fastest growing emerging growth trend labiaplasty and vaginal cosmetic surgery

“labiaplasty and vaginal cosmetic surgery are the fastest growing emerging growth trend in cosmetic plastic surgery.” 

Although surgeons for years have unofficially performed surgical procedures resulting in alterations in genital size, appearance, and function (labial size alteration, perineorrhaphy, anterior/posterior colporrhaphy, intersex and transsexual surgical procedures, and alterations on children and adolescents for benign enlargements of the labia minora), Honore and O’Hara in 1978 [2], Hodgekinson and Hait in 1984 [3], and Chavis, LaFeria, and Niccolini in 1989 [4] were the first to discuss genital surgical alterations performed on adults for purely aesthetic reasons. While there are at present no accurate and ongoing published statistics from either the American Society of Plastic Surgeons, American Academy of Cosmetic Surgeons, or American College of Obstetricians and Gynecologists, it has become apparent in the lay press that aesthetic surgery of the vulva and vagina is gaining significantly in popularity. As far back as 2004, Dr. V. Leroy Young, chair of the emerging trends task force of the Arlington Heights, Illinois, American Society of Plastic Surgeons, commented in a personal communication that he felt that “labiaplasty and vaginal cosmetic surgery are the fastest growing emerging growth trend in cosmetic plastic surgery.”

Aesthetic surgery of the vulva and vagina has heretofore not been officially described as such, nor “sanctioned” by specialty organizations, as they are community rather than university or academically driven. The operations themselves, however, are really not new; the only new thing is the concept that women may individually wish to alter their external genitalia for appearance or functional reasons, or tighten the vaginal barrel to enhance their sexual pleasure. However, since any surgery has potential for causing morbidity including pain and distress (both physical and psychological) if not performed properly, and especially since FGPS involves concepts and procedures that are not yet fully researched nor understood, guidelines for training, surgical technique, and patient selection should be discussed.

Although certainly the vulva and vagina are areas under the purview of gynecology and gynecologic training, virtually no training is offered in OB/GYN residencies in plastic technique, cosmetic labiaplasty, or pelvic floor surgery designed specifically for enhancement of female sexual pleasure (see Chapter 21). With the subject adequately addressed by only a portion of plastic surgery residencies (and in these, usually LP/ RCH only), an individual patient finds herself on her own when endeavoring to navigate a path to successful reconstruction. With little guidance from specialty or regulatory agencies, “caveat emptor” became the rule, and un‐ or undertrained surgeons began performing these plastic procedures, frequently with less‐than‐ optimal, and occasionally disastrous, results


In conclusion, excessive expectations with vaginal rejuvenation procedures are currently unwarranted. If “vaginal laxity” is the result of an over‐distension of the puborectalis muscle, as Dr. Dietz suggests 1, it might be better managed with pelvic floor training rather than surgery, and comparative trials are needed here. Women's sexuality is not a mechanistic process, as it results from the interaction of multiple physical and psychosocial dimensions 2. Surgery focuses exclusively on the anatomical and biomechanical component. Therefore, the very nature of sexual dysfunctions must be carefully investigated before resorting tout courtto narrowing vaginal procedures. This message should be clearly conveyed to all women seeking “vaginal rejuvenation” and, when appropriate, they should be invited to consider pelvic floor training or sexual counseling before surgery. Patients' complaints must always be taken seriously, but because sexual dysfunction is often multifactorial, restoring a “tight vagina” may only provide a partial answer.