A C TA Obstetricia et Gynecologica

AOGS RE P L Y L ET T ER

Female genital cosmetic surgery: beyond a mechanistic view of sexual satisfaction

Sir, We appreciate the interest of Prof. Petros in our commentary on female genital cosmetic surgery (1), as well as his insightful considerations on some anatomical and biomechanical aspects of sexual intercourse. Certainly, physiological pelvic floor functioning, resulting from undamaged muscular and suspensory ligament systems, plays an important role in sexual satisfaction. An association between pelvic floor dysfunctions – such as urinary stress incontinence, cystocele, rectocele, and genital prolapse in general – and female sexual dysfunctions has been observed (2). Moreover, female sexual functioning may improve after successful surgery for pelvic floor dysfunctions. In this regard, as suggested by Prof. Petros, vaginal excision or laser treatments of the vaginal walls do not seem to be the best options. Vaginal delivery, especially when operative, is a risk factor for pelvic floor disorders, as muscles, ligaments, and nerves may be injured during the second stage of labor (3). However, there is no consensus regarding the definite impact of parity and mode of delivery on future sexual function and satisfaction (4). Some investigators have observed improved sexual functioning after vaginoplasty performed in women with a postpartum perception of “wide vagina” and decreased sensation at intercourse (5). However, with the exception of advanced-degree anatomical alterations, we believe that sexuality may not merely depend on the relation between ligaments, muscles, nerves, forces, and vaginal tensions. Understanding female sexual functioning requires a non-mechanistic, “holistic” approach, and sexuality should be considered as the result of the interaction of multiple dimensions (i.e. anatomical, biomechanical, physiological, sexological, psychosocial, and relational). Indeed, when women are asked to examine their sexual problems and identify possible causes, they often focus on relational and socio-cultural issues, so confirming that surgery may not always be the correct answer to their problems. For this reason, gynecologists and plastic surgeons should be cautious in performing female genital cosmetic surgery as well as vaginoplasties, especially when the main complaint is sexual dysfunction in the absence of major vulvovaginal anomalies, and the patients should be informed that their expectations may be unrealistic.

Giussy Barbara1,*, Federica Facchin2, Michele Meschia1 and Paolo Vercellini3 1 Department of Obstetrics and Gynecology, “G. Fornaroli” Hospital, Magenta, Milan, 2Faculty of Psychology, Catholic University of Milan, Milan and 3Department of Obstetrics and Gynecology, “IRCCS Ca’ Granda” Foundation, “Maggiore Policlinico” Hospital and University of Milan, Milan, Italy *Corresponding Author: Giussy Barbara E-mail: [email protected] DOI: 10.1111/aogs.12687

References 1. Barbara G, Facchin F, Meschia M, Vercellini P. “The first cut is the deepest”: a psychological, sexological and gynecological perspective on female genital cosmetic surgery. Acta Obstet Gynecol Scand. 2015;Apr 18. doi:10.1111/aogs.12660. [Epub ahead of print]. 2. Rogers RG. Sexual function in women with pelvic floor disorders. Can Urol Assoc J. 2013;7(9–10 Suppl 4):S199– 201. 3. Elenskaia K, Thakar R, Sultan AH, Scheer I, Onwude J. Effect of childbirth on pelvic organ support and quality of life: a longitudinal cohort study. Int Urogynecol J. 2013;24:927–37. 4. Fehniger JE, Brown JS, Creasman JM, Van Den Eeden SK, Thom DH, Subak LL, et al. Childbirth and female sexual function later in life. Obstet Gynecol. 2013;122:988–97. 5. Moore RD, Miklos JR, Chinthakanan O. Evaluation of sexual function outcomes in women undergoing vaginal rejuvenation/vaginoplasty procedures for symptoms of vaginal laxity/decreased vaginal sensation utilizing validated sexual function questionnaire (PISQ-12). Surg Technol Int. 2014;24:253–60.

ª 2015 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 94 (2015) 1029

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Female genital cosmetic surgery: beyond a mechanistic view of sexual satisfaction.

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