Labiaplasty – the most commonly performed FGCS procedure, this involves removal of tissue from labia minora that extends beyond the labia majora and/or removal or increase tissue from the labia majora in order to achieve symmetry. The procedure falls into two broad categories:
- Amputation technique, or labial trim, where the edge of the labium is cut out and the edges sewn over.10
- Removal of a section of the labia to preserve the natural contour, such as wedge resection4,5 and de-epithelialisation techniques.12,13
Clitoral hood reduction – exposes clitoris and aims to increase sensitivity. This is sometimes combined with a labiaplasty procedure.
Perineoplasty – undertaken to strengthen the pelvic floor and, in the FGCS setting, aimed at establishing penile pressure with coital thrust.14 This procedure is technically similar to perineal reconstruction, in which the perineal length is restored following childbirth trauma or previous surgery. It is commonly performed as part of vaginal prolapse surgery. However, even in this setting there is no evidence that this procedure improves sexual function and, in fact, it may cause dyspareunia.
Vaginoplasty – the purpose of this procedure is vaginal creation in gender reassignment but, in the FGCS setting, it refers to tightening the vagina, which can be surgical or non-surgical – as in ‘laser vaginal rejuvenation’ or ‘designer laser vaginoplasty’.
Hymenoplasty – also called ‘revirgination’ and is designed to restore the hymen. It is often advertised as a ‘gift’ to one’s partner.14 This procedure is occasionally requested by women of certain cultural backgrounds in which premarital sex is forbidden and an intact hymen is considered evidence of virginity.12
Vulval lipoplasty – removal of fat from mons pubis or augmentation of the vulva.
G-spot augmentation – involves autologous fat or collagen transfer via injection into the pre-determined G-spot location. There is no existing scientific literature describing this procedure. Similar procedures include G-spot amplification and G-shot collagen injection into the region.15
Orgasm shot (O-shot) – often described as a sexual and cosmetic rejuvenation procedure for the vagina using the preparation and injection of blood-derived growth factors into the G-spot, clitoris and labia.12,14
Terms such as ‘vaginal rejuvenation’, ‘designer laser vaginoplasty’, ‘revirgination’ and ‘G-shot’ are commercial in nature. The consumers at whom they are targeted can then mistakenly believe such official-sounding terms refer to medically-recognised procedures.17,18
Cosmetic surgery redefines the patient as a ‘consumer’, and uses advertising to promote the ‘product’. Advertising for female genital cosmetic surgery tends to reflect and reinforce sociocultural messages about the vulva and vagina, potentially creating dissatisfaction among women who do not meet the narrow ideal of normality. Advertising suggests that FGCS procedures are simple, and offer high levels of satisfaction. It normalises surgical procedures and is likely to create demand among those women who experience genital dissatisfaction.14,15