DHSC 09

7 April 2017

Female Genital Cosmetic Surgery

(including, but not limited to, labiaplasty and vaginoplasty)

Female genital cosmetic surgery will not be routinely funded. Women vary widely in genital dimensions. There is no evidence that any particular size or shape of any part of the genitalia is associated with clinical or functional symptoms (e.g. discomfort) and there are no grounds for regarding any particular variant of size, shape or symmetry as pathological and requiring surgical intervention. Terms such as ‘labial hypertrophy’ or ‘over developed labia’ (which are sometimes used by clinicians to describe what are simply large labia) should not be used as they imply abnormality, where none is present, and reinforce the patient’s negative image of themselves as ‘not normal’. NOTE: Female genital mutilation (a collective term for procedures which include either the partial or total removal of the external genital organs for cultural or other non-therapeutic reasons) is illegal on the Isle of Man under The Prohibition of Female Genital Mutilation Act 2010.

Strength of evidence Clinical Effectiveness Cost Effectiveness

Inadequate Inadequate

Female genitalia vary widely in size, shape and symmetry. There are no grounds for regarding any particular variant as abnormal. There is no evidence for any causal link between size of genitalia and any functional or physical symptom. There is no evidence that surgery is effective in relieving discomfort/pain. There is no evidence that surgical intervention to ‘improve’ the appearance/reduce the dimensions of the genitalia has any impact on psychological or relationship wellbeing. Recent work has demonstrated that patient satisfaction with the cosmetic outcome of surgical attempts to create normative feminine genital appearance tends to be poor, with up to 80% requiring further reconstructive surgery (Lloyd et al, 2005).

There is inadequate data to support the safety of these procedures given the potential complications including infection, reduced sensation, dyspareunia, adhesions and scarring.

There is no evidence of cost effectiveness.

Department of Health and Social Care Crookall House, Demesne Road, Douglas, Isle of Man, IM1 3QA.

DHSC09 V1 May 2017

Summary of evidence

Lloyd J, Crouch NS, Minto CL, Creighton SM. (2005) Female genital appearance: ‘normality’ ‘unfolds’. BJOG - An

International Journal of Obstetrics and Gynaecology 2005; 112:643-64 http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2004.00517.x/pdf

Interim Clinical Commissioning Policy: Labiaplasty, vaginoplasty and Hymenorrhaphy November 2013 http://www.england.nhs.uk/wp-content/uploads/2013/11/N-SC023.pdf

Bramwell R, Morland C, Garden AS Expectations and experience of labial reduction: a qualitative study. BJOG An

International Journal of Obstetrics and Gynaecology 2007; 114:1493-1499. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01509.x/pdf

Liao LM, Michala L, Creighton SM. (2010) Labial surgery for well women: a review of the literature. BJOG An international Journal of Obstetrics and Gynaecology 2010;117: 20-25

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02426.x/pdf

Goodman MP, Placik OJ, Benson RH et al, (2010) A large multicentre outcome study of female genital plastic surgery. Journal of Sexual Medicine 2010;7:1565-77. http://www.ncbi.nlm.nih.gov/pubmed/19912495

Isle of Man Safeguarding Children Board, Procedure 4.7: Female Genital Mutilation http://www.proceduresonline.com/iom/scb/chapters/p_fem_genit_mut.html

Royal College of Obstetricians and Gynaecologists, Ethical Opinion Paper: Ethical Considerations in Female Genital Cosmetic Surgery, RCOG, 2013

https://www.rcog.org.uk/globalassets/documents/guidelines/ethics-issues-and-resources/rcog-fgcs-ethical-opinion-

paper.pdf

Crouch, NS et al, Clinical Characteristics of Well Women Seeking Labial Reduction Surgery: A Prospective Study,

British Journal of Obstetrics and Gynaecology, 2011 https://www.ncbi.nlm.nih.gov/pubmed/21883873

Reason for Requesting a Policy Recommendation: Reviewed within Effective Use of Resources Project Where a patient is considered to have exceptional need for and capacity to benefit from a treatment that is not routinely funded, a request for individual funding may be made to the Individual Funding Requests Panel. The patient must be made aware that the Panel may not support the request and must not be given any expectation that they will be able to have the treatment until a decision to fund has been received in writing from the Panel. Further information contact: Tel: +44 (0)1624 642646 Email: clinicalcommissioning.dhsc@gov.im Website: www.gov.im/dhscclinicalcommissioning