Sexual function after female genital cosmetic surgery: A systematic review and meta-analysis

Abstract

Objectives: To evaluate postoperative sexual function after female genital cosmetic surgery (FGCS)-predominantly labia minora reduction with or without clitoral hood reduction (CHR)-and to contextualize safety, satisfaction, and technique-related signals.

Methods: We systematically searched MEDLINE, Embase, Scopus, and Cochrane (2015-2025). Eligible designs included randomized or nonrandomized studies and case series (n ≥ 5) reporting validated sexual outcomes. Two reviewers independently screened and extracted data; risk of bias was assessed with Cochrane Risk of Bias 2, the Newcastle-Ottawa Scale, and the JBI checklist. Random-effects meta-analysis was performed, with prespecified subgroups by technique (trim/edge, wedge, composite) and follow-up.

Results: Eleven studies met inclusion; six used the Female Sexual Function Index (FSFI) and were pooled quantitatively. In primarily uncontrolled pre-post cohorts, pooled standardized mean change in sexual function corresponded to a moderate improvement (standardized mean difference 0.52; 95 % confidence interval 0.38-0.65)., although the certainty of evidence was low due to nonrandomized single-arm designs and serious risk of bias. Studies using other validated instruments (Female Genital Self-Image Scale, Sexual Function Questionnaire-28, Sexual Quality of Life-Female, BODY-Q) demonstrated convergent gains in genital self-image and sexual well-being. Reported complications were uncommon and mostly minor, with infrequent revisions during follow-up. No technique showed clear superiority. One prospective cohort with standardized sensory testing found no reduction in clitoral or labial sensitivity after labiaplasty with CHR.

Conclusions: Observational pre-post data suggest that FGCS is associated with moderate short-term improvements in sexual function and genital self-image, but these findings are based on small, uncontrolled studies that are vulnerable to regression to the mean, expectancy effects, and natural recovery. High-quality controlled trials are needed to confirm the magnitude and durability of benefit. Benefits appear consistent across commonly used techniques, but technique-specific differences remain uncertain. Counseling should integrate validated patient-reported measures and realistic timelines for recovery and sexual resumption. Further comparative studies with standardized reporting and ≥12-month follow-up are needed.

Keywords: Clitoral hood reduction; Complications; Female genital cosmetic surgery; Labiaplasty; Meta-analysis; Patient-reported outcomes; Satisfaction; Sexual function.