(There has been an avalanche of publicity �in women�s magazines, the popular press, talk shows and amongst doctors themselves �about a about a procedure called labiaplasty, the cosmetic surgery to change the look of the labia. Some call it �labia rejuvenation,� or cosmetic plastic surgery. The argument touched a nerve in the medical community, triggering at least one group of doctors and academics to discuss it on their internet listserve. The issue isn�t about needed medical labia surgery, but surgery generally and mainly done for cosmetic reasons. Many doctors claim that woman get the idea of the �perfect vulva� from magazine such as Playboy, and that woman rarely see other women�s vulvas, much less their own.)
Here are some comments gleaned from doctors and health care providers. We are not using their names, but their thoughts certainly help set the stage...
In this article by Dr. Andrew T. Goldstein, a gynecologist, author and lecturer and the medical director of ourwww.ourgyn.comsite and Dr. Gail Goldstein, a dermatologist, look at the ethical issues involved. After you finish, take the instant survey on your thoughts about this and then join Dr. Goldstein�s Bulletin Board forum to discuss it with others by clicking here
By Andrew T. Goldstein, MD,
And Gail R. Goldstein, MD, MA
Labiaplasty (labia minora reduction, nymphectomy) has been discussed in the peer-reviewed medical literature since 1971. However, early reports of this procedure consisted of correction of labial hypertrophy caused by congenital malformation, exogenous hormones, myelodysplasia, and manual stretching of the labia with weights (a practice of the Khoikhoi tribe in south-western Africa).(1)
In 1984, Hodgekinson and Hait were the first to discuss this procedure performed for purely aesthetic reasons. (2) More recently, while there are no published statistics from either the American Society of Plastic Surgeons or the American College of Obstetricians and Gynecologist, it has become apparent in the lay press that �this surgery is one of the fastest growing� areas of plastic surgery.(3) Unfortunately, there has been no discussion in the peer-reviewed medical literature that addresses the biomedical ethical issues surrounding this procedure.
Therefore, the authors of this paper, (a gynecologist specializing in the treatment of vulvar disorders with experience performing this procedure (AG), and a dermatologist with an advanced degree in medical ethics who performs aesthetic procedures (GG)) thought it necessary to examine this procedure through the lens of established and accepted principles of biomedical ethics to offer guidelines for physicians who might consider performing this procedure.
The four medical ethical principles applicable to this discussion are autonomy, non-maleficence, beneficence, and justice.(4) However, it is important to recognize that each of these four principles are not given equal weight when making medical decisions.
In conclusion, we have attempted to examine the labiaplasty within the construct of established medical ethical principles. After applying these principles to this procedure, it is apparent that performance of this procedure is not always ethical, nor it is always unethical. Therefore, it is the surgeon�s burden to be aware of the ethical principals involved and to practice well within the boundaries of ethical conduct. Lastly, while this paper has only examined the medical ethical issues surrounding labiaplasty, the same principles can be applied to other vulvovaginal cosmetic procedures such as �vaginal rejuvenation� and �hymenoplasty.� (12/06)
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1. Alter GJ. A new technique for aesthetic labia minora reduction. Ann Plast Surg 1998;40(3):287-90.
2. Hodgkinson DJ, Hait G. Aesthetic vaginal labioplasty. Plast Reconstr Surg 1984;74(3):414-6.
3. Kobrin S. More Women seek Vaginal Plastic Surgery. Women's Enews 2004:http://www.womensenews.org/article.cfm/dyn/aid/2067/context/archive.
4. Beauchamp T, Childress, JF. Principles of Biomedical Ethics. 3rd ed. New York: Oxford University Press; 1989.
5. Ethics ACoOaGCo. Ethical Ways for Physicians to Market a Practice. Obstet Gynecol 2006;108(1):239-42.
6. Rouzier R, Louis-Sylvestre C, Paniel BJ, Haddad B. Hypertrophy of labia minora: experience with 163 reductions. Am J Obstet Gynecol 2000;182(1 Pt 1):35-40.
7. Giraldo F, Gonzalez C, de Haro F. Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora. Plast Reconstr Surg 2004;113(6):1820-5; discussion 6-7.
8. Maas SM, Hage JJ. Functional and aesthetic labia minora reduction. Plast Reconstr Surg 2000;105(4):1453-6.