Breast and Labial Surgery in Adolescents
April 21, 2016
Washington, DC — With adolescent women already inquiring about breast augmentation and reduction surgeries at a high rate and a recent increase in the marketing of labiaplasty, female adolescents may be under particular stress to conform to societal conceptions of the "ideal" body. Increasingly, obstetrician-gynecologists are receiving requests from young women for advice about surgery for the breast or vulva in order to improve appearance and function.
As the leading health care providers for women, ob-gyns are in a unique position to screen, counsel, and educate their adolescent patients who have these concerns. Today, the American College of Obstetricians and Gynecologists (ACOG) released a new Committee Opinion, "Breast and Labial Surgery in Adolescents," to aid Members in their comprehensive and thoughtful approaches to these matters.
When adolescents seek medical treatment, the first step is often education and reassurance regarding normal variation in anatomy, growth and development. "There is a wide range of what is considered 'normal,'" stated Julie Strickland, MD, MPH the chair of ACOG's Adolescent Health Care Committee and lead author of the Committee Opinion. "It's important for ob-gyns to discuss sexual development and the variability of what breasts and genitalia may look like."
Assessment of physical and emotional maturity of the adolescent is an important aspect of patient counseling. Furthermore, the patient's ability to make autonomous decisions free from peer or family pressure is an essential part of screening. Individuals should also be screened for body dysmorphic disorder as it can lead to repeated surgical correction without relief of perceived or actual symptoms. If an ob-gyn suspects a patient has body dysmorphic disorder, referral to a mental health professional is appropriate.
"Variety in the shape, size, appearance and symmetry of labia can have particularly distressing psychological effects on young women," stated Strickland. "It's one more body part that women are insecure about and it's our job, as ob-gyns, to reassure our young patients."
More on cosmetic vaginal procedures can be found in Committee Opinion #378, Vaginal "Rejuvenation" and Cosmetic Vaginal Procedures. It states that these procedures are not medically indicated, and the safety and effectiveness of these procedures have not been documented.
Committee Opinion #662 "Breast and Labial Surgery in Adolescents" was updated and replaced by Committee Opinion 686. The Committee Opinion was updated to clarify medical indications and reflect legal considerations for performing genital surgery on females younger than 18 years of age. The updated Committee Opinion 686 is available here.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org