A Preliminary Qualitative Analysis of women's Experiences With Vaginal Fractional CO2 Laser Treatments.

Background: Menopause involves a range of bodily changes, with impacts on physical and psychological well-being. Around half of the postmenopausal women experience genitourinary syndrome of menopause (GSM). Fractional CO2 laser treatment can promote tissue regeneration in the vaginal wall to potentially assist with managing GSM. However, the results from clinical trials of this treatment have been mixed, and the personal perceptions and experiences of women receiving this treatment have been largely unexplored. Objectives: To qualitatively explore the motivations and outcomes of women who have undergone vaginal fractional CO2 laser treatment. Methods: Fourteen postmenopausal women were involved in the study. These women had undergone vaginal fractional CO2 laser treatment between 2 and 48 months earlier (M = 32.1, standard deviation = 14.9 months). Telephone interviews were conducted to explore women's motivations and their experiences after treatment. Interviews were recorded and transcribed verbatim. Deductive and inductive thematic analysis was conducted to analyze interviews. Results: Analyses produced 4 major themes. First, motivations mostly revolved around participants seeking relief from menopausal symptoms. Second, some participants noted positive sexual outcomes, including improved sexual pleasure after treatment. Third, participants noted positive physical and psychological effects, including improvements in incontinence and overall confidence. Lastly, a subset of participants reported no discernible changes. Conclusions: This novel qualitative exploration of women's motivations and outcomes of fractional CO2 laser therapy demonstrates the multifaceted impact of treatment. These findings highlight the importance of considering the holistic effects of fractional CO2 laser therapy on women's health during midlife, particularly amid menopausal changes.

Patient Perspectives on Intimate Relationship Outcomes After Labiaplasty: A Preliminary Qualitative Analysis.

BACKGROUND: The popularity of labiaplasty has increased over the last decade and patients consistently report high levels of satisfaction with outcomes. Specifically, patients generally experience improved sexual satisfaction, but there is very limited research on the impacts on intimate relationships more broadly, even though these experiences are often crucial to women's lives. OBJECTIVES: The aim of this study was to conduct an in-depth qualitative exploration of the impacts of labiaplasty on intimate relationship quality. Qualitative semistructured telephone interviews were conducted with adult women (n = 15), who had undergone labiaplasty between 1 and 72 months previously (mean [standard deviation], 28.1 [24.3] months). Participants were asked about any perceived changes to their intimate relationships and how labiaplasty may have influenced those changes (if any). Thematic analysis of the transcribed interview data was performed. RESULTS: The results showed that most women reported greater confidence engaging in new relationships, and partaking in subsequent sexual experiences was also commonly reported. However, other women reported no changes to their intimate relationship quality after labiaplasty. Over half of the women reported concerns that their current or a future partner may perceive their postsurgery genital appearance as not "natural." CONCLUSIONS: The current study adds some novel depth and nuance to the impacts of labiaplasty on intimate relationship quality. Although most women experience improved sexual confidence in their intimate relationships, a proportion may also experience concerns around their partner's reactions to the surgery.

Beyond Motivations: A Qualitative Pilot Exploration of Women's Experiences Prior to Labiaplasty.

BACKGROUND: The demand for labiaplasty has increased rapidly over the last 10 to 15 years. Women's reasons for pursuing the procedure have been thoroughly documented in the literature, but other preoperative aspects are less well defined. These include women's expected outcomes, concerns about having the surgery, and the impacts of support from others in their personal lives as well as their treating team. OBJECTIVES: The aim of this study was to explore women's preoperative labiaplasty experiences, particularly expectations, concerns, and interpersonal support. METHODS: Semistructured interviews were completed with 15 adult women in the United States and Australia who had undergone a labia minora reduction. The women were asked about their motivations for having a labiaplasty, expected outcomes, concerns regarding surgery, and support received from family members, friends, and the treating surgeon. The interviews were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: Two overarching themes with accompanying subthemes emerged from the analyses: (1) "motivations/influences" which included appearance concerns, physical discomfort, negative impacts on self-confidence, and negative experiences with partners and/or peers; and (2) "perceptions approaching labiaplasty procedure" where women reported concerns about recovery duration and impacts on sexual sensation as well as expectations for their postoperative vulvar appearance to be "neat," "tidy," and "natural." In addition, the women stated that they felt well supported by their surgeons prior to the procedure, but some felt too embarrassed to seek support from family members and friends. CONCLUSIONS: These new insights into women's preoperative experiences may assist clinical teams in enhancing their support and education of women seeking labiaplasty.

Men's Experiences and Psychological Outcomes of Nonsurgical Medical Penile Girth Augmentation: A Preliminary Prospective Study.

BACKGROUND: The popularity of penile augmentation procedures is increasing, but investigation into men's experiences with these procedures and their impact on psychological well-being is lacking. OBJECTIVES: The aim of this study was to investigate men's experiences with nonsurgical medical penile girth augmentation and assess, based on valid psychological measures, the impacts these procedures have on psychological well-being. METHODS: Men seeking to undergo a girth augmentation (n = 19) completed an online questionnaire prior to their procedure and 6 months later that contained standardized measures assessing impacts of the procedure, penile size self-discrepancy, body dysmorphic disorder, psychological distress, self-esteem, and body image-related quality of life. Girth size was also measured preprocedure and 6 months postprocedure for a subsample of men. RESULTS: Almost half of the men reported positive impacts of "increased self-confidence" and "increased sexual pleasure" after their procedure. Despite an average girth increase of 3.29 cm, the men still perceived that their penile girth and length was less than what they should be or less than the ideal size after their augmentation procedure. However, this perceived discrepancy was significantly smaller than before their procedures. Prior to the procedure, the men who met diagnostic criteria for body dysmorphic disorder according to self-reported questionnaire (11%, n = 2/19) and clinical interview (7%, n = 1/15) lost this diagnosis at 6 months. There were no changes in psychological distress, self-esteem, or body image-related quality of life from pre- to postprocedure. CONCLUSIONS: Men report positive impacts on their lives after penile girth augmentation, but impacts on broader psychological well-being are mixed.

Motivations and Psychological Characteristics of Men Seeking Penile Girth Augmentation.

BACKGROUND: The popularity of penile augmentation procedures is increasing, but little is known about the motivations and psychological characteristics of men who seek these procedures. OBJECTIVES: Employing valid psychological measures, the authors sought to investigate the motivations and psychological characteristics of men seeking penile girth augmentation. METHODS: Men seeking to undergo a penile girth augmentation (n = 37) completed an online questionnaire containing standardized measures assessing their motivations to undergo augmentation, penile size self-discrepancy, psychological distress, self-esteem, body image-related quality of life, body dysmorphic disorder (BDD), and cosmetic procedure screening scale-penile focused dysmorphic disorder. RESULTS: Men's motivations for seeking penile girth augmentation were characterized as "improve self-confidence," "change penile size/appearance," "sexual function/pleasure," "feelings of insecurity," and "medical issues," with self-confidence being the most commonly reported motivation. The men perceived their actual penis size (girth, flaccid length, erect length) as significantly smaller than ideal size, the size they believed their penis should be, and their expected size postaugmentation. Compared with non-clinical norms, the men seeking penile augmentation had higher penile dysmorphic disorder symptoms, lower self-esteem and lower body image-related quality of life, but comparable psychological distress. In addition, 4 of the men met diagnostic criteria for BDD according to self-reported questionnaire (11%, n = 4/37) and clinical interview (14%, n = 4/29). CONCLUSIONS: Men seek penile girth augmentation for a variety of reasons and perceive all their penile dimensions to be smaller than ideal sizes. They differ from non-clinical samples in some psychological characteristics, and a small but sizeable portion experience BDD.

Do Genital Cosmetic Procedures Improve Women's Self-Esteem? A Systematic Review and Meta-Analysis.

BACKGROUND: The popularity of genital cosmetic procedures in women is increasing. These procedures are often assumed and promoted as having a positive effect on women's psychological well-being, particularly their self-esteem. Empirical support for these claims is lacking. OBJECTIVES: The aim of this study was to conduct a systematic review and meta-analysis of the impact of genital cosmetic procedures on self-esteem in women. METHODS: The authors performed a systematic literature review of MEDLINE, PreMEDLINE, Ebase, EMBASE, OVID, CINAHL, Cochrane, PsycINFO, and PubMed to identify articles that measured self-esteem in women after a genital cosmetic procedure. A meta-analysis was conducted to assess the pooled effect of these procedures on self-esteem. RESULTS: The authors identified 5 eligible studies for the meta-analysis, comprising 2 prospective and 3 retrospective studies. Labia minora reduction was the most commonly studied procedure. All 5 studies used different measures of self-esteem, with only 1 study employing a validated psychometric measure at both preoperative and postoperative time points. The meta-analysis results showed a pooled logit rate estimate of 1.230, indicating a positive effect of surgery on self-esteem. However, there was substantial heterogeneity across studies. CONCLUSIONS: Female genital cosmetic procedures, particularly labiaplasty, appear to have a positive effect on women's self-esteem. However, inconsistencies in study measures and methods limit our conclusions. Future research should involve the development of standardized outcome measures to more accurately assess the impact of these procedures on self-esteem, and on psychological well-being more generally.

Measuring Quality of Life in Female Genital Cosmetic Procedure Patients: A Systematic Review of Patient-Reported Outcome Measures.

BACKGROUND: In the subspecialty of female genital cosmetic procedures, patient satisfaction and quality of life are key outcome measures. As such, valid and reliable patient-reported outcome measures (PROMs) examining these outcomes are essential. OBJECTIVES: The authors sought to identify and scrutinize all PROMs developed for female patients undergoing genital cosmetic procedures. METHODS: The authors performed a systematic literature review utilizing MEDLINE, PreMEDLINE, Ebase, Embase, OVID, CINAHL, Cochrane Library, PsycINFO, PubMed, and Google Scholar to identify PROMs developed and validated for utilization in female genital cosmetic procedure patients. Instruments identified were assessed according to international guidelines for health outcome measures development and validation. RESULTS: The authors identified 50 outcome questionnaires employed in the female genital cosmetic procedure literature. Of these, 26 were ad hoc instruments (ie, had not been formally developed and tested) and 22 were generic instruments (ie, intended for use in broad groups of people, not only specific patient groups). Only 2 instruments have been validated in a female genital cosmetic procedure patient population. These were the Genital Appearance Satisfaction scale and the Cosmetic Procedure Screening Scale-Labiaplasty. Although both these scales had undergone fairly rigorous psychometric development and validation, both had content limitations. CONCLUSIONS: There is a lack of specific, valid, and reliable satisfaction and quality-of-life PROMs in the field of female genital cosmetic procedures. Future research should involve the development of such measures to more accurately assess the outcomes and benefits of these procedures.

Sociocultural Influences on Men's Penis Size Perceptions and Decisions to Undergo Penile Augmentation: A Qualitative Study.

BACKGROUND: An increasing number of men, dissatisfied with their penises, are seeking cosmetic procedures to enhance their penis size. However, little is known about the social and cultural factors that influence men to consider these procedures. OBJECTIVES: The aim of this study was to investigate the sociocultural factors affecting men's attitudes toward their penis size as well as their decisions to undergo penile augmentation. METHODS: One-on-one semistructured interviews were conducted with 6 adult men who had previously undergone a penile augmentation. The men were asked about the sociocultural factors that they thought contributed to dissatisfaction with their penis size, and their motivations for having penile augmentation. All interviews were audio recorded and then transcribed verbatim. Interview transcripts were analyzed through the use of thematic analysis. RESULTS: Three main themes emerged from the interviews, namely "influence of pornography," "comparison with peers," and "indirect appearance-related teasing." The men noted that the large penises of male actors in pornography had skewed their perception of normal penis size. All men had compared their penises with those of their peers, usually in the locker room, and often felt their own penis was smaller as a result. None of the participants had received direct negative comments about their penis size, but were aware that having a small penis was a source of mockery from exposure to jokes on mainstream media sources. CONCLUSIONS: These new insights into the sociocultural factors, namely media and peers, that influence men's desire for penile augmentation may assist clinicians in enhancing their communication with prospective patients.

Nonsurgical Medical Penile Girth Augmentation: A Retrospective Study of Psychological and Psychosexual Outcomes.

BACKGROUND: Although interest in penile augmentation procedures is increasing, there is a significant lack of research into the psychological and psychosexual outcomes of these procedures. OBJECTIVES: To investigate the psychological and psychosexual outcomes of nonsurgical medical penile girth augmentation. METHODS: This retrospective study involved a mixed method approach. Twenty-five men who had undergone a nonsurgical medical penile girth augmentation between 1 and 12 months prior (mean, 6.6 months) completed an online questionnaire containing measures of procedure motivation, procedure satisfaction, genital self-image, penile-focused body dysmorphic disorder symptoms, self-esteem, and sexual relationship satisfaction. Six of these men elected to complete in-depth one-to-one semi-structured phone interviews to further explore the psychological impacts of the procedure. RESULTS: In the online questionnaire, most men were satisfied with their penile size, appearance, and function after penile girth augmentation. The men also reported statistically significant improvements in their genital self-image (P < 0.001) and self-esteem (P = 0.008), and a reduction in penile-focused body dysmorphic disorder symptoms (P = 0.002) at the time of completing the questionnaire compared to recalled pre-procedural levels. The in-depth interviews yielded 3 themes surrounding penile augmentation outcomes: (1) high satisfaction with increased penis girth; (2) increased self-confidence, particularly in situations in which the penis would be seen, such as a locker room; and (3) increased sexual confidence, but some mixed impacts on sexual relationships. CONCLUSIONS: Most men appear to be satisfied with their nonsurgical medical penile girth augmentation results, and they also seem to experience improvements in their overall self-esteem.

Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations.

Penile augmentation is increasingly sought by men who are dissatisfied with the size and/or appearance of their penis. However, augmentation procedures are still considered to be highly controversial with no standardized recommendations reported in the medical literature and limited outcome data. Nevertheless, these procedures continue to be performed in increasing numbers in private settings. Therefore, there is a need for safe, effective, and minimally invasive procedures to be developed, evaluated, and reported in the research literature. In this article, we focus particularly on girth enhancement procedures rather than lengthening procedures as penile girth appears to be particularly important for sexual satisfaction. We discuss the advantages and disadvantages of the common techniques to date, with a focus on the minimally invasive injectable girth augmentation techniques. Based on considerable operative experience, we offer our own suggestions for patient screening, technique selection, and perioperative care.