ACOG recommends that women considering cosmetic vaginal procedures should be informed about the lack of data supporting the effectiveness of these procedures as well as their potential complications, including infection, altered sensation, dyspareunia (pain), adhesions, and scarring.
Over the past several years, an increasing number of physicians have been offering various types of vaginal surgeries that are marketed to women as ways to enhance genital appearance and sexual gratification. Some of these procedures, such as "vaginal rejuvenation," appear to be modifications of traditional vaginal surgical procedures for genuine medical conditions. These medical conditions may include pelvic prolapse, vaginal relaxation with symptoms, the reversal or repair of female genital cutting ("female circumcision") and treatment for labial hypertrophy or asymmetrical labial growth due to congenital conditions, chronic irritation, or excessive androgenic (male) hormones.
"Many women don't realize that the appearance of external genitals varies significantly from woman to woman. As ob-gyns, we know this to be the case from years of experience," said Abbey B Berenson, MD, a member of ACOG's Committee on Gynecologic Practice. An honest discussion about the wide variation in the appearance of normal genitalia could reassure women who are insecure about the look of their own genitalia, said Dr Berenson.
Ob-gyns whose patients ask about these procedures should discuss the reason for the request and perform a physical evaluation for any signs or symptoms that may indicate a need for surgical intervention. Women who want to improve their sexual response should be evaluated for sexual dysfunction, and nonsurgical interventions, including counseling, should be considered.
"There are always risks associated with a surgical procedure," said Dr. Berenson. "It's important that women understand the potential risks of these procedures and that there is no scientific evidence regarding their benefits."
Very few cosmetic vaginal procedures are medically indicated nor are there published studies that assess the safety, complication rates, and long-term satisfaction for any of these unproven surgical procedures. "It is imperative that studies on these procedures be conducted and published in peer-reviewed publications so that the evidence and clinical outcomes can be reviewed," said Dr. Berenson. "Until that time, the absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable."
ACOG also is concerned with the ethical issues associated with the marketing and national franchising of cosmetic vaginal procedures. A business model that controls the dissemination of scientific knowledge is troubling, according to the new committee opinion. "When a new surgical procedure or a variation of an established surgical procedure is developed, physicians typically do not attempt to keep it proprietary or restrict who can perform the procedure," said Dr. Berenson.
About thts article: This information was provided by The American College of Obstetricians and Gynecologists. September 2007
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