AUGS-IUGA executive summary: Joint report on terminology for cosmetic gynecology

Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society

ABSTRACT

Introduction and hypothesis: The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties.

Methods: This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus.

Results: A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field.

Conclusions: A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.

SUMMARY

Cosmetic gynecology (also known as female genital plastic and cosmetic surgery) lacks standardized nomenclature and procedural definitions. The field is widely understood to encompass an array of interventions to alter the aesthetic appearance of the vulva but is usually also understood to include some elective procedures on the vagina aiming to enhance sexual function. These procedures are typically but not exclusively performed by gynecologists or plastic surgeons, and the terminology used varies by medical specialty and across individual practitioners. The adoption of several colloquial or trademarked phrases (e.g., "0-Shot"), for marketing purposes, has additionally resulted in widespread ambiguity and uncertainty about the aims and actual surgical techniques used in the field. Most significantly, there is a paucity of high-quality data to support the efficacy and safety of current practice. The American College of Obstetricians and Gynecologists (ACOG) pointedly addressed these concerns in their 2020 Committee Opinion1 stating that the "safety and effectiveness of these elective procedures have not been well documented." A previous systematic review2 has evaluated the existing peer-reviewed literature noting substantial heterogeneity in part due to a lack of standardization of terminology. Despite these concerns, cosmetic procedures are becoming increasingly prevalent.3 The primary aim of this project was to develop clear, uniform descriptive terminology for cosmetic gynecology that would be useful to patients, researchers, and practitioners across multiple specialties. We aimed to do the following: (1) Define the clinical domains of Cosmetic Gynecology and distinguish it from (a) medically indicated procedures and (b) female genital mutilation. (2) Clarify terminology for specific cosmetic gynecology procedures and provide a brief overview of preoperative considerations and therapeutic options. (3) Suggest clinically meaningful outcome metrics for patients and researchers (when applicable), including collecting or developing standardized classification systems to describe anatomical variants and facilitate uniform reporting of post intervention changes. (4) Develop a standardized adverse event, reoperation, and revision rate reporting scaletailored to cosmetic gynecology procedures. This was a joint International Urogynecologic Association (IUGA) and American Urogynecologic Society (AUGS) project consisting of five representative members from each organization and a chair. A literature review of non-medically indicated elective procedures on the labia minora, clitoral hood, labia majora, mons pubis, and vagina was then performed. An iterative discussion then ensued until at least 70% consensus was achieved for each topic. Consistent with previous IUGA/AUGS Terminology publications this document will not review the clinical evidence or recommend a particular technique. It should be stressed that all procedures considered to be cosmetic are defined in this document irrespective of the presence or absence of peer-reviewed literature. Inclusion of any specific procedure does not constitute an endorsement but rather an objective description for future research. Although this is a developing multidisciplinary field, this document was created by female pelvic medicine & reconstructive surgeons. It does not endorse or make recommendations as to which providers should perform these procedures or what prerequisite experience is required.

This IUGA/AUGS joint working group recognizes that there is substantial ambiguity concerning the terminology, classification, adverse event reporting, and outcome metrics in the field of cosmetic gynecology. We also acknowledge that these procedures are being offered on a fee for service basis across the world and that the efficacy of many of these techniques has not been fully investigated. Without either endorsing or denouncing any of topics within cosmetic gynecology, this document seeks to establish a framework and uniform language upon which future research can be conducted in an effort to improve safety, advance evidence-based medicine, and empower women. Most importantly, it should be re-emphasized that all anatomic variants, unless they cause physical discomfort or bothersome symptoms, are normal. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s00192- 021-05010-7.

REFERENCES

1. ACOG. Committee Opinion #795: Elective female genital cosmetic surgery. Obstet Gynecol 2020;135(1):e36–e42.

2. Garcia B, Scheib S, Hallner B, et al. Cosmetic gynecology-a systematic review and call for standardized outcome measures. Int Urogynecol J 2020;31(10):1979–1995.

3. Liao LM, Creighton SM. Requests forcosmetic genitoplasty: how should healthcare providers respond? Bmj 2007;334(7603):1090–1092. https:// doi.org/10.1136/bmj.39206.422269.be. 4. Alshiek J, Garcia B, Minassian VA, et al. V

(Female Pelvic Med Reconstr Surg 2022;28: 351–366)

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