Aesthetic procedures of the female genital area include both surgical and non-surgical methods. Treatment may be considered for vaginal and perineal changes after childbirth, hormonal changes associated with menopause, age-related functional changes, difficulties affecting emotional or sexual life, aesthetic concerns or body-image distress. For some women, the appearance of the intimate area is particularly important. Minimally invasive methods such as fillers, thread techniques and laser treatments may alter the appearance of the labia, reconstruct a deformed perineum, vaginal entrance or mons pubis, improve vaginal-wall tone and selected aspects of sexual function, including vaginal tone and sensitivity. In carefully selected cases, they may also help prevent or improve mild urinary incontinence. Sensitivity in the area commonly described as the G-spot may sometimes be increased by injecting selected materials into the vaginal wall.
Minimally invasive methods generally involve less physical burden and a shorter recovery. They can often be performed under local anaesthesia, without surgical incisions or visible scars, and with a relatively low risk of bleeding. They may be considered at different ages, including before childbirth, although the duration of the result varies by method. A gynaecological and urological examination is required beforehand. Deformities of the vagina, perineum, mons pubis and labia may also be treated with reconstructive surgery. Common procedures include liposuction and fat transfer, surgical correction of the mons pubis or labia, reconstruction of the vaginal entrance or vaginal wall, surgery for pelvic-organ prolapse and incontinence using slings or meshes, and removal of cysts or other benign lesions of the genital region. Clitoral correction may also be considered in selected cases to improve sexual quality of life.
Labiaplasty
Plastic-surgical procedures involving the labia minora or labia majora are referred to as labiaplasty. Surgery may be requested for cosmetic reasons that can also be accompanied by functional, psychological, hygienic or sexual difficulties. The most common requests include reducing labia that are considered excessively long, wide or thick, and correcting asymmetry. Less commonly, aesthetic reconstructive surgery may be indicated after previous operations, including an unsatisfactory cosmetic result after earlier gender-affirming surgery, after injury or childbirth, or because of hormonal changes, lymphatic swelling, chronic irritation, infection, skin disease or congenital developmental abnormalities. Many reconstructive techniques are available, and the choice is always individual.
Further information and clinical images are available on the English-language website of our partner centre.
Incontinence, cystocele, rectocele and vaginal prolapse
Urinary incontinence means involuntary leakage of urine. The three principal forms are stress, urgency and mixed incontinence. If urine leaves the body by a route other than the urethra, this is not classified as urinary incontinence but as leakage through another pathway, for example a fistula. In stress incontinence, varying amounts of urine may leak during coughing, sneezing, lifting, laughing, straining or physical activity. The main problem is insufficient closure of the urethra. In women, the most common underlying factor is reduced support of the urethra due to weakness of the perineal and pelvic-floor muscles. Childbirth, hormonal deficiency after menopause, excess weight, smoking and age are all risk factors. In urgency incontinence, leakage is preceded by a sudden, compelling need to urinate and may occur before the person reaches a toilet. Possible causes include bladder stones, inflammation, tumours, neurological disorders and other factors. Mixed incontinence includes features of both stress and urgency incontinence.
Other forms include overflow incontinence caused by an over-distended bladder, reflex incontinence associated with congenital or acquired neurological disorders, nocturnal enuresis and continuous incontinence. Treatment depends on the type, cause and severity. Options include lifestyle changes, weight reduction, stopping smoking, pelvic-floor and bladder training, physiotherapy, electrical stimulation, biofeedback, medication, especially for urgency incontinence, injectable bulking agents around the urethra and surgery. Tension-free sling and mesh procedures are widely used for stress incontinence and for selected cases of cystocele, where the bladder bulges into the front wall of the vagina, and rectocele, where the rectum bulges into the back wall. Open abdominal operations are now used less frequently. Severe vaginal prolapse with incontinence may be treated by restoring and fixing the vagina in its normal position using laparoscopic or open sacrocolpopexy. In selected cases of severe stress incontinence, an artificial urinary sphincter may be considered. For urgency incontinence, rare surgical options include bladder augmentation and sacral neuromodulation.