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Reply: Growing Body of Evidence Supports Safety of Female Genital Cosmetic Surgery.

Reply: Growing Body of Evidence Supports Safety of Female Genital Cosmetic Surgery Sir: I am honored to have Dr. Sisti, a surgeon who is well acquainted with labiaplasty and coauthor of a comprehensive review,1 comment on our investigation.2 He discusses two studies of male preferences regarding female genital appearance. These findings confirm the results of an earlier article we have published regarding cultural expectations for the female pudenda as reflected in the media and specifically in the archetypal men’s magazine, Playboy.3 Dr. Sisti similarly echoes the observations of others who also stress the aesthetic goals of labiaplasty as being the preeminent motivating factor for women seeking labiaplasty.4 It is clear that the popularity of the procedure is not limited to the United States; reports from experienced surgeons such as Triana and Robledo,5 Mayer,6 Gress,7 Oranges et al.,1 Veale et al.,8 Giraldo et al.,9 Felicia Yde,10 Choi and Kim,11 and others (e.g., from Colombia, Argentina, Germany, Italy, England, Spain, Brazil, and South Korea), indicate that this specialty is an international phenomenon and has wide appeal to a variety of differing cultures. Dr. Sisti’s commentary resonates with my impression that surgeons experienced in labiaplasty will testify that the vast majority of patients express a high degree of satisfaction that is equal to or exceeds nearly any other aesthetic procedure. Despite the demand and the safety of Regarding the same type of surgery, Dr. Mazloomdoost et al. recently published an article entitled “Survey of Male Perceptions Regarding the Vulva.”2 In that study, men aged 18 to 80 years were recruited by means of e-mails sent by an Internet provider to participate in a 27-question Web-based survey. The questionnaire included images and queried demographics, men’s familiarity with vulvar anatomy, preferences regarding labial appearance, and awareness of labiaplasty. With regard to preferences, more respondents considered smaller labia attractive compared with large labia; multivariable analysis revealed younger age to be associated with preferences for small labia and complete genital hair removal, and familiarity with labiaplasty. In this national survey, the majority of men do not have a preferred appearance for female genitalia, nor do they support female genital cosmetic operations or consider discussing genital surgery with their partner.2 This conclusion is also supported by a recent study on the same topic from Dr. Horrocks et al.3 A total of 500 online surveys were sent out and 248 respondents were included in the study; only 14 percent of men supported genital cosmetic surgery, whereas 29.6 percent are undecided about the practice. The most common preferred pubic hair appearance is completely hairless (45 percent). The problem of hypertrophy of the labia minora arises mainly from the need of the patient herself. The demand for cosmetic surgery for reduction of the labia minora by women is growing. Although women are motivated by functional implications, aesthetic causes, such as appearance, account for almost half of the impetus driving this demand.2 Women prefer a prepubescent aesthetic, with the labia minora tucked within the confines of the labia majora. Psychological counseling is recommended to inform women that surgery is not a definitive solution to treat psychologically based pain or dysfunction.4 To date, there are eight different techniques available for this type of surgical procedure, they have been listed and graphically represented in a recent review.5 In general, a very low complication rate and satisfactory aesthetic outcomes for the patients were reported for all the techniques performed. We regularly perform this type of surgery using the wedge technique and found high satisfaction of patients and a very low complication rate. With this letter, we want to encourage young plastic surgeons and even gynecologists to perform this type of surgery, when requested, because it is simple to implement and relatively safe. DOI: 10.1097/PRS.0000000000002202