Behind the Decision: Exploring Motivations, and Psychological and Sexual Outcomes of Labiaplasty

Abstract

Background:

Labiaplasty has rapidly gained popularity among women in recent years. However, limited studies are available discussing the motivations influencing their decisions to undergo the procedure and its implications for psychological and sexual satisfaction. This systematic review was conducted to identify the primary motivations for labiaplasty and its effects on patients’ psychological aspects and intimate relationships.

Methods:

This systematic review was conducted by searching 6 online databases with related keywords. Cohort, cross-sectional studies, clinical trials, and case series that reported patients who underwent labiaplasty in adulthood were included. We excluded studies that had subjects with other operations on the genital area.

Results:

Sixteen eligible studies involving a total of 1143 participants were analyzed. Among women seeking labiaplasty, functional complaints (52.2%) were the primary motivators, followed by concerns about appearance (46.3%), psychological motivations (26.9%), and sexual reasons (20.5%). Improved self-esteem and confidence were the primary psychological outcomes observed, with 1 study also showing a significant reduction in anxiety (P < 0.05). Most patients reported improvements in sexual function, including relationship satisfaction and intercourse comfort, although these changes were nonsignificant. Psychosexual outcomes showed increased sexual confidence and reduced anxiety, but most findings were nonsignificant.

Conclusions:

Functional complaints were found to be the primary motivations for women seeking labiaplasty, followed by appearance, psychological, and sexual complaints. The psychological, sexual, and psychosexual outcomes after labiaplasty showed some improvements. However, concluding the overall results was challenging due to the divergent assessment tools. Standardized assessment tools that are acceptable worldwide to assess such outcomes are needed for further study.

Takeaways

Question: What are the primary motivations for the labiaplasty procedure, and how does the procedure affect patients’ psychological well-being and intimate relationships?

Findings: A systematic review was conducted by searching online databases using related keywords, and 16 eligible studies were included. Functional complaints were identified as the main motivation for undergoing the procedure. Improvement in self-esteem, sexual function, and sexual confidence, along with reduced anxiety, was also observed.

Meaning: Labiaplasty may improve a patient’s psychological and sexual outcomes, but physicians should identify any underlying issues beforehand.

INTRODUCTION

Labiaplasty is a genital surgery to reduce labial hypertrophy caused by congenital abnormalities, trauma, or infection.^1,2 The demand for this procedure has risen during the past decade.³ After the COVID-19 pandemic, a study reported that interest in labiaplasty significantly increased in Brazil, Russia, and Turkey.⁴ The American Aesthetic Plastic Surgery National Databank also reported that in 2020, 13,697 labiaplasties were performed, up from 12,903 cases in 2019.^5,6 This trend is supported by a study that reported an increase in the number of labiaplasty procedures from 8341 to 12,756 over 4 years (2014–2018).⁷

The perception of normal labia minora form has shifted from a petite, nonprotruding form to a broader range influenced by age, ethnicity, number of pregnancies, hormones, and sexual activity.⁸ This new perception has increased the demand for labiaplasty, particularly in more developed societies.⁹ Many factors contribute to patients’ motivation when it comes to cosmetic surgery. A study found that women who had undergone labiaplasty were more exposed to the idealized genital image in the media.¹⁰ Moreover, approximately 57% of participants sought labiaplasty due to pain and discomfort from elongated labia.^7,11,12

Labiaplasty is a personal decision shaped by individual factors and perceptions, with each woman holding a subjective opinion regarding the procedure. Some women reported that the appearance of their genitals is abnormal, impacting self-esteem and sexual well-being.¹³ Aesthetic and sexual concerns often stem from psychological factors, particularly self-esteem issues. It is important to assess outcomes related to an individual’s psychological well-being and psychosexual dynamics with partners. Although studies often focus on surgical and functional outcomes, few explore the psychological and motivational aspects of undergoing labiaplasty. To date, no comprehensive review has evaluated these motivations and their impact on psychological well-being. Owing to the limited research on its implications for women’s psychological and sexual satisfaction despite its popularity, this study systematically reviewed labiaplasty’s impact on psychological well-being and relationships while also aiming to identify key motivations behind the procedure.

MATERIAL AND METHODS

Protocol and Registration

This systematic review was conducted to explore the motivations and evaluate psychological, sexual, or psychosexual outcomes of labiaplasty in adults. We conducted this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines (Fig. 1).

Fig. 1.

Preferred Reporting Items for Systematic Reviews and Meta-analysis methodology for systematic review.

Eligibility Criteria

We included studies reporting the motivations and evaluating the psychological, sexual, or psychosexual outcomes of labiaplasty in adults, covering all surgical techniques. Studies that had subjects with other operations on the genital area were excluded. There was no comparison of every surgery. We included clinical trials, cohort studies, and case series. The primary outcome of the study was exploring the motivations behind and examining the psychological, sexual, or psychosexual outcomes of labiaplasty.

Search Strategy

We systematically searched 6 databases (PubMed, ProQuest, Scopus, ScienceDirect, Elton B. Stephens Company, and Google Scholar). A combination of the following keywords was used: “labiaplasty,” “motivation,” “interest,” “consideration,” “psychological,” “sexual,” “psychosexual,” “outcomes,” and “result.” Non-English language studies and studies that had subjects with other operations on the genital area were excluded. Studies that were published more than 10 years ago were also excluded. This approach minimizes data collection bias by using English as a universal language and ensures the inclusion of the most up-to-date data. The complete search strategy in all databases is listed in Table 1.

Table 1.

Search Strategy

Online Database	Keywords
PubMed	(labiaplasty[Title/Abstract]) AND ((psychological[Title/Abstract]) OR (sexual[Title/Abstract]) OR (psychosexual[Title/Abstract]) OR (motivation[Title/Abstract]) OR (interest[Title/Abstract]) OR (consideration[Title/Abstract])) AND ((outcomes[Title/Abstract]) OR (result[Title/Abstract]))
ProQuest	(labiaplasty AND (psychological OR sexual OR psychosexual OR motivation OR interest OR consideration) AND (outcomes OR result))
Scopus	(TITLE-ABS-KEY (labiaplasty) AND TITLE-ABS-KEY (psychology) OR TITLE-ABS-KEY (sexual) OR TITLE-ABS-KEY (motivation) TITLE-ABS-KEY (interest) OR TITLE-ABS-KEY (consideration) AND TITLE-ABS-KEY (outcomes))
Science Direct	Title, abstract, keywords: (labiaplasty AND (psychological OR sexual OR psychosexual OR motivation))
EBSCO	Labiaplasty AND (psychological OR psychosexual OR motivation OR interest) AND (outcomes)
Google Scholar	With all of the words labiaplasty, psychosexual, psychological, outcomes

EBSCO, Elton B. Stephens Company.

Study Selection

Three contributors independently screened the titles and abstracts from the online databases according to the eligibility criteria. Any disagreement among the contributors was resolved through discussion. Where feasible, additional information was requested for studies that lacked adequate data. Duplication of literature was excluded after initial screening. The contributors reviewed the full-text literature independently.

Data Collection Process

Three contributors independently extracted the data from the literature according to the eligibility criteria into a specified data collection form. Data extracted from studies included title, author, publication year, study design, total participants, mean age at surgery, duration of follow-up, surgical technique, motivations to undergo labiaplasty, and outcomes of labiaplasty (including psychological, sexual, and psychosexual outcomes). The 4 contributors resolved any identified discrepancies through discussion.

Risk of Bias

Three contributors independently assessed the quality of the studies. The Risk of Bias in Non-randomized Studies—of Interventions tool was used to assess the risk of bias by evaluating 7 domains, including bias related to confounding factors, interventions, and participant and data selection (Fig. 2). Disagreement among the contributors was resolved through discussion.

Fig. 2.

ROBINS-I risk of bias analysis. ROBINS-I, Risk of Bias in Non-randomized Studies—of Interventions.

Method of Analysis

Data regarding motivations were classified into 5 groups and presented in tabular form, with meta-analysis conducted when feasible. Evaluation of outcomes was synthesized narratively, focusing on psychological, sexual, and psychosexual outcomes of labiaplasty in adults. Mean age at surgery, duration of follow-up, and surgical technique were included as additional data.

RESULTS

Search Results

The initial search of 6 databases produced 517 articles, with 208 remaining after removing duplicates (Fig. 1). Twelve studies met the specified criteria for this review, exploring the motivations for the labiaplasty procedure (Table 2). A total of 6 studies explored labiaplasty outcomes with 4 studies reporting psychological outcome data, 4 providing sexual outcome data, and only 2 reporting psychosexual outcome data (Table 3). A meta-analysis was not conducted due to the heterogeneity of the data.

Table 2.

Summary of Subjects’ Main Motivations to Undergo Labiaplasty

Author	Year	Total Participants	Mean Age, y	Main Motivations
				Functional, %	Psychological, %	Appearance, %	Sexual, %	Prone to Infection, %
Veale et al14	2014	125	30.0	62.5	—	70.8	37.5	—
Zwier et al15	2014	78	21.5	52.5	71.0	—	—	—
Sharp et al10	2016	65	31.3	68.6	45.7	71.4	60.0	—
Sharp et al7	2016	14	38.4	42.9	71.4	21.4	85.7	—
Sorice et al16	2017	50	33.5	—	—	—	—	—
Dogan et al17	2018	71	32.0	21.1	39.4	52.1	46.5	54.9
Surroca et al18	2018	58	32.2	—	—	81.0	—	10.3
Sorice-Virk et al 19	2019	124	34.2	—	—	—	—	—
Propst et al20	2021	21	30.0	90.5	—	71.4	—	4.8
Erdogan21	2021	100	36.2	35.0	1.0	30.0	34.0	—
Chang et al9	2023	131	30.3	91.5	—	62.0	—	4.2
Qiang et al22	2023	216	31.0	38.4	4.2	22.2	—	—
Total		1053	31.2	52.2	26.9	46.3	20.5	18.3

Table 3.

Overview of the Included Studies of Labiaplasty Outcomes

Study (Year)	No. Subjects	Mean Age, y	Duration of Follow-up, mo	Techniques	Outcomes
					P	S	PS
Veale et al (2014)12	49	34	3	Trim labiaplasty (30.6%); central wedge reduction (18.4%); de-epithelialization technique (6.1%); superior pedicle flap reconstruction (4%)	x	x
Sharp et al (2016)7	14	—	5–16	—			x
Sharp et al (2016)23	29	38.8	6	—	x	x	x
Surroca et al (2018)18	58	32.16	3–6	Wedge excision (75.8%); W-plasty excision (24.2%)	x
Turini et al (2018)24	12	38.8	3	Trim labiaplasty (100%)	x	x
Erdogan (2021)21	100	36.17	6	Wedge excision, trim labiaplasty		x
Total	262	35.2

P, psychological; PS, psychosexual; S, sexual; x, article includes the required outcome information.

Motivations to Undergo Labiaplasty

Functional Motivations

Our findings indicate that functional issues constitute the primary motivation among women seeking labiaplasty, affecting 52.2% of the participants, followed by appearance (46.3%), psychological (26.9%), sexual (20.5%), and infection-related concerns (18.3%) (Table 2). Functional motivations were assessed using subjective measures. Noteworthy complaints included discomfort or pain, hygiene issues, and exercise-related discomfort. Among the studies focusing on functional motivations, 52.2% of participants identified discomfort or pain as the primary driver. Additionally, 28.1% of participants pointed to hygiene problems, whereas 22.3% reported exercise-related difficulties. However, this percentage does not provide a complete picture of the population, as not all studies mentioned report on hygiene and exercise-related discomfort. Sorice et al¹⁶ reported that 56.5% and 62.9% of their subjects experienced twisting and tugging, respectively.

Psychological Motivations

Seven studies evaluated psychological issues, with all studies using subjective assessments. The psychological aspects were categorized into self-psychological problems (eg, low self-esteem) and social problems (eg, societal pressure). Across 7 studies, 40.2% of participants identified social problems as the most common psychological concern, whereas 37.6% cited low self-esteem as a factor in their decision to undergo labiaplasty (Table 4).

Table 4.

Summary of Subjects’ Psychological, Appearance, and Sexual Motivations to Undergo Labiaplasty

No.	Author	Year	Discomfort/Pain, %	Functional		Psychological		Appearance			Sexual
				Hygiene, %	Exercise Discomfort, %	Self, %	Social, %	Visible in Tight Clothing, %	Exposure to Bathing Suit, %	Pain During Intercourse, %		Negative Experience on Intimacy, %
1	Zwier et al15	2014	27.5	7.5	21.3	48.8	38.8	—	—	21.3		21.3
2	Sharp et al10	2016	35.7	—	7.1	45.7	—	—	—	—		—
3	Sharp et al7	2016				—	71.4	—	—	—		—
4	Sorice et al16	2017	72.0	—	—	66.0	—	54.0	40.0	48.0		64.0
5	Dogan et al17	2018	38.0	50.7	31.0	—	60.6	—	—	46.5		35.2
6	Sorice-Virk et al19	2019	50.8	—	—	59.7	65.3	44.4	34.7	35.5		56.5
7	Erdogan21	2021	16.0	—	19.0	—	1.0	—	—	34.0		—
8	Propst et al20	2021	90.5	—	—	—	—	—	—	—		—
9	Chang et al9	2023	91.5	—	—	—	—	—	—	—		—
Total			52.2	28.1	22.3	37.6	40.2	47.2	36.2	35.8		44.4

Appearance Motivations

Appearance-related concerns were examined in 9 studies, all using subjective measures. However, only 2 studies explicitly detailed participants’ concerns regarding appearance-related issues as motivations for undergoing labiaplasty. Specifically, 36.2% reported exposure in bathing suits, whereas 47.2% expressed discomfort due to the visibility of labia minora in tight clothing (Table 4).

Sexual Motivations

Five studies highlighted sexual concerns as key motivations for labiaplasty. A subjective questionnaire revealed 2 primary complaints: pain during intercourse (35.8%) and negative experiences with intimacy, including partner judgments (44.4%) (Table 4).

Outcomes of the Labiaplasty Procedure

Psychological Outcomes

Four studies reported the psychological outcomes of labiaplasty. Seven studies compared outcomes before and after intervention, whereas only 1 included a control group (Table 5). Three studies assessed the objective outcomes. Veale et al¹² used the Hospital Anxiety and Depression Scale, a self-report instrument that assesses the severity of anxiety and depressive symptoms separately (scale 0–21), finding improvement in anxiety symptoms but no significant change in depression symptoms. The Body Image Quality of Life Inventory was used to quantify the impact of body image on a broad range of life domains; however, the study showed inconclusive results. Sharp et al²³ and Turini et al²⁴ used the Rosenberg Self-Esteem Scale to assess individual self-esteem, where a lower score indicates lower self-esteem. Both studies reported results that were not statistically significant. The Hopkins Symptom Checklist measured anxiety and depression symptoms, whereas the Satisfaction with Life Scale assessed life satisfaction; however, both showed no significant results. Two studies used unvalidated questionnaires by the authors; both results reported improvements in confidence and self-esteem.

Table 5.

Psychological Outcomes of Labiaplasty

Study (Year)	No. Subjects	Comparison	Tools	Result		P	Trend
				Objective (Mean)	Subjective
Veale et al (2014)12	26	Pre- and postintervention	HADS, anxiety	5.59	—	0.005	Improve
			HADS, depression	4.50	—	0.895	Indifference
	26	Pre- and postintervention	BIQLI	0.70	—	0.066	Indifference
Sharp et al (2016)23	27	Pre- and postintervention	PSQ	—	Increased confidence in general: 34.50%; appearance relief (self-esteem): 34.50%	—	Improve
	29	Pre- and postintervention	HSC	1.80	—	0.314	Indifference
	29	Pre- and postintervention	RSES	20.50	—	0.787	Indifference
	29	Pre- and postintervention	SLS	23.30	—	0.800	Indifference
Surroca et al (2018)18	58	Pre- and postintervention	PSQ	—	Improve self-esteem: 86.21%	—	Improve
Turini et al (2018)24	21	Control	RSES	5.88	—	>0.050	Indifference

BIQLI, Body Image Quality of Life Inventory; HADS, Hospital Anxiety and Depression Scale; HSC, Hopkins Symptom Checklist; PSQ, Patient Subjective Questionnaire; RSES, Rosenberg Self-Esteem Scale; SLS, Satisfaction with Life Scale.

Sexual Outcomes

Four studies assessed sexual outcomes of labiaplasty, with only 1 study incorporating a subjective assessment (Table 6). Veale et al¹² used the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire for evaluating sexual function, showing insignificant results before and after the procedure. Sharp et al²³ included both objective and subjective measures. The Relationship Assessment Scale questionnaire measured general relationship satisfaction, reporting no significant improvement. Subjectively, 10.3% experienced increased comfort during sexual intercourse, although this was not statistically significant. Turini et al²⁴ and Erdogan²¹ used the Female Sexual Function Index for evaluation, with mixed results on improvement across indicators.

Table 6.

Sexual Outcomes of Labiaplasty

Study (Year)	No. Subjects	Comparison	Tools	Result		P	Trend
				Objective (Mean)	Subjective
Veale et al (2014)12	26	Pre- and postintervention	PISQ	102.6	—	0.016	Improve
Sharp et al (2016)23	12	Pre- and postintervention	RAS	29.8	—	0.796	Indifference
	27	Pre- and postintervention	PSQ	—	Increase sexual intercourse comfort (10.3%)		Indifference
Turini et al (2018)24	12	Pre- and postintervention	FSFI	Desire: 18.17	—	0.056	Indifference
				Arousal/sensation: 12.25		0.082	Indifference
				Arousal/lubrication: 6.83		0.104	Indifference
				Arousal/cognitive: 6.08		0.138	Indifference
				Orgasm: 9.50		0.212	Indifference
				Pain: 10.75		0.044	Improve
				Enjoyment: 19.33		0.044	Improve
				Partner: 7.42		0.056	Indifference
Erdogan (2021)21	100	Pre- and postintervention	FSFI	Desire: 8.08	—	<0.001	Improve
				Arousal: 24.92		<0.001	Improve
				Lubrication: 5.60		0.345	Indifference
				Orgasm: 12.37		<0.001	Improve
				Pain: 11.71		<0.001	Improve
				Satisfaction: 12.45		<0.001	Improve
				Sexual function scale: 75.13		<0.001	Improve

FSFI, Female Sexual Function Index; PISQ, Pelvic Organ Prolapse–Urinary Incontinence Sexual Function Questionnaire; PSQ, Patient Subjective Questionnaire; RAS, Relationship Assessment Scale.

Psychosexual Outcomes

Only 2 studies were identified that reported on psychosexual outcomes, referring to psychological aspects experienced around sexual intercourse (Table 7). Both studies by Sharp et al^7,23 reported a reduction in anxiety (83.3%) and an increase in confidence (48.3%) in sexual intercourse. An objective assessment using the Sexual Interaction Satisfaction and Compatibility questionnaire showed indifferent results. Owing to the variation in tools used and the data reporting method, a meta-analysis was not conducted.

Table 7.

Psychosexual Outcomes of Labiaplasty

Study (Year)	No. Subjects	Comparison	Tools	Result		P	Trend
				Objective (Mean)	Subjective
Sharp et al (2016)7	10	Pre- and postintervention	PSQ	—	Reduction in anxieties around sexual intercourse (83.3%)	—	Improve
Sharp et al (2016)23	14	Pre- and postintervention	PSQ	—	Increased confidence in intimacy (48.3%)	—	Improve
	23	Pre- and postintervention	SISCL	31.2 ± 5.7	—	0.157	Indifference

PSQ, Patients Subjective Questionnaire; SISCL, Six-item Sexual Confidence Scale.

DISCUSSION

Motivations to Undergo Labiaplasty

Labiaplasty has grown increasingly popular, with more procedures performed over the years.^9,25 Despite this rise, understanding women’s motivations and evaluating the sexual and psychological outcomes of labiaplasty remain challenging for clinicians, partly due to prejudices about female genitalia.²⁶ This study explored the primary motivations for seeking labiaplasty, focusing solely on its psychological and sexual outcomes.

Our systematic review identified that functional issues were the primary motivations for labiaplasty, as reported subjectively by participants. Goodman et al²⁷ noted that 76% of 177 women underwent labiaplasty due to discomfort and dyspareunia, with enlarged labia minora being a key cause of pain from friction with clothing or during exercise.²⁸ Aesthetic concerns also played a role. Rouzier et al²⁹ reported that 87% of 163 patients sought labiaplasty for aesthetic dissatisfaction. This aligns with a systematic review showing that dissatisfaction with specific body features is associated with greater interest in cosmetic procedures.³⁰ However, Miklos and Moore³¹ reported that only 37% of 131 patients had purely aesthetic motivations. These findings suggest that functional complaints are more prominent than aesthetic concerns, although the “designer vagina” trend may influence some women’s perceptions of genital appearance.^32,33

Psychological factors also influence the decision, with many women expressing concerns about social judgment. A study found that 33% of women pursued the procedure to boost self-esteem, often influenced by societal pressures.²⁷ However, another study reported that 75% of clinicians refer women with psychological motivations to mental health services before proceeding, highlighting ethical concerns.³⁴ Notably, women diagnosed with body dysmorphic disorder (BDD) are ineligible for labiaplasty.²⁸ Sexual motivation is another factor, with some women seeking the procedure due to sexual concerns, particularly pain during intercourse.²⁹ Sexual concerns often overlap with psychological issues, as some women reported negative comments from their sexual partners, leading to low sexual confidence and relationship dissatisfaction.^34,35 A meta-analysis studying the role of a sexual partner in labiaplasty revealed that 36.7% of women seeking labiaplasty mentioned negative comments from their partners as a contributing factor to their decision.³⁶

Hygiene concerns and the risk of infection are additional reasons for seeking labiaplasty. Labial hypertrophy, combined with risky sexual behaviors, may increase the likelihood of infections, including sexually transmitted diseases. However, they also suggested that genital surgery might improve sexual health and safety.³⁷ Additionally, labial protrusion or hypertrophy can increase the risk of urinary tract infections and disrupt vaginal pH levels, reducing the natural acidity that helps protect against infections.³⁸

Many studies identify BDD as a potential bias. BDD is a psychological disorder marked by obsessive concerns over perceived appearance flaws, leading to shame, excessive mirror checking, heavy makeup use, and repeated aesthetic procedures.³⁹ Individuals with BDD frequently visit dermatologists and plastic surgeons, with approximately 6%–15% of BDD patients seeking cosmetic surgery.^40,41 Indeed, a systematic review showed that BDD-like symptoms were a significant predictor of interest in cosmetic surgery. However, most studies do not specify whether their subjects have BDD. Recognizing BDD is crucial, as affected patients may remain dissatisfied despite acceptable surgical outcomes.³⁰ This highlights the need for further research to identify BDD among those seeking labiaplasty or other cosmetic procedures.

Ethnicity may not significantly influence the motivation for labiaplasty. One study reported that most Chinese patients seek labiaplasty for functional reasons, with only a few being influenced by media or sexual partners.²² Meanwhile, Zwier¹⁵ analyzed motivations for labiaplasty in online communities of women from Western countries, including American, British, and Dutch individuals, and found no significant differences in motivations.

Zwier¹⁵ also highlighted insurance coverage as a bias in labiaplasty research. Although typically considered a cosmetic procedure, some cases receive coverage for medical reasons. They included participants from various nationalities, including American, Dutch, and British populations, and emphasized that future research should consider whether insurance covers this procedure, as it may influence patients’ motivations for undergoing genital surgery.¹⁵ Additionally, many studies rely on single-center data from private clinics, where patients pay out of pocket. From 2015 to 2020, only 1.5%–2.2% of labiaplasty procedures were covered by insurance, meaning the vast majority were self-funded.⁴²

Outcomes of the Labiaplasty Procedure

Our review found that some studies used objective measures through validated questionnaires, whereas others relied on subjective patient-reported outcomes. These subjective outcomes, often based on clinical interviews without standardized tools, tended to show more favorable results than objective measures. This aligns with the findings by Sarwer,⁴³ who noted that psychometric tools often report more minor self-esteem improvements than clinical interviews. All of the studies were followed up postoperatively for a minimum of 3 months or more, as this corresponds to the period when wound healing is most robust and comparable to healthy tissue. Therefore, this timeframe is appropriate for assessing outcomes.

The use of diverse instruments and the absence of standardized psychological evaluation tools complicate the assessment of psychological outcomes. Some studies reported improvements in self-esteem and confidence, consistent with research highlighting labiaplasty’s positive impact on women’s self-esteem.^35,44,45 This aligns with studies on other aesthetic procedures, such as silicone breast implants, which also found self-esteem improvements.⁴⁶ However, our review revealed that some psychological outcomes, such as self-esteem, were not significantly improved after the procedure, despite increased satisfaction with the genital appearance.^12,23 Similar findings have been observed in studies on other aesthetic procedures, such as breast surgery.⁴³ Women seeking labiaplasty often had lower life satisfaction and a higher incidence of BDD, though not necessarily higher levels of depression or anxiety.^14,47 These findings underscore the need for careful evaluation to determine whether surgery will address self-esteem issues or if additional psychological assessment is required.⁴⁸

Similar to psychological outcomes, this review showed mixed results regarding the sexual outcomes of labiaplasty. Some studies reported improvements, whereas others found no significant changes. The tools used to assess sexual outcomes also differed across studies. Laumann et al⁴⁹ suggested that negative genital self-image could contribute to sexual dysfunction, with improvements in self-image potentially leading to enhanced sexual function. However, this was not consistently observed in the studies reviewed. Goodman et al⁵⁰ reported no significant changes in sexual function before and after labiaplasty. Crouch et al¹¹ found that more than 60% of women interested in labiaplasty had never been sexually active, implying that surgery may not always address sexual concerns. Therefore, a thorough assessment is crucial to determine whether labiaplasty is likely to resolve a patient’s sexual issues before proceeding with the procedure.

In terms of psychosexual aspects, such as sexual confidence, self-esteem, and anxiety related to sexual intercourse, the review found diverse results. These findings reflect a pattern in psychological outcomes, where subjective patient-reported improvements often exceeded those from objective measures. In line with other studies on sexual outcomes, Sharp et al⁷ reported that 83.3% of women with sexual difficulties experienced reduced anxiety after labiaplasty. However, 33.3% of these women indicated that their psychological concerns about sex might have been of a psychological origin and were not resolved by the surgery.

Ethical Considerations

Labiaplasty remains a debatable procedure with strong ethical arguments on both sides. Opponents view it as unnecessary vulvar cosmetic surgery. On the other side, proponents argue that the majority of patients seek the procedure not solely for aesthetic reasons and that it is their right of autonomy to make an informed decision.³⁴

Some opponents compare labiaplasty to female genital mutilation/cutting, which is banned by the World Health Organization as a violent cultural practice.⁵¹ However, labiaplasty is considered an individual’s right to alter their own body, unlike female genital mutilation/cutting, which is driven by societal pressure.³⁴ Others argue that vulvar cosmetic surgery is more comparable to breast surgery, as both have functional and aesthetic purposes.^27,34,52

To respect patient autonomy and nonmaleficence, labiaplasty should follow regulated guidelines. Physicians should assess patient motivations, confirm medical indications, and provide thorough risk information, emphasizing that surgery may not resolve psychological or physical concerns.⁵³ Physicians should be aware of patients with BDD, as they may lack full decision-making autonomy.^54–56 Several studies have reported that labiaplasty is rarely motivated by functional complaints, with dissatisfaction regarding physical appearance and/or psychosexuality concerns being more prevalent.^34,15,57 However, other studies report functional issues as the main motivation, aligning with the findings of this review.^27,31,47

Labiaplasty raises ethical challenges in assessing motivations, which often rely on subjective complaints and tools such as the Genital Appearance Scale. Future research should adopt standardized questionnaire tools to better assess patient motivations and enhance clinical decision-making. The heterogeneity in outcomes from labiaplasty may stem from the varied measurement tools used. Although some validated questionnaires assess psychological, sexual, and psychosexual outcomes, no standard tools take precedence. Because psychological and sexual concerns are rarely the primary motivators, physicians should discuss with patients that the procedure may not resolve these underlying issues. A multidisciplinary approach may better address these concerns, as the British Association of Aesthetic Plastic Surgeons recommends.

CONCLUSIONS

This systematic review revealed that functional complaints are the primary motivation for women seeking labiaplasty, followed by other factors. This study also highlighted some improvements in psychological, sexual, and psychosexual outcomes after labiaplasty. However, the diversity of assessment tools complicates the evaluation of these results. Physicians must carefully identify underlying issues related to psychological and sexual complaints before proceeding with surgery. Standardized assessment tools and globally accepted methodologies, both for assessing motivation and evaluating outcomes, are urgently needed to improve future research and clinical practice.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.