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Liao and Creighton refer to idiosyncratic decisions about cosmetic genitoplasty in the absence of local and national guidelines.1 Having worked as a clinical psychologist in women's health for several years, I have seen patients at various stages on the labial surgery pathway, and the reasons for referral to me have been varied.
Some women have had labial surgery and request further interventions, thus causing concern to their surgeons. Satisfaction with surgery has been professed, but it has not changed how they feel about their bodies. These women are faced either with the prospect of more surgery or the stark reality that such a solution may not offer everything they had hoped. Other referrals are to “cover all bases,” check that the patient is in “sound mind,” and rarely can a serious psychiatric diagnosis be invoked. Unfortunately, some of these patients have already been given a date for their surgery and think that it can proceed unless the psychologist says otherwise. Thus they are unlikely to embrace a psychological rather than a surgical solution.
My surgical colleagues seem to be reluctant to provide such interventions, but they respond to psychological distress and can be disempowered by the general rhetoric of “patient choice.” Surgical solutions for various concerns about the body may be what patients seem to want, but increasing the availability of surgery can inhibit the visibility of other choices.
Some clinicians may believe that labial surgery is on the fringes of obstetrics and gynaecology. But history repeats itself. We have all seen the rise in caesarean section rates in the United Kingdom. This is reported to have happened because of concerns about litigation, but another process may be in operation—the sanitisation of a surgical solution to giving birth. This comes from the widespread availability of a surgical solution. Do we not already have a snapshot of how things will develop if we do not debate this issue now?
Competing interests: None declared.