Labia Minora Surgery in the Adolescent Population: A Cross-Sectional Satisfaction Study

Abstract

Background Labia minora surgeries are gaining popularity and we have limited data available to help counseling patients, especially in the adolescent population. Aim This study is meant to assess the complications and satisfaction of patients who had the surgery as adolescent. Methods We identified and reviewed all labia minora surgeries performed to address symptoms within the adolescent population from 2006 to 2016. A cross-sectional study was then performed. Questionnaires were sent through an Internet-based survey. Adolescent and adult populations from the literature were used for comparison. Outcomes A three-part questionnaire assessed surgical indications, current satisfaction regarding the surgery, and the sexual function, including the Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS). RESULTS A total of 44 cases, from 12 to 18 years old, were included for the retrospective review. The major complaint leading to surgery was described as daily basis discomfort (39%) and aesthetics (33%). Surgical indications were similar for the survey responder group. 3 patients (6.8%) underwent redo surgery. We were able to reach 28 of the 44 potential participants for the cross-sectional study. A total of 17 questionnaires were completed (39%). We found a 20.5% rate of complication with 14% dehiscence, 9.3% significant bleeding, and 1 case of wound infection. This complication rate is higher than what has been found in the literature so far. All responders were partially (53%) or fully (47%) satisfied with the surgery. Results of FSFI were different in two of the 6 domains: lower lubrification (P = .0416) and higher orgasm (P = .0495) score compared to adolescent controls. The cutoff criteria for Hypoactive Sexual Desire Disorder was met by 75%. Patients responded positively to the FGSIS questionnaire (M = 21.65, 95% CI: 20.31-22.98). Clinical Implications This study helps to identify specificities of the adolescent population who underwent labia minora surgery, potential increased complication rates compared to the adult population, even with overall significant postoperative satisfaction. Strengths & Limitations Lack of adequate control group for the FSFI and FGSIS, a small sample size, and a low response rate could have biased our results. To our knowledge, this is the biggest study to date to address this issue exclusively within the adolescent population, with the addition of validated questionnaires. The long delay since surgery (Mean = 8.3 yrs) permits to highlight temporal changes and potential long term complications. CONCLUSIONS Patients seem to have no regret about the surgery and sexual dysfunction rate comparable to the literature data, except for possible increased hypoactive sexual desire disorder.

Spanish Translation, Transcultural Adaptation, Validation and Clinical Applicability of Female Genital-Self Image Scale (FGSIS)

“…32 However, it has barely been evaluated in the context of women considering cosmetic surgery. 24 This is of interest as interventions, such as counselling concerned patients or health education in this area, could be measured with this scoring system. We have found that items 1, 2 and 6 are the most affected in women concerned about their genitals and interventions targeting these areas would probably be the most effective when trying to improve women's self-perception.…”

“…However, FGSIS has been tested in some contexts such as sexual satisfaction, 23 but barely in others such as women's desire of undergoing cosmetic surgery. 24 Although there are scales in Spanish designed to evaluate selfesteem or self-image perception, none of them examine female self-perception about their genitalia (including FGSIS). Therefore, the scale needs validation prior to its use in this setting.…”

Understanding adolescent girls' and young women's health‐seeking for female genital cosmetic surgery: How can clinicians help their patients?

“…A 2021 study reported a high complication rate (20.5%) of labioplasty in an adolescent population ( n = 17), with a 6.8% reoperation rate. Nearly half of this sample (47%) reported their labia had changed in size since the post‐operative period 11 …”

“…Nearly half of this sample (47%) reported their labia had changed in size since the post-operative period. 11 It is evident in the literature that concerns about appearance are a key reason given for adult women seeking genital cosmetic surgery. [12][13][14] It has been hypothesised that exposure to social media, web content and pornography might be a driver of FGCS.…”

Cosmetic labiaplasty on minors: a review of current trends and evidence

“…Despite poor follow-up and high complication rates, the providers reported that 47% of the participants were fully and 53% partially satisfied with the outcome of the procedure. Also of note, 75% of participants met the cut-off criteria for “Hypoactive Sexual Desire Disorder (HSDD)” [ 25 ]. The retrospective design, poor response rate, small numbers, and the contested diagnosis of HSDD [ 26 , 27 ] raise questions about the value of this research.…”