scientifically that prolapse affects sexual function, and when repaired, sexual function improves. Vaginal rejuvenation surgery (vaginal tightening for sexual function) is the repair of VLS that may or may not involve symptomatic prolapse. In the early years of these procedures there was very little scientific evidence to support this type of surgery, however in the recent years scientific studies supporting vaginal rejuvenation are surfacing and being presented at scientific meetings throughout the world. Scientific articles as well as book chapters in very reputable female urology textbooks (example: Cardoza and Staskin) are becoming more prevalent as the procedure is becoming more mainstream. Certainly, however, it is vitally important for more high level scientific studies to be completed to validate these procedures in women.
Female genital cosmetic surgery also includes aesthetic procedures to improve the cosmetic appearance of the external vulvar/vaginal region. Procedures include labiaplasty or labia minora reduction with or without excess prepuce reduction, labia majora reduction or augmentation, vaginal introital repairs for cosmetic issues as well as reduction of lipodystrophy in the mons pubis region. Labiaplasty procedures have been reported to be the largest growing trend of plastic or cosmetic surgery procedures for women in the US and throughout the world. This may be secondary to the increased public awareness created by the media or popular TV shows, or it may be secondary to the fact that in the past women’s feelings about the appearance of their genitalia have been ignored. It has been scientifically shown that the appearance of a woman’s genitalia affects her self-confidence and sexuality. Women now have been empowered with the choice of options to change the external appearance of their vulvovaginal region if they are unhappy with the cosmetic appearance. Studies have also recently shown that this is a trend driven by women themselves, and not their sexual partners. However, with this trend there have been many different procedures described with very little scientific validation and therefore there is a danger that surgeons with very little experience with vulvar or vaginal surgery (inside or outside the field of gynecology) are doing these procedures incorrectly and causing injury or damage to women.
Recently, new technology has been introduced in the field offering non-surgical/office based procedures to treat female sexual dysfunction (VLS), vaginal health and vulvo/vaginal cosmetic issues for women. This technology includes non-fractional lasers as well as radiofrequency treatments. Scientific studies are currently evaluating this technology for these uses as well as treatment for mild urinary incontinence, urgency/frequency issues as well as vaginal dryness.
What do doctors who perform these procedures have in common?
The leaders of these procedures and technology worldwide, with few exceptions, come from the area of urogynecology. This is not surprising considering that of the four subspecialties within Obstetrics and Gynecology (perinatology, reproductive endocrinology, oncology, urogynecology) only urogynecology deals with the management of pelvic floor disorders. Thus, this subspecialty is best suited to address the aesthetic, functional, and sexual concerns of women and should be taking the lead in this newly developing field. No other subspecialty has the expertise that our specialty has in vaginal reconstructive surgery, and we should therefore not let other specialties take the lead on these procedures or the scientific validation of these procedures.
We may categorically say that there are no less than 20 courses or symposiums on Cosmetic Gynecology running every year worldwide. If we add countless lectures, conferences and training courses, we are facing a new area of gynecology that is growing exponentially and is impossible to stop. We urogynecologists have noted with concern that many of these procedures, whether performed in isolation or in association with other conventional surgeries such as hysterectomies, urinary incontinence correction and prolapse correction, are being performed by other health professionals who, in our opinion, are not the most suitable.
Due to the aforementioned facts, a group of IUGA members with proven experience and interest in aesthetic/cosmetic vulvo-vaginal surgery have created the Cosmetic Gynecology Special Interest Group.
Aims and Objectives of the Group
- Define, spread and explain within IUGA the different surgical and non-surgical procedures and their different applications, including the adequate selection of patients.
- Properly establish that in the vast majority of cases, due to associated pathologies,
urogynecologists are the most suitable professionals to perform such procedures, including non-surgical procedures that also require a previous evaluation by a specialist who will give the patient the best treatment choice to his/her reason for consultation.
- Promote the presentation of scientific publications on cosmetic gynecology within IUGA.
- Help promote the scientific validation of cosmetic and functional aesthetic vaginal procedures (both surgical and non-surgical) both within IUGA as well as outside the organization.
- Promote IUGA as a leader in the field of Vaginal/Vulvar Reconstructive and Aesthetic procedures.
- Promote women’s sexual health and sexual function through studies, courses, and grants to IUGA.