Should gynecologists provide cosmetic labiaplasty procedures?

An increasing number of patients are seeking cosmetic procedures of the vulva. In 2007, the American College of Obstetricians and Gynecologists released a Committee Opinion (#378) advising against cosmetic vaginal procedures due to a lack of safety and efficacy data. A growing number of observational studies has suggested overall high satisfaction rates, and complication rates that are acceptable, although a paucity of comparative data and validated outcomes measures remains. The issue is further intensified and complicated by the proprietary or franchised techniques and devices that surgeons sell to each other, and by the fee-for-service model that circumnavigates some of the rigors of the physician-payor-patient relationship. This point/counterpoint article, based on a debate held at the Society of Gynecologic Surgeons' 2014 Annual Scientific Meeting, addresses the issue of an individual seeking a cosmetic reduction labiaplasty from her gynecologist in the contexts of available literature and standard ethical frameworks. The specific question posed to the panelists was, Should the gynecologist feel comfortable offering cosmetic labiaplasty procedures to his or her patients?