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International Society for the Study of Vulvovaginal Disease Recommendations Regarding Female Cosmetic Genital Surgery

Vieira-Baptista, Pedro, MD1; Almeida, Gutemberg, PhD2; Bogliatto, Fabrizio, PhD3; Bohl, Tanja Gizela, MD4; Burger, Matthé, PhD5; Cohen-Sacher, Bina, MD6; Gibbon, Karen, MD7; Goldstein, Andrew, MD8; Heller, Debra, MD9; Likes, Wendy, DNSc10; Longo da Silva, Celene, PhD11; Marchitelli, Claudia, MD12; Moyal-Barracco, Micheline, MD13; Posey, Kathleen, MD14; Sluga, Maria Celeste, MD12; Stockdale, Colleen Kennedy, MD, MS15; Marquini, Gisele Vissoci, MD16; Zalewski, Kamil, MD17,18

Journal of Lower Genital Tract Disease: October 2018 - Volume 22 - Issue 4 - p 415–434
doi: 10.1097/LGT.0000000000000412
Clinical Practice

Female genital cosmetic surgeries (FGCSs) and procedures are increasingly being advertised as common, simple, and complication-free, capable of not only improving aesthetic appearance but also increasing self-esteem and sexual pleasure.

Guidelines for physicians and clear, scientifically correct information for patients must be made available, to minimize the number of ineffective or deleterious procedures.

The International Society for the Study of Vulvovaginal Disease positions/recommendations regarding FGCS are as follows:

1. There is a wide variation regarding genital normalcy; providers must be able to explain this to women.

2. There are no data supporting FGCS including, G-spot augmentation, hymenoplasty, vulvar and perianal bleaching/whitening, vaginal tightening procedures, and other procedures aimed at increasing sexual function.

3. Women should not be offered FGCS before the age of 18 years.

4. Women undergoing FGCS should be evaluated by a provider with expertise in vulvovaginal diseases, including attention to their psychological, social, and sexual context. Evaluation by an experienced mental health provider should be considered when the motivation for seeking surgery and/or expectations are not clear or realistic.

5. Female genital cosmetic surgery is not exempt from complications.

6. Informed consent must always be obtained.

7. Surgeons performing FGCS should refrain from solicitous advertising or promoting procedures without scientific basis, including on Web sites.

8. Surgeons should not perform surgery that they do not agree with and explain their rationale/position when pressured by patients.

9. The genital surgeon must be adequately trained in performing FGCS including knowledge of the anatomy, physiology and pathophysiology of the vulva, vagina and adjacent organs.

1Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal;

2Institute of Gynecology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Post-Graduate Program in Surgical Sciences, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil;

3Lower Female Anourogenital Tract Network - ASLTO4, Chivasso Civic Hospital, Torino, Italy;

4Vulva Clinic, Jean Hailes Medical Centre, Clayton, Victoria, Australia;

5Emeritus professor of Gynaecology, University of Amsterdam, the Netherlands;

6Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel;

7Department of Dermatology, Barts Health NHS Trust, London, United Kingdom;

8The Center for Vulvovaginal Disorders, Washington, DC;

9Department of Pathology, Rutgers-New Jersey Medical School, Newark, NJ;

10College of Nursing, University of Tennessee Health Science Center, Memphis, TN;

11Faculdade de Medicina da Universidade Federal de Pelotas, Pelotas, Brazil;

12Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;

13Department of Dermatology, Hôpital Tarnier-Cochin, Paris, France;

14Private Practice, Madisonville, LA;

15Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA;

16Gynecology and Obstetrics, Nucleus of Health Assistance to the Worker, Federal University of Uberlandia, Minas Gerais, Brazil;

17Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland; and

18Department of Obstetrics, Gynecology and Oncology, 2nd Faculty of Medicine, Warsaw Medical University, Poland

Correspondence to: Colleen Kennedy Stockdale, MD, MS, Department of Obstetrics and Gynecology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242. E-mail:

The authors have declared they have no conflicts of interest.

Copyright © 2018 by the American Society for Colposcopy and Cervical Pathology