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Drivers and Dilemmas of Female Genital Cosmetic Surgery

Female genital cosmetic surgery includes many procedures undertaken at the request of the woman and is the fastest-growing area of cosmetic surgery, despite calls for avoidance or extreme caution from professional organizations responsible for women’s health. Low genital self-image is presumed to drive requests, but root causes have not been studied. The vast majority of these surgeries are not indicated medically, have unknown long-term effects, and are being performed in a private-pay environment in a context of significant ethical concerns regarding informed consent, autonomy and beneficence, and conflict of interest. This chapter explores normal physiologic development of female genitalia as it pertains to knowledge of what is “normal,” self-image and the drivers of genital self-image, concerns about specific procedures, and statements of professional organizations. Ethical tensions and dilemmas for clinicians highlight physicians’ ethical responsibility to provide accurate information about potential harms and benefits of these procedures.