'Designer Vagina' Web Sites Confusing, Inaccurate

Diedtra Henderson

November 26, 2012

Web sites advertising "designer vagina" surgical procedures provide a confusing tangle of information, use unsubstantiated effectiveness claims, and minimize the risk of surgical procedures, according to a new study.

The research, conducted by Lih-Mei Liao, PhD, from the UCL Elizabeth Garrett Anderson Institute of Women's Health, University College Hospital, London, United Kingdom, and colleagues was published online November 21 in BMJ Open.

According to the authors, numerous Web sites advertise cosmetic surgery for women who are concerned about the appearance of their genitals, with procedures ranging from hymenoplasty to labiaplasty, "G-spot amplification," and "vaginal rejuvenation." The American College of Obstetricians and Gynecologists took the unusual step of warning practitioners in 2007 that such procedures were "not medically indicated and the safety and effectiveness of these procedures have not been documented."

Still, the female genital cosmetic surgery (FGCS) procedures continue with little scrutiny. The researchers sought to analyze the quality, quantity, and accuracy of the clinical information presented by the Web-based advertisements.

Dr. Liao and colleagues typed the term "designer vagina" into Google's search engine and, from the listed search results, included the first 5 providers from the United Kingdom and the first 5 from the United States in the study. They analyzed the Web sites according to 16 criteria, including the types of procedures offered, stated or implied benefits of surgery, risks of surgery, and presence of "before" and "after" images.

Half of the Web sites used different terms to refer to the same procedure, such as "hymen repair," "hymenoplasty," "hymen reconstruction," and "revirgination." All of the Web sites listed aesthetic concerns among the indications for surgery, with some sites recommending surgery to make labia appear "sleeker" and "more appealing." Nine of 10 Web sites mentioned physical indications for surgery, including discomfort with certain types of clothing, discomfort during intercourse, or difficulty inserting a tampon.

Risk information was included in all 10 Web sites. The 6 Web sites with the most detail listed surgical risks, such as bleeding and infection, described them as uncommon or minimized the surgical risks by saying they were "lower than pregnancy." Six sites had "before" and "after" labiaplasty photographs with larger normal labia before surgery and "homogenised vulval appearance" after surgery, according to the authors.

No Lower Age Limit

"Consumers looking at these sites may be confused by the myriad labels for the procedures and uncertain as to how to determine whether some of them are the same or different from each other," the authors write.

"The absence of evidence for clinical effectiveness was not only left out, but in combination the sites actually made scientifically inaccurate claims that the procedures were effective along physical, psychological, social and sexual parameters," they add.

None of the sites included in the study included a lower age limit for the cosmetic surgery, which the authors said was their "most disturbing" finding. In the United Kingdom alone, 343 labiaplasties were performed within the National Health Service on girls aged 14 years and younger in the last 6 years.

In addition, a recent observational study found girls as young as age 9 years with normal labia seeking corrective surgery. Because the labia minor change as girls become women, the younger they undergo elective cosmetic surgery, "the higher the number of lifetime operations and the greater and more multiple the risks," the authors note.

Rather than surgery, physical discomfort could be remedied by emollients, psychological complaints could be addressed by psychological interventions, and healthcare providers should emphasize that "healthy vulvas come in all shapes, sizes and colours," the authors write.

The current guidance provided by medical professional societies "seem ineffectual," Dr. Liao and colleagues note, adding that clear and detailed guidelines on how to raise the standards for FGCS information are "urgently needed."

The research team used a single search term and a single search engine. Women looking for information about the cosmetic surgery may see a different array of advertisements. Despite these limitations, the authors say the results they found were similar across Web sites, which implies that Web sites they did not analyze would contain the same information.

"While the 10 websites analysed are small in number, the findings offer useful glimpses into the quality of information for the potential consumer and have implications for clinical standards," the authors conclude. "This report highlights significant gaps in the breadth, depth, accuracy and quality of clinical information given by some service providers of FGCS."

The authors have disclosed no relevant financial relationships.

BMJ Open. Published online November 21, 2012. Full text