Partner Satisfaction in Labiaplasty Patients

Abstract

Background

Labiaplasty, which has become increasingly popular in recent years, is chosen by women for both cosmetic and functional reasons. It creates significant changes in female sexuality, resulting in high satisfaction rates, but there are limited data on its effects on male sexual response.

Objectives

The aim of this study was to investigate the effects of labiaplasty on partners.

Methods

The partners of 49 patients who underwent labiaplasty between January 2020 and May 2023 were included in the study. Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD), Golombok-Rust Sexual Satisfaction Scale, and New Sexual Satisfaction Scale questionnaires were administered to the partners preoperatively and 6 months postoperatively.

Results

There was no significant difference between preoperative and postoperative responses to the MSHQ-EjD questionnaire. The postoperative increase in the New Sexual Satisfaction Scale compared with the preoperative score was statistically significant. Statistically significant positive changes were observed postoperatively in the Golombok-Rust Sexual Satisfaction Scale categories of intercourse frequency, communication, satisfaction, and nature of sexual intercourse.

Conclusions

Labiaplasty operation had positive effects on male sexual response but had no effect on ejaculation function and difficulty.

Level of Evidence: 3

Labiaplasty is a surgical procedure performed to improve both function and aesthetic appearance. The aim of labiaplasty is to revise labium tissue in need of restoration in such a way that it does not extend beyond the labium majus.¹ Historically, operations to the genital area were generally performed in cases of medical necessity, but recently they have started to be performed for aesthetic purposes. The frequent coverage of this issue on media platforms and in medical institutions has increased interest in this operation.^2,3 According to recent data from The Aesthetic Society, the money spent on labiaplasty procedures in 2022 had increased by 7% to more than US$64 million compared with the year before.⁴ Although it has not reached the point of social acceptance, labiaplasty is one of the fastest increasing aesthetic surgeries.^5,6 It is a reliable surgical procedure and has a high satisfaction rate.⁷

Among the reasons women request labiaplasty, aesthetic appearance ranked first, with 52.1%, and sexual dysfunction ranked second, with 46.5%.⁸

Negative genital self-image has also been found to have negative effects on sexual function.⁹ Positive genital self-perception has been found to have a negative effect on the incidence of sexual dysfunction and depression and a positive effect on the incidence of sexual desire.¹⁰ However, dissatisfaction in the sexual life of women who are unhappy with the appearance of their genitals has been associated with a lack of self-confidence, which affects their sexuality, and results in decreased sexual satisfaction due to subconscious thoughts during sexual activity.¹¹

Although the perception of perfection on media platforms in today's society negatively affects women, the same perception imposed on the female body has had different effects in men. An experiment was performed on a social media platform in which images of women's vulva were taken, and while women looked at their vulva with a displeased expression, it was observed that their partners reacted to the same vulva with loving and proud reactions. It was noted that women were surprised by these reactions of their partners.¹² In another study, it was revealed that the main factor in women's negative perception of their genital area was their ex-boyfriends.¹³

In the literature, the results of genital aesthetic operations are mostly evaluated on women and there are limited studies on the effects on men.

The aim of this study was to determine the change in the sexual functions of the partners of the patients after labiaplasty surgery by looking at the frequency of sexual intercourse, contact, avoidance, touching, satisfaction, impotence, premature ejaculation, and the nature of sexual intercourse as assessed by the Golombok-Rust Sexual Satisfaction Scale.

METHODS

This study included 49 patients who underwent labiaplasty for cosmetic purposes only between January 2020 and May 2023 and had a partner. This study was approved by the Esenyurt University Ethics Committee (approval number 2023/08-10). Each patient was interviewed face to face in a room before the operation. A detailed medical, sexual, and gynecological history was taken after making sure that the patient had no significant psychological problems or had not been abused.¹⁴ Preoperative questionnaires were filled out in the presence of a doctor in order to accurately understand the complaint and demand.¹⁵ We explained with drawings how the areas that the patient sees as problematic will look after the operation. For all patients, mutual negotiations were made regarding their wishes, and the final image was agreed upon. The labiaplasty technique was selected accordingly.

Patients who had previously undergone vaginal reconstruction surgery, who had undergone genital aesthetic surgery in addition to labiaplasty, who had no partner, who had psychiatric disorders, and who were being treated/had been treated for vaginusmus were not included. The partners of the included women who had psychiatric disorders or who used psychiatric drugs or who used drugs with side effects on sexual function, or who had previously been treated/were currently being treated for erectile dysfunction were not included in the study. At least 6 months after the operation the partners were interviewed face to face in a separate room. The native language validated Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD), Golombok-Rust Sexual Satisfaction Scale and New Sexual Satisfaction Scale (NSSS) questionnaires were administered to the partners by a doctor. Preoperative and postoperative results were compared.

The MSHQ-EjD is a 4-question questionnaire that evaluates the erectile function of men. The first 3 questions evaluate ejaculation function, while the last question evaluates ejaculation difficulty. The higher the total score, the better the sexual health is considered to be.¹⁶

The Golombok-Rust Sexual Satisfaction Scale is a questionnaire that evaluates categories of sexual function, such as frequency of intercourse, communication, avoidance, touching, satisfaction, impotence, premature ejaculation, and nature of sexual intercourse. A score of 4 points or more in the frequency and communication categories suggests that there is a problem; a score of 9 points or more in the categories of avoidance, touching, satisfaction, impotence, premature ejaculation, and nature of sexual intercourse suggests that there is a problem.¹⁷

The NSSS is a questionnaire consisting of 20 questions to measure sexual satisfaction. The higher the overall score, the higher the sexual satisfaction.¹⁸

Surgical Procedure

In patients who elected to undergo linear labiaplasty under spinal anesthesia, the area defined as problematic by the patient was marked with a sterile marker pen up to the posterior labium minus. The labium minus tissue was restored to remain above 1 cm.¹⁹ Resection was performed with a needle-tipped cutter. The center and mucosa of the labium were sutured with 5-0 Vicryl Rapide (Ethicon, Inc., Raritan, NJ).

In patients who elected to undergo wedge resection under appropriate conditions of spinal anesthesia, the area described as problematic by the patient in the labium minus was marked with a sterile marker pen. Excess tissue was removed in a “V” shape from the redundant area to reduce the labium minus. The center and mucosa of the labium were sutured with 5-0 Vicryl Rapide. No preoperative or postoperative complications were observed in the patients included in this study.

RESULTS

A total of 49 women aged between 25 and 51 years were included in the study; their mean [standard deviation] age was 39.08 [6.17] years. The demographic data of the patients are shown in Table 1. The obstetric and gynecological histories of the patients are given in Table 2. The age at first sexual activity varied between 14 and 35 years, with a mean of 23.24 [5.01] years and a median of 23 years. Relationship status is given in Table 3. Demographic data about the partners are shown in Table 4. Preoperative and postoperative sexual function evaluations of the partners based on the MSHQ-EjD, Golombok-Rust Sexual Health Scale, and NSSS results are shown in Tables 5-7, respectively.

Statistical Analyses

Statistical analysis of the findings was performed with IBM SPSS Statistics 22 software. Kolmogorov-Smirnov and Shapiro-Wilks tests revealed that the parameters did not show a normal distribution. In addition to descriptive statistical methods (mean, standard deviation, median, frequency), the Wilcoxon signed-rank test was used for preoperative-postoperative comparisons of quantitative data. Spearman's ρ correlation analysis was used to analyze the relationships between the scale scores. Significance was evaluated at the P < .05 level.

DISCUSSION

This study revealed that sexual pleasure and satisfaction in the partners of women who underwent labiaplasty changed positively and ejaculation functions were not affected. It is known that sexual satisfaction is directly related to sexual well-being, dyadic relationships, and intimacy, and that this satisfaction depends on both individual and relational factors. Because men and women have different ways of achieving sexual satisfaction, it is important for couples to communicate with each other about their sexual needs and problems.^20,21 In addition, it has been shown in studies that there is no specific rule and frequency of sexual intercourse to achieve sexual satisfaction, that quality is more important than quantity, and that sexual frequency and relationship level are important as desire by the person and his/her partner.²² It is thought that the body image of individuals has an effect on libido and sexual desire. In the literature, it has been shown that partner dissatisfaction or negative comments by partners are among the main reasons pushing women to undergo gynecological aesthetic surgery.^23-26 In another study, it was found that approximately 9% of women were affected by external factors and that their partners were the biggest factor in the decision to have surgery.²⁷

Women who have undergone genital aesthetic surgery generally feel psychologically better and report that the frequency and satisfaction of sexual intercourse has increased.^28,29 In literature reviews, it has been determined that the improvement in body image of women who have undergone labiaplasty provides an increase in their sexuality and sexual satisfaction.³⁰ It has been observed that the frequency of sexual intercourse increased in 64% of women who underwent aesthetic gynecological surgery, the frequency of reaching orgasm was improved in 52%, and the sexual satisfaction of their partners increased during intercourse.³¹ It was also reported that women who underwent labiaplasty felt comfortable forming new relationships and allowing their partners to see their genitals.³² In this study, criteria such as sexual satisfaction, pleasure, and nature of sexual intercourse were evaluated by Golombok-Rust and NSSS questionnaires in males after their partners’ had undergone labiaplasty, and a statistically significant improvement was observed postoperatively. According to these results, there is a statistically significant increase in sexual functioning and sexual satisfaction in couples in which the women have undergone labiaplasty. We think that this situation is associated with an increase in women's participation in sexual life and sexual desire as a result of the increase in their self-confidence with the improvement in sexual self-perception and appearance after the operation.

Literature reviews and the results of this study suggest that if we improve women's body image and sexual function, their partners will be positively affected by this improvement. Although labiaplasty is an operation performed on the female body, it can be said to have positive secondary effects on male sexual response.

Ejaculation has a multifactorial mechanism, and it is thought that the effect of visual improvement alone is weak. In 1 study, men experiencing premature ejaculation were compared with healthy men and no difference was found between erectile responses to visual sexual stimuli.^33,34 In another study, it was shown that men with premature ejaculation reached high levels of sexual arousal very quickly and may ejaculate rapidly due to inadequate control over their rapidly increasing arousal.³⁵ From the results of MSHQ-EjD questionnaire applied in this study, it was observed that performing labiaplasty did not cause a statistically significant difference in terms of the partner’s ejaculation function and difficulty. This suggests that visual image is not an important factor on ejaculation function and difficulty, and frequency, quality and satisfaction of sexual intercourse are more important factors. Metin and Özyalvaçlı also showed a positive relationship between sexual arousal and ejaculation reflex in their study.³⁶ In this study, statistically positive changes were observed in the parameters of frequency of sexual intercourse, communication, avoidance, touching, satisfaction, impotence, premature ejaculation, and nature of sexual intercourse in the Golombok-Rust Sexual Satisfaction Scale administered to the partners of patients who underwent labiaplasty. In addition, according to the Golombok-Rust Sexual Satisfaction Scale, it was observed that men ejaculated statistically earlier in the postoperative period than in the preoperative period, but this was not pathological premature ejaculation. Improving the appearance of the genital area with labiaplasty increases sexual arousal in partners, which shortens the ejaculation time in a nonpathological way. These results suggest that improvement in the external genital appearance of women has a positive effect on male sexual response.

The limitation of the study is that the satisfaction of the women included in the study was not investigated.

The strength of the study is that all patients were operated by the same surgeon. In addition, questionnaires addressing all aspects of male sexual response were used. We consider this to be an important study because there are limited data in the literature examining the effects of female genital aesthetic operations on men. Furthermore, we believed the findings will shed light on studies with a larger number of patients in which the number of partners, partner gender, and the duration of time spent with their partners are investigated and the satisfaction of the patients is evaluated.

CONCLUSIONS

Literature reviews and the results of this study suggest that if we improve women's body image and sexual function, their partners will also be positively affected by this improvement. Although labiaplasty is an operation performed on the female body, it can be said to have positive effects on male sexual response by increasing the frequency of intercourse, sexual satisfaction, pleasure, and well-being.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

REFERENCES

Author notes