Cosmetic gynaecology

Key contentFemale genital cosmetic surgery (FGCS) includes several procedures involving the labia minora, labia majora, clitoris, vagina, mons pubis and genital area; procedures may involve, for example, reduction or augmentation and be surgical or energy based.Indications for FGCS can be broadly divided into cosmetic and functional reasons.Counselling on the risks and cosmetic outcomes, as well as sexual and functional results, should be provided, and the woman's expectations discussed.Learning objectivesTo develop a holistic view when discussing cosmetic gynaecology concerns, including psychosexual assessment.To understand the procedures that are currently available, the evidence-base behind these procedures, and their risks and benefits.To understand the implications of genital cosmetic surgery on patients, including their psychosexual wellbeing, and the legality of these procedures with reference to female genital mutilation (FGM).Ethical issuesThe 'postcode lottery' in commissioning cosmetic gynaecological procedures in the UK leads to the question: should they be available on the NHS?Who should be performing cosmetic gynaecological procedures: the plastic surgeons who do little vaginal surgery, or the gynaecologists?There is currently no formal training in this area for gynaecologists.