152 - Meta-analysis of Vulva Morphometry: Implications for Patient Advocacy and Education Prior to Female Genital Cosmetic Surgery

Poster Board Number: 152
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Abstract Body : Introduction and Objective:
Cosmetic labiaplasty, a type of Female Genital Cosmetic Surgery (FGCS), is performed with the deliberate intent to alter the appearance and morphology of the external genitalia in the absence of medical concerns. In recent years there has been a significant increase in the demand for FGCS; the year-on-year increase in 2019 was 24.1% with growing uptake by adolescent girls. This increase against the backdrop of the paucity of literature on the anatomy of female genitalia, the lack of awareness of the range of diversity, and the continuous representation in popular media of the vulva as ‘non-existent’ and/or labia majora with no protrusion, is concerning. This study therefore aimed to assess the current evidence of morphometric diversity of the vulva with emphasis on the labia majora and minora.

Materials and Methods:
A systematic review and meta-analysis was conducted following the PRISMA guidelines, with a comprehensive search of the MEDLINE, EMBASE, SCOPUS and Web of Science databases. Research reports with extractable morphometric data on the labia majora and/or minora from healthy and pre-operative individuals, aged 10 years and over, born with female genitalia were included. The AQUA tool was used to assess the quality of included studies. Data was analysed using RStudio 1.4.1106 (Vienna, Austria).

Results:
A total of 19 studies were identified for the systematic review with a pooled sample of 2978 subjects while 12 studies were identified for meta-analysis with a pooled sample of 2368 subjects. The age range for the subjects was 10-96 years. The studies were conducted in: North America, 5; UK/Europe, 6; Asia, 2; Middle East, 6. The length of the labia minora ranged from 5-100mm with a pooled mean length of 51.9mm. The width of the labia minora ranged from 0-79mm with a pooled mean width of 14.4mm. Asymmetry was common with no significant differences in the length and width of the labia majora and labia minora.

Conclusion and Significance/Implication:
The current meta-analysis of the morphometry of the labia majora and minora is the first comprehensive assimilation of the evidence on the diversity of the vulva in people aged 10 years and older. From this review, it is apparent that studies documenting the range of normal anatomy of the female genitalia is warranted. It is imperative that information on the diversity of the anatomy of the female genitalia is made more accessible to biological females considering FGCS, and should be considered an imperative part of the discussion in decision making and planning of FGCS. There is also a broader obligation to educate adolescents on the range of normality of the female genitalia, which may positively impact perceptions of body image in this vulnerable population group.