Female Genital Surgery

What is Female Genital Cosmetic Surgery (FGCS)?

FGCS refers to non-medically indicated cosmetic surgical procedures which change the structure and appearance of the healthy external genitalia of women, or internally in the case of vaginal tightening. This includes cosmetic surgery resulting from the distress caused by a perception of abnormality.

What does the FGCS involve?

Your surgeon will take a full medical history from you combined with an examination. Following this, a plan for the best approach to treat your symptoms will be made. This usually involves addressing the abnormalities present such as excess size, tissue redundancy and asymmetrical appearance.

What are the benefits of surgery?

The aim of surgery is to address the specific symptoms you may have. Whether these be physical, such as discomfort and bleeding with normal activities and sports or during intercourse, or psychological, such as distress caused by the perception of abnormality.

What are the risks of surgery?

All surgery carries risks of complications. These include:

Swelling: This is common early after surgery. Mostly swelling has resolved by 6 weeks, but in some cases may be long-term and persistent.

Bleeding: Bruising is common and usually resolves within 3 weeks. Actual bleeding is rare 1 - 5%, and may require a return to theatre for another procedure.

Infection: 1-10% infection may cause increasing pain in the wounds, spreading redness, or a smelly discharge. If this occurs you must seek urgent medical attention for treatment, which often involves antibiotics in the early stages.

Permanent altered or reduced sensation: This can occur either at or around the wounds. It can involve the labia, or the clitoris, or tissues around them. This may lead to long-term problems with intercourse and satisfaction with sexual interaction.

Persistent sutures: Persistence of the absorbable stitches after three to four weeks, requiring removal.

Adverse scarring: Scars may take up to 18 months to fully mature. In that time they may be tender, raised, red or lumpy. Some patients may develop excessive scarring known as hypertrophic or keloid scars that lead to long-term raised itchy, tender scars. Scarring can distort local tissues and prolong discomfort.

Prolonged Recovery/Delayed wound healing/Dehiscence: Wounds in this area may take longer to heal than elsewhere, leading to a prolonged recovery. In up to 30% of cases, wounds may not fully heal and may come apart (dehiscence) which may or may not require further treatment

Asymmetry or distortion of normal tissues: Every effort is made to achieve symmetry but this is not always possible, particularly if there is asymmetry pre-operatively. There may also be abnormal distortion of tissues as wounds heal.

Too little or too much tissue removal: One of the risks of surgery is the balance between too little and too much tissue being removed. As this is a cosmetic procedure the aim includes improving the appearance of the genitalia. You may have a different appearance in mind than your surgeon. Additionally, there are limitations to the amount of surgical improvement possible.

Dissatisfaction: Failure to be completely satisfied with the cosmetic result

Dyspareunia (pain during intercourse): Rare - due to scarring, or wound healing problems, there may be long-term persistent discomfort or pain with intercourse or even an inability to engage in intercourse.

Changes in sexual arousal: Rare - you may experience increased or decreased levels of sexual arousal related to changes from the surgery.

Difficulty giving birth in the future – rare - any surgery to the genital area may cause future problems with having a vaginal delivery and in conception.

Difficulty with urination/Bladder control: Very rare - you may experience difficulties with urination or with continence and bladder control

Need for revision surgery in the future: Occasionally there is a need for removal of excess skin or scarring at a later date.

What are the alternatives to surgery?

Your surgeon will discuss with you all treatment options for your specific symptoms. Even if surgery is the only recommended course to manage your symptoms, you may still choose not to proceed and to have no procedure done.

What should I expect before the procedure?

It is good to ensure that you are not having your period at the time of surgery. Ensure that your vulval area is clean by twice daily showers for a few days prior to any operation. The operation may be performed under a general or local anaesthetic. In cases where a general anaesthetic is used, you will be asleep during the procedure. For a general anaesthetic, on the day of your surgery you will be asked to stop eating food 6 hours prior to your surgery and drink only water until 2 hours before your surgery. An anaesthetist will see you on the day of your surgery to discuss the anaesthetic in more detail. You will also see your surgeon again to confirm your consent to proceed.

What happens during the procedure?

The exact nature of the surgery will be discussed with you during the consultation with your surgeon. The operative plan may however change at the time of your surgery, but this would only be to act in your best interests and achieve your desired outcome.

What happens after the procedure?

After the procedure you will usually only feel minimal discomfort due to local anaesthetic injected into the operated area during the surgery. Once this wears off, you may feel some mild pain that may require regular oral painkillers. Your surgeon will see you after your operation to explain how the procedure went. On discharge from hospital wear a panty pad which is changed regularly. Clean yourself gently twice a day with soap and water and put the antibiotic ointment onto the wounds which you will be prescribed. Stay off work for 2 weeks, and do no exercise for 3 weeks. If complications occur the time off work and sport will be prolonged.

Checklist before coming into hospital

• Make sure I know all the medications you are taking before surgery.
• Do not take any Aspirin or blood thinning drugs (which include some homeopathic supplements) for at least 2 weeks prior to surgery. Paracetamol is safe.
• Oral contraceptives can increase the risk of Deep Vein Thrombosis or Pulmonary Embolism. The contraceptive "pill" should ideally be stopped a month prior to surgery but please use some alternative form of contraception.
• It is advisable not to smoke six weeks prior to surgery and until complete healing has taken place. Nicotine reduces oxygen levels required for wound healing.
• Please have a shower in the morning of surgery and do not apply deodorant or any other products (e.g. body lotion, perfume etc.)
• Please do not have anything to eat (including chewing gum) 6 hours prior to surgery. You are able to drink still clear water up to 2 hours prior to your admission.