Start with the overview: Genital Aesthetics
Genital aesthetics is not a single procedure but a heading covering surgical procedures such as labiaplasty (inner labia reduction) as well as laser, filler and injection treatments. Their levels of evidence differ greatly: procedures that correct a functional problem have established techniques, while injections aimed at sexual function carry explicit warnings from ACOG and the FDA. The decision weighs the examination findings together with expectations; if the findings do not support it, the procedure is not recommended.
A feeling of vaginal looseness (laxity) usually comes from muscles and supporting tissue at the vaginal entrance that have stretched during childbirth; age and menopause also contribute. In mild cases the first step is pelvic floor (Kegel) exercises. Non-surgical methods such as laser and radiofrequency have not been shown to work in the long term for this purpose. If there is clear muscle separation or prolapse, surgical vaginal tightening (vaginoplasty) is performed; the aim is to repair the muscles, not merely to narrow. Over-narrowing causes pain during intercourse.
Perineoplasty is the rejoining of the muscles of the area between the vaginal entrance and the anus (the perineum) that have separated during childbirth, together with removal of a problematic scar from the cut made at delivery. It is considered for functional complaints such as a painful scar, a gaping entrance or air escaping from the vagina during intercourse. It is planned at least 3–6 months after childbirth; over-narrowing can cause pain, and the evidence rests mostly on small studies.
Labiaplasty (inner labia reduction) is the surgical reduction of the inner labia. It is considered for examination findings such as inner labia that extend outwards, are thickened or are of the ruffled type. Tissue is removed either along the edge of the labium or as a slice from the most protruding part (wedge technique). It is not recommended for people whose inner labia are already small, however keen they may be; the scarring and risks would outweigh the change that could be achieved.
Genital laser is a treatment that delivers heat to the vaginal tissue in tiny spots. It is most often considered for the dryness, burning and pain during intercourse that come with menopause (genitourinary syndrome). It is done in the outpatient setting, usually without anaesthesia; the common protocol is 3 sessions 4–6 weeks apart. It is not a replacement for moisturisers or hormone treatment, and the FDA and ACOG have stated that there is no official approval for this use.
Genital radiofrequency is a non-surgical treatment that warms the tissue of the genital area in a controlled way. It comes up for complaints such as vaginal laxity, dryness due to menopause and mild urinary incontinence; for each of these there are treatments with stronger evidence that come first. It has been reported to be done in the outpatient setting without anaesthesia. The FDA has not approved the safety and effectiveness of these devices for this purpose, and ACOG has stated that cosmetic vaginal procedures are not based on adequate evidence.
Hymenoplasty is the surgical repair of the hymen; its aim is to narrow the entrance opening temporarily. According to the sources it is not medically necessary, and the Royal College of Obstetricians and Gynaecologists (RCOG) strongly opposes it. Virginity cannot be determined by examination, and no technique can predict or promise bleeding at first intercourse. The first step is not surgery but accurate information and counselling.
Outer lip augmentation is the general name for procedures aimed at addressing the loss of volume and fullness in the outer lips (labia majora); this loss is seen most often with the menopause. The main method described in the sources is the transfer of the person's own fat tissue, passed through a filter (microfat), to the area; PRP (plasma obtained from the person's own blood) may be added to support the graft taking hold. The evidence in this field is still developing, and the long-term effects need further evaluation.
Genital skin lightening is a cosmetic procedure that aims to lighten darker skin of the outer genital area and groin using methods such as laser or chemical peeling. The skin of this area is naturally darker than the surrounding skin. Darkening is usually linked to friction, hair removal and hormones; however, sudden, one-sided, raised or itchy changes need an examination first. Scientific evidence is limited, results vary from person to person and the colour can darken again over time.
PRP applied to the genital area means injecting platelet-rich plasma (PRP), prepared from the person's own blood, into the clitoral area and the glands around the urinary tract. The aim is to stimulate new nerve formation and secretion in these areas. Its effectiveness has not yet been established by large comparative studies, and part of the reported results rest on unpublished observations. With a complaint relating to sexual function, the first step is to have its cause assessed.
Clitoral hood reduction (hoodoplasty) is the surgical reduction of excess hood skin covering the clitoris; it is not a procedure on the clitoris itself. It is rarely done on its own and is usually planned together with inner lip reduction. Its functional results are not fully known and its effect on sexual function has not been established, so it is regarded as predominantly a procedure to do with appearance. Aggressive incisions can cause lasting loss of sensation.
G-spot augmentation means injecting a filler material into an area in the front wall of the vagina. It is mentioned as a procedure aimed at sexual function and is done in the outpatient setting under local numbing. ACOG states that it has no medical justification and no long-term evidence, and the FDA has given no official approval. The existence of the target area is disputed, and although very rare, life-threatening risks have been reported.