Ep. 14 Cosmetic Gynecology with Dr. Cheryl Iglesia

In this episode, Dr. Mark Hoffman invites Dr. Cheryl Iglesia to shed light on the topic of cosmetic gynecology. --- SHOW NOTES Dr. Iglesia is the Director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, as well the current President of the Society of Gynecologic Surgeons. In addition to being involved with a consensus document regarding cosmetic gynecology, Dr. Iglesia has contributed numerous studies to the growing field and hopes to educate other providers on the topic. The episode begins with Dr. Iglesia sharing how she became passionate about cosmetic gynecology. Her experience initially began with a weekend course in California learning about topics such as “laser vaginal rejuvenation” and “designer laser vaginoplasty,” which were early marketing terms used for the field. After multiple years of training and education within a field filled with gray areas and limited evidence-based medicine, she later helped develop a consensus document about cosmetic gynecology procedures, which provides clarification for patients and opportunity for future research studies. Dr. Iglesia then describes the field of cosmetic gynecology, which includes the elective intervention to alter the aesthetic appearance of the external genitalia or modify the genital organs. These elective, functional procedures may be performed in the absence of any pathology (e.g., no incontinence, prolapse, etc.) with the goal of improving a person’s quality of life (e.g., sexual function). She describes two pillars of the field, including cosmetic (e.g., labiaplasty) versus functional (e.g., surgical tightening of the vagina for vaginal laxity) procedures. The physicians then address the concerns of societal pressure, agreeing that the goal is to help patients make well-informed, ethical decisions, which requires discussing goals with patients. After discussing the field as a whole, Dr. Iglesia then highlights different procedures and technologies. For example, a fractionated laser may be used to stimulate tissue growth and may be utilized for diagnosis such as genitourinary syndrome (GSM) of menopause or lichen sclerosis. In addition, she briefly mentions aesthetic procedures, including a clitoral frenulum reduction (frenulectomy) or clitoral amplification with platelet rich plasma or the O-Shot. She addresses that a lot of the procedures and technologies are proprietary, have limited evidence, and are not risk-free. Ultimately, Dr. Iglesia states that there is a need for more data, urging the need for future level I trials. --- RESOURCES Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Joint Report on Terminology for Cosmetic Gynecology. Int Urogynecol J. 2022 Jun;33(6):1367-1386. Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA. 2021 Oct 12;326(14):1381-1389. Paraiso MFR, Ferrando CA, Sokol ER, Rardin CR, Matthews CA, Karram MM, Iglesia CB. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: The VeLVET Trial. Menopause. 2020 Jan;27(1):50-56. Burkett LS, Siddique M, Zeymo A, Brunn EA, Gutman RE, Park AJ, Iglesia CB. Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):968-978. Cosmetic Gynecology and the Elusive Quest for the “Perfect” Vagina: https://journals.lww.com/greenjournal/Citation/2012/10000/Cosmetic_Gynecology_and_the_Elusive_Quest_for_the.34.aspx