A new injectable solution containing low-molecular-weight hyaluronic acid (HA) and a specific amino acid mixture was formulated with proper aesthetic performance for the main signs of facial skin photoaging. The present study aimed to investigate its new application for rejuvenating and augmenting labia majora using clinical and biometric assessments. Three sessions of intradermal injections were performed using 3 ml of test extracellular matrix (ECM) for 10 eligible post-menopause female subjects (age 53.6 ± 7.93 years). The effectiveness of the intervention was assessed by an independent physician using before-and-after pictures based on the physician\'s global assessment score. Objective biophysical skin assessments, including skin hydration, skin erythema, and melanin index, as well as elasticity parameters including firmness (R0), gross elasticity (R2), and net elasticity (R5), were also performed before the first injection and then on the 2nd and 12th weeks after the last session. Patients\' satisfaction and all reported or observed adverse events were documented. At week 12, all the subjects reported an aesthetic improvement of 25% or more in rejuvenation and sagging of the labia major area. A statistically significant improvement was also detected in R0 and R5 at week 12 (p-values 0.005 and 0.022, respectively). Patient satisfaction surveys revealed a median score of 8 at both follow-up visits. The results showed a new indication of the tested HA ECM for providing a beneficial, durable, rejuvenating effect on the labia majora with a good safety profile.

OBJECTIVE: Due to the increasing demand for improving the morphology and function of the external genitalia amongst women, it is necessary to conduct statistical analysis of research data on female genital reconstruction. The current study aimed to use bibliometric analysis to analyse the research hotspots and trend frontiers of the female genital reconstructive research.
METHODS: Publications on the female genital reconstructive research were extracted from the Web of Science Core Collection database. VOSviewer 1.6.18 was used to establish visualisation maps and find top authors, institutions, countries, burst keywords, co-cited authors, journals, research hotspots, and trends.
RESULTS: A total of 2207 studies published by 364 different journals authored by 7479 researchers were contained in this study. In the co-authorship analysis, the bulk of the retrieved studies was conducted by the USA, followed by England, Italy, and Netherlands, whilst the most productive institution, journal, and author were U.S. Univ Calif San Francisco, Journal of Sexual Medicine, and Bouman Mark-Bram, respectively. In the co-cited analysis, the top most-cited author and journal were Hage JJ and Journal of Sexual Medicine, respectively. The map of keywords occurrence revealed the most active research aspects were focussed on \"vaginoplasty\", \"feminised genitoplasty\", \"laser treatment of vaginal atrophy\", \"transsexualism\", and \"labiaplasty\". The time overlay mapping showed that the study of female genital plastic surgery focusses on the energetic treatment of genitourinary syndromes caused by transsexualism and menopause, especially by using management and treatment of vulvovaginal atrophy for the research trends, and through the vaginoplasty, feminising genioplasty, and laser treatments in the direction of treatments related to physical and mental problems.
CONCLUSIONS: This novel inclusive bibliometric analysis can help research workers to quickly understand the potential and active researchers, landmark studies, and topics within their interests. We are willing to provide more beneficial data to contribute valuable research of female genital plastic surgery through this study.
METHODS: The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

Research on female genital cosmetic surgery usually comes from Anglophone countries. We investigated female genital cosmetic surgery in the predominantly Muslim South-East Asian country of Indonesia, aiming to identify the procedures offered by medical clinics on Instagram, how they are justified, and what they claim to achieve; and to understand what this means for women and their bodies. The 184 eligible posts from 19 clinics between 1 January to 31 March 2021 offered vaginoplasty, labiaplasty, hymenoplasty, and other procedures. Reflexive thematic analysis yielded three themes: Why you should have female genital cosmetic surgery, Indications for female genital cosmetic surgery, and What you will gain from female genital cosmetic surgery. Posts were similar to those identified in other countries, revealing implicit vulvar aesthetics, expectations that women choose to \'improve\' their genitals, the need to please men, and that female genital cosmetic surgery is straightforward. Two differences from Anglophone advertising were the use of euphemisms to describe the vulva and an emphasis on physical \'virginity\'. Across countries, female genital cosmetic surgery advertising appears to arise from patriarchal constructs of women\'s bodies and determination to control them. We contend that Indonesia shares with other countries the need for education-of medical practitioners and the general public-about sexuality and the vulva, and that the advertising of female genital cosmetic surgery should be regulated and rigorously monitored.

BACKGROUND: Female genital cosmetic surgery (FGCS) changes the structure and appearance of healthy external genitalia. We aimed to identify discourses that help explain and rationalise FGCS and to derive from them possibilities for informing clinical education.
METHODS: We interviewed 16 health professionals and 5 non-health professionals who deal with women\'s bodies using a study-specific semi-structured interview guide. We analysed transcripts using a three-step iterative process: identifying themes relevant to indications for FGCS, identifying the discourses within which they were positioned, and categorising and theorising discourses.
RESULTS: We identified discourses that we categorised within four themes: Diversity and the Normal Vulva (diversity was both acknowledged and rejected); Indications for FGCS (Functional, Psychological, Appearance); Ethical Perspectives; and Reasons Women Seek FGCS (Pubic Depilation, Media Representation, Pornography, Advertising Regulations, Social Pressure, Genital Unfamiliarity).
CONCLUSIONS: Vulvar aesthetics constitute a social construct to which medical practice and opinion contribute and by which they are influenced; education and reform need to occur on all fronts. Resources that not only establish genital diversity but also challenge limited vulvar aesthetics could be developed in consultation with women, healthcare practitioners, mental health specialists, and others with knowledge of social constructs of women\'s bodies.

OBJECTIVE: Gynecologists need resources related to labia minora, severe cosmetic surgical complications currently unavailable in the medical literature. Women\'s requests for genital cosmetic surgery significantly increased within the last two decades; however, the medical literature does not report severe complications and their causes. Therefore, the author hypothesizes that currently used surgical concepts for labia minora reduction are partially responsible for cosmetic surgical debilitating complications. This clinical research aims to present photo documentation of severe surgical complications associated with various cosmetic surgical interventions.
METHODS: A prospective case series study was conducted in a single gynecologic corrective surgical practice to show different debilitating symptoms associated with labia minora cosmetic surgery. Primary data sources were obtained from direct clinical examinations. Secondary data sources were acquired from scientific-clinical and psychological medical literature articles, websites, medical records, procedure reports, statistical data, and recommendations. Data collection was done prospectively, and data analysis performed retrospectively included variable clinical observations and the severity of symptoms related to different surgical technique concepts.
METHODS: Patients were exposed to medical interviews, examinations, discussions, and validated questionnaires. In addition, an analysis of commonly used surgical cosmetic intervention concepts scrutinized (labia minora amputation, central wedge resection, and labial delamination).
METHODS: The single practice center for corrective cosmetic surgery.
METHODS: The study\'s sample size was 110 women with severe cosmetic surgical complications of labia minora.
RESULTS: The primary outcome measures the prior cosmetic surgical intervention outcomes of the labia minora, and the secondary outcome measures the occurrence of symptoms. Procedure duration was measured from the initial incision to the last suture placement. The follow-up study was conducted at a one-year interval for three years. The labia minora cosmetic severe complications were associated in 76 % with labial amputation, 21% with central wedge resection, and 3% with modified delamination. The most common symptomatic complication in labia minora amputation was over-resection. In all subjects, debilitating physical pain, neurological pain, psychological disorders, and sexual dysfunction were observed.
CONCLUSIONS: Current labia minora cosmetic surgical concepts contribute to severe surgical complications with debilitating physical, emotional, and sexual dysfunction.

Mounting evidence indicates that female genital aesthetic complaints impact sexual relationships.
The study sought to determine the strength of the correlation between genital self-image and sexual function.
Electronic databases were comprehensively searched including PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library from January 2000 to December 2022. After duplicate removal, 146 articles were retrieved by searching keywords in titles and abstracts.
A positive correlation is noted between genital self-image and sexual function; the strength of this correlation was 0.375.
By omitting irrelevant articles according to the eligibility criteria, 16 articles remained for a total of 13 505 participants. All but 1 of them indicated a statistically significant positive correlation between genital self-image and sexual function. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity.
The results of this study may be used in counseling women with sexual dysfunction who are dissatisfied with their genital appearance.
This study is the first systematic review to reveal the strength of the correlation between genital self-image and sexual function. The most important limitation of this study is the heterogeneity of the studies reported.
This systematic review indicates a positive correlation between genital self-image and sexual function. The results are restricted by inconsistency of the articles considered. Using different tools in different cultural contexts without considering confounding factors leads to a wide range of correlation sizes and significant heterogeneity is evident.

Female genital cosmetic surgery consists of multiple procedures, usually including labiaplasty, clitoral prepuce reduction, labia majora augmentation, and vaginoplasty. The reasons for women to undergo these surgeries can be categorized as functional and aesthetic ones. In this study, we introduced the modified vaginoplasty with acellular dermal matrix (ADM) and briefly reviewed our experience in the combination of multiple procedures to achieve the optimal effect.

Introduction Female genital cosmetic surgery (FGCS) is a trending topic in the field of gynecology practice. It is defined as any genital procedure that is not medically indicated but is designed to improve the appearance of the genitals. With the increasing demand for FGCS, little is known about the attitudes of physicians, especially gynecologists, toward FGCS. The study objective is to assess physicians\' attitudes towards female genital cosmetic surgeries in Jeddah, Saudi Arabia. Methods A cross-sectional survey was done among physicians in Jeddah, Saudi Arabia. Four-sectioned questionnaires were distributed to physicians. All board-certified consultants and registrars of obstetrics and gynecology, plastic, and reconstructive surgery in private/public hospitals were included in the study. Data management was done using the SPSS program version 19 (IBM Corp., Armonk, NY, USA). Results Out of 165 physicians, 40 were practicing physicians (female genital cosmetic surgery) (24.2%) while 125 were non-practicing physicians (75.8%). The age of practicing and non-practicing respondents ranges from 26 to 60 with a mean and standard deviation (42.6±8.6) and 24 to 60 (40.1±8.9) years old. Our study showed that there were females under 18 years old requesting FGCS from all physicians. Results of attitude towards FGCS showed that the majority of non-practicing physicians were more comfortable in providing advice about FGCS (N=53) and very confident about female anatomy (N=65). Non-practicing physicians also knew a lot more about the long and short-term risks of FGCS and discussed them all the time with their patients. In terms of giving advice on labiaplasty, clitoral hood reduction, perineoplasty, hymenoplasty, and G-spot augmentation procedures, practicing physicians were more confident compared to non-practicing physicians. Statistical analysis showed a significant difference between practicing and non-practicing physicians in terms of gender (p=0.001), career level (p=0.005) and type of work (p=0.006), giving advice on labiaplasty (p=0.001), clitoral hood reduction (p=0.001), perineoplasty (p=0.016) and G-spot augmentation (p=0.001), the number of patients per month, patients seeking advice about FGCS, knowledge about short-term and long-term risks and possible risks of FGCS, vaginal examination, offering referral/counseling and confidence in assessing female anatomy (all, p=0.001).  Conclusion Physicians in Jeddah, Saudi Arabia showed an overall positive attitude towards FGCS. The study suggests that with enough training and knowledge about FGCS, physicians could exhibit a more positive attitude towards FGCS.

Nowadays, Female Genital Cosmetic Surgery is quite prevalent, resulting in a wide range of medical and cultural implications. The majority of women who undergo this operation suffer from anxiety, depression, and other emotional symptoms. The present study was carried out in order to explore women\'s perspective on and experience of genital cosmetic surgery given their special context and cultural aspects.
The qualitative study applying content analysis examined the experiences of nine women who received genital cosmetic surgery in Erbil, Kurdistan-Iraq, between 2021 and 2022. Each of the semi-in-depth face-to-face interviews lasted between 40 and 60 min and was conducted at the physician\'s clinics.
Semi-structured interviews led to emergence of two main themes, namely \"husband satisfaction\" and \"self-confidence\". Interpreting the participants\' stories resulted in some relevant subthemes and meaning units like \"ugly appearance\", \"anxiety related to husband undesirable intercourse\", and \"dyspareunia\". Finally, the related conclusions of each theme were explored.
As suggested by the study findings, female genital cosmetic surgery improves the women\'s body image and sexual function and the couples\' sexual satisfaction, especially that of husbands. Because of the people\'s sociocultural aspects in Kurdistan region, their awareness of female sexual needs and marital relationship needs to be raised.

OBJECTIVE: The purpose of our study is to evaluate the information available on YouTube regarding FGCS procedures in terms of content, accuracy, reliability and quality.
METHODS: Videos were listed on YouTube on 01.10.2020 by searching the terms \"plastic surgery for female genital\", \"vaginoplasty\", \"labiaplasty\" and selecting their relevance from the filtering options. Among these listed videos, the 50 most watched videos were listed and recorded excluding commercials, repeating videos, those shorter than 60s and non-English ones. The videos were scored by two researchers using DISCERN and JAMA scales. The DISCERN scale varies between 0-75 points and according to the scores obtained from the scale, videos are classified as 63-75: (excellent); as 51-62: (good); as 39-50: (moderate) as 28- 38: poor and as <28 very poor. JAMA scale is a scale that evaluates the accuracy, usefulness and reliability of video sources between 0-4. Insufficient data on 1 point video source obtained from the scale, refers to. 2-3 (partially sufficient data) and 4: (completely sufficient data).
RESULTS: The evaluation on DISCERN scores given to the videos revealed that the average DISCERN score of the first researcher was 45.65±13.271 and the average of the second researcher\'s DISCERN score was 44.65±14.235. The average of JAMA scores was 2.67±0.826 for the first researcher and 2.49±0.845 for the second researcher. Accordingly, a statistically significant linear relationship was found between DISCERN (r=0.812) scores and JAMA (r=0.622) scores by the researchers.
CONCLUSIONS: We found that YouTube has the potential to provide patients with easy access to a large amount of information on FGCS, although almost all of the videos we included in the study were uploaded by health professionals, the overall quality of the content on the subject was moderate. We strongly suggest that any videos on health should be uploaded by experts and these videos should definitely be reviewed by a referee.