Intimate Attention

Aging is a natural, universal, and irreversible process that affects all organs and systems of the human body, including the female genital tract. The reduction in Estrogen levels during the aging process leads to significant atrophic changes in vaginal tissues, including reduced elasticity, hydration, and tissue thickness. These changes can result in symptoms such as dryness, dyspareunia, and external alterations in the appearance of genitalia. The progressive reduction in circulating Estrogens, particularly Estradiol, leads to diminished fibroblast function, resulting in a decreased production of structural components such as collagen and hyaluronic acid, as well as compromised microvascular integrity within genital tissues. Concurrently, a decline in androgen levels, including Dehydroepiandrosterone (DHEA) and Testosterone, further aggravates vulvovaginal atrophy by impairing epithelial renewal and reducing sebaceous gland activity.

To address these challenges, the medical field of aesthetic gynecology has developed, offering a range of interventions targeting both functional and aesthetic concerns. Aesthetic gynecology encompasses both surgical and nonsurgical techniques designed to enhance the aesthetic appearance and functionality of female genitalia. Common procedures include laser vaginal rejuvenation, radiofrequency therapy, filler injections, labiaplasty, and vaginoplasty. These interventions are particularly beneficial for women experiencing menopausal changes, postpartum effects, or dissatisfaction with genital appearance due to aging. By improving genital functionality and aesthetics, these procedures contribute to enhanced quality of life, self-esteem, and sexual satisfaction.

Aesthetic surgery stimulates and promotes a strong, positive self-image, enabling external improvements to translate into inner changes that help individuals build resilience against their internal vulnerabilities. Considering that aesthetic surgery often results in permanent and sometimes significant changes, it is essential to have a clear understanding of the benefits expected from the procedure, both from a physical and psychological perspective.

Common aesthetic procedures in this domain include labiaplasty, microneedling, clitoral hood reduction, PRP therapy aesthetic vaginoplasty, hymenoplasty, hyaluronic acid fillers, G-spot amplification, and lipofilling and liposuction of the mons pubis.

Labiaplasty, a surgical procedure designed to reduce the size of the labia minora, has emerged as one of the most popular interventions in female genital cosmetic surgery, particularly over the past decade. Despite its increasing prevalence, a standardized definition of “labial hypertrophy” remains elusive. Studies have reported a wide range of normal labial variations, with widths ranging from 3 mm to 45 mm, Research has further emphasized the complex structure of the labia minora, demonstrating their rich network of innervation and vascularization, which contributes to tissue engorgement during sexual arousal, and due to these intricate nerve patterns, they are believed to play a significant role in sexual sensation and arousal [17]. These findings raise concerns about the potential impact of labiaplasty on sexual function and sensation.

Microneedling has gained attention as a minimally invasive technique for skin rejuvenation. By creating controlled micro-injuries, this procedure stimulates collagen production, improves tissue elasticity, and enhances cellular turnover. While commonly used for facial rejuvenation, microneedling has also been applied in gynecology, particularly for treating external genital laxity and improving sexual satisfaction.

Clitoral hood reduction, sometimes referred to as partial clitoridectomy, is an elective surgical procedure involving the separation of the prepuce from the clitoral tissue and the removal of excess skin. Another surgical approach involves the bilateral removal of excess clitoral hood tissue using elliptical, fusiform, or semicircular incisions. This technique exposes more of the clitoris while maintaining its central position. You should be counseled on potential risks, including scarring, pain, and nerve damage. It is crucial to distinguish clitoral hood reduction from clitoridectomy, a procedure considered a form of female genital mutilation. Clitoral hood reduction is sought to enhance sexual function by exposing more of the clitoris, improve aesthetics, enhance hygiene, or reduce discomfort caused by a hooded clitoris. The goal is to decrease the length and protrusion of the clitoral hood.

PRP, which was initially introduced in cardiac surgery, contains key growth factors such as platelet-derived growth factor, transforming growth factor beta, and epidermal growth factor. Over the years, it has found diverse applications, including in aesthetic medicine. PRP injections have emerged as a promising non-invasive option for addressing female sexual dysfunction, inadequate lubrication, and stress urinary incontinence.

Aesthetic vaginoplasty is a procedure designed to tighten the vaginal opening. The most common surgical technique involves posterior vaginal wall repair (posterior colporrhaphy), often combined with perineal reinforcement. Nonsurgical methods, such as radiofrequency and laser treatments, have also been explored to induce tissue tightening. The combination of labiaplasty and aesthetic vaginoplasty is sometimes referred to as “vaginal rejuvenation”. However, there is limited scientific evidence to support the claim that these procedures enhance vaginal sensitivity.

Hymenoplasty is a controversial procedure involving the repair or reconstruction of the hymen. While this procedure lacks official legal recognition and is not subject to laws prohibiting female genital mutilation, it remains a topic of ethical and medical debate.

G-spot amplification is a procedure aimed at temporarily enhancing the sensitivity of the G-spot in sexually active women.

In 1981, Addiego et al. identified a similarly sensitive area associated with female ejaculation and named it the “Gräfenberg spot” in recognition of his work. Although the exact anatomy is still not fully understood, it is believed to be a neurovascular complex linked to vaginal orgasm. G-spot amplification, or the “G-shot”, is a minimally invasive aesthetic procedure aimed at temporarily increasing the size of the G-spot. Enhancing the G-spot through the use of fillers like collagen or autologous fat transfer has been reported to increase the volume of the vaginal lumen, potentially improving sexual activity. The procedure involves the use of HA-based fillers, though in some instances, autologous fat transfer is also employed and injected into the bladder–vaginal septum. However, it is important to note that hyaluronic acid is not approved in the U.S. by the FDA for vaginal use, and the American College of Obstetricians and Gynecologists does not endorse this procedure as either effective or safe. In fact, a case of pulmonary embolism following its use in the vagina has been reported.

Lipofilling, another regenerative approach, involves transferring autologous fat to increase the thickness of vaginal walls, rejuvenate vulvar skin, and restore genital volume. This procedure utilises adipose-derived stem cells (ADCs), which have a very low risk of rejection.

Liposuction of the Mons Pubis is another procedure that can be performed either alone or in combination with abdominal liposuction. It is claimed that reducing the Mons Pubis can enhance the aesthetic appearance of the external genitalia. These procedures, however, carry risks such as local infections and scarring, and there is no evidence to support any long-term benefits.

Aesthetic gynecology has emerged as a revolutionary field addressing both the functional and aesthetic challenges associated with female aging and physical changes. By enhancing body image, self-esteem, and sexual satisfaction, these procedures can significantly improve a woman’s quality of life. However, their growing popularity also raises significant ethical and psychological concerns, such as reinforcing unattainable beauty ideals and the risk of overlooking underlying psychological issues, including Body Dysmorphic Disorder (BDD). To achieve patient-centered care, it is essential to foster collaboration between healthcare providers, including gynecologists and mental health professionals. This approach ensures that patients are well informed, their motivations are carefully assessed, and their expectations are realistic. Such multidisciplinary engagement can help empower women while minimising potential psychological risks.

Promoting positive body image through interventions that foster body compassion and functional appreciation can mitigate the negative impact of social media on self perception. Encouraging women to value their bodies for their functionality rather then appearance may reduce susceptibility to sociocultural pressures and aesthetic modifications. Early implementation of such strategies could enhance psychological resilience and critical engagement with media-driven beauty standards. As aesthetic gynecology continues to grow, it is imperative to maintain a focus on using these interventions as tools for empowerment rather than reinforcing unrealistic ideals. Future advancements in this field should integrate innovative technologies with comprehensive ethical guidelines to promote both physical and psychological well-being.

Not my own work. For the full article, please see:

Marano, G.; Anesini, M.B.; Sfratta, G.; d’Abate, C.; Traversi, G.; Rossi, S.; Lisci, F.M.; Brisi, C.; Paris, I.; Pola, R.; et al. Aesthetic Gynecology and Mental Health: What Does It Really Mean for Women? Cosmetics 2025, 12, 28. https://doi.org/10.3390/cosmetics12010028 . (Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy and other establishments.)