In short
- At ICPM we perform labiaplasty — with or without reduction of the clitoral hood —, labia majora augmentation with fat transfer, mons pubis reduction, vaginoplasty or perineoplasty, and vulvovaginal treatment with laser or radiofrequency.
- We do not perform gender-affirming vaginoplasty, which is a different reconstruction altogether and belongs to multidisciplinary gender identity units.
- Labiaplasty is the procedure with the most literature behind it: a 2024 meta-analysis reports 94 % satisfaction across the different techniques.
- That does not make it a risk-free procedure. The same review puts wound dehiscence at 8 % for the wedge resection technique, and the complications described include pain, bleeding, infection, scarring, altered sensation and the need for further surgery.
- In some consultations the correct indication is not to operate: when what brings the patient in is the idea of a «normal» anatomy that does not exist, the assessment stops there.
Vulval anatomy varies enormously between healthy women, and a good number of female intimate surgery consultations begin with a comparison against an image that does not represent that variability. Before considering any procedure, two things that get mixed up daily have to be separated: a real physical problem — which exists, can be examined and in many cases is corrected well — and an aesthetic concern built on a reference that is not normality.
This guide from the Instituto de Cirugía Plástica del Mediterráneo (ICPM), in Valencia, sets out which female intimate surgery procedures are performed at the centre, which are not offered and on what clinical grounds, what the available evidence supports in each case, and in which situations the right approach is not a surgical one.
What female intimate surgery means
That label covers procedures with very different purposes, and it is worth separating them first of all:
- Vulval contour procedures: changes to the shape or size of the labia minora, the clitoral hood, the volume of the labia majora or the contour of the mons pubis.
- Functional and reconstructive procedures: correction of the after-effects of childbirth, of previous surgery or of trauma, and repair of the perineum.
- Gynaecological and urogynaecological procedures: prolapse, urinary incontinence, vulvovaginal atrophy of the menopause, cervical disease. These belong to gynaecology and are not performed at the centre.
Confusion between the three groups is common, and sorting it out is the first thing done in an assessment. The commercial term «vaginal rejuvenation» mixes all three deliberately, which is why it is worth taking apart early on.
Which procedures are performed at ICPM
Labiaplasty, with or without reduction of the clitoral hood
Reduction and reshaping of the labia minora when their size or asymmetry causes discomfort with clothing, with exercise or during intercourse. Reduction of the clitoral hood may be added when excess skin in that area unbalances the result; it is an additional step, not a different operation, and it is decided on each patient’s anatomy.
It is the procedure in this group with the most published literature, and also the one that has grown most: between 2014 and 2018 labiaplasties increased by more than 50 % in the United States, according to the reference document of the American College of Obstetricians and Gynecologists.
It has a page of its own: labiaplasty, in detail.
Labia majora augmentation with fat transfer
Filling of the labia majora with the patient’s own fat when they have lost volume — with age, after significant weight loss or constitutionally — and that emptying leaves the labia minora more exposed than the patient would like.
Autologous fat is used, not permanent filler material. As with any fat graft, part of the volume is reabsorbed in the first few months and the final result is assessed after that time; a second session may be needed.
Mons pubis reduction
Correction of the contour of the pubis when it protrudes because of excess fat or excess skin, usually after significant weight loss or a pregnancy. It is resolved with liposuction, with skin excision or by combining both, and is frequently considered alongside an abdominoplasty because the underlying problem is the same tissue.
Vaginoplasty and perineoplasty
Surgical correction of laxity of the vaginal canal and repair of the perineum, typically after one or more births. It is functional surgery with an anatomical basis, not a treatment for a subjective sensation: the indication comes from the examination, and if the examination does not produce one, we say so.
⚠️ When prolapse or urinary incontinence is involved, the case is not ours: it belongs to gynaecology or urogynaecology, and operating on the perineum without resolving the other problem first is starting at the end.
Vulvovaginal treatment with laser or radiofrequency
Non-surgical treatment of the quality of the vulvovaginal tissue. It is performed at the centre, and it is explained as frankly as everything else: it is the procedure in this group with the most disputed evidence, and that is worth knowing before deciding.
What is known today, put precisely:
- The American Urogynecologic Society put 40 statements about these devices through a structured Delphi process. 28 reached consensus among the experts and 12 did not, lack of evidence being one of the main reasons.
- In 2018 the FDA issued a safety communication warning that «the safety and effectiveness of energy-based devices to perform these procedures has not been established», and listing reported adverse events: vaginal burns, scarring, pain during intercourse, and recurring or chronic pain.
For that reason, it is offered here with three explicit limits:
- It is not a treatment for urinary incontinence or prolapse. If that is the problem, the place is gynaecology or urogynaecology.
- It does not replace surgery when there is a surgical indication: it does not correct excess skin or structural laxity.
- The adverse effects described are explained in writing before the first session, as is the fact that its effectiveness has not been established.
If after that conversation the patient would rather not go ahead, that is a perfectly reasonable decision and it is said as much in the consultation.
Of the procedures above, the most asked about has a page of its own today:
What is not offered: gender-affirming vaginoplasty
Gender-affirming vaginoplasty is not performed. It is not a variant of the vaginoplasty described above: it is a completely different reconstruction, with a different technique, different follow-up and different complications.
This type of surgery is carried out within multidisciplinary gender identity units, with prior assessment, endocrinology, mental health and long-term follow-up that a plastic surgery centre cannot replace on its own. Offering it in isolation would mean doing it worse.
Anyone looking for this surgery should approach one of those units; we will point you towards them in the consultation if needed.
What the evidence supports, and what it does not
It is worth being precise, because these procedures are advertised with a confidence the literature does not have.
There is data on labiaplasty, and it is good. The most complete meta-analysis published to date brought together 86 peer-reviewed studies, 53 of which contributed quantitative data, and found overall satisfaction of 94 % (CI 93–95 %) across the techniques as a whole.
For the rest of the group there is far less. The ACOG document says so plainly: the absence of published studies and of a common nomenclature for these procedures «results in a lack of clear information on their incidence and prevalence, and limited data on risks and benefits». Its recommendation is that the patient should be expressly informed of that lack of quality data before deciding.
That is exactly the conversation held in the consultation: not that the procedure is bad, but that less is known about it than the advertising suggests.
When the problem is not surgical
There are consultations in which the anatomy is within the normal range and what has brought the patient in is an idea of normality built on retouched images. Operating there resolves nothing, because what is troubling her is not in the tissue.
ACOG recommends that, where an underlying psychological concern is suspected, body dysmorphic disorder should be specifically assessed and the patient referred for evaluation before surgery is considered. That recommendation is followed here, and explaining it properly is part of the consultation.
When the case belongs to another specialty
- Genital prolapse, urinary or flatal incontinence: gynaecology or urogynaecology.
- Dryness and vulvovaginal atrophy of the menopause: this is a medical problem, not a surgical one.
- Pain during intercourse with no visible anatomical cause: this needs investigating before anything is considered; a painful vestibule and a hypertonic pelvic floor are not operated on.
- Recurrent infections or skin lesions: dermatology or gynaecology depending on the case.
What the assessment involves
The consultation begins with the examination and with understanding exactly what is troubling you and in what situations. Your obstetric history, medication and surgical history are reviewed, you are examined standing and lying down, and asymmetry is documented, which is the rule and not the exception.
From that comes one of three answers: there is a surgical indication and we explain which; there is not, and we explain why; or the case belongs to another specialty and you are referred on.
Risks of this surgery
Those described for female genital cosmetic surgery procedures, according to the ACOG document, are pain, bleeding, infection, scarring, adhesions, altered sensation, pain during intercourse and the need for further surgery.
To that, in labiaplasty, is added wound breakdown: the 2024 meta-analysis puts dehiscence at 8 % (CI 5–13 %) with the wedge resection technique, and describes differences between techniques in bleeding, swelling and haematoma as well.
None of these figures is a reason not to have surgery. They are the reason the indication has to be right.
Prices
| Procedure | Range |
|---|---|
| Labiaplasty | 2,400 – 3,900 € |
| Vaginoplasty | 2,400 – 3,900 € |
| Labia majora augmentation with fat transfer | 2,400 – 3,900 € |
| Mons pubis reduction | 2,400 – 3,400 € |
| Vulvovaginal laser treatment | Depends on each case |
The range depends on the extent of the procedure, on whether several procedures are combined in the same operation, and on the type of anaesthesia. No range is given for laser treatment because the number of sessions and its indication are decided at the assessment. The quote is settled after the consultation, never over the phone.
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Frequently asked questions
Does labiaplasty reduce sensation?
Altered sensation is among the complications described, and that is why you are told about it. The technique is chosen to preserve the nerve supply, but it is a real risk that has to be named before surgery, not afterwards.
When can I go back to normal activity?
It depends on the procedure and on the patient; it is settled in the consultation with your case in front of us. What is worth knowing in advance is that intercourse is delayed by several weeks and that complete healing takes months.
Can it be done before having children?
Yes, there is no contraindication on those grounds. Vaginoplasty is a different matter, as its result can be altered by a subsequent birth; that is discussed before deciding on timing.
What if what I want is for it to look «normal»?
Normal vulval anatomy varies enormously: there is no correct shape to compare yourself with. If the aim is to resemble a particular reference, that conversation comes before any surgery.
Do you offer vaginal laser treatment?
Yes, and it is explained with its limits: it does not treat incontinence or prolapse, it does not replace surgery when there is a surgical indication, and its effectiveness has not been established — that is what the FDA said in 2018 and what the pelvic floor society’s consensus reflects. With that information in front of her, the decision is the patient’s.
Do you perform gender reassignment surgery?
No. Gender-affirming vaginoplasty is a different reconstruction and is carried out in multidisciplinary gender identity units, not in a plastic surgery centre on its own.
Sources
- American College of Obstetricians and Gynecologists. Elective Female Genital Cosmetic Surgery. ACOG Committee Opinion No. 795. Obstet Gynecol. 2020;135(1):249-250. PMID 31856120 — lack of quality data, list of complications, assessment of body dysmorphic disorder, and the rise in labiaplasties between 2014 and 2018.
- Géczi AM et al. Comprehensive Assessment of Labiaplasty Techniques and Tools, Satisfaction Rates, and Risk Factors: A Systematic Review and Meta-analysis. Aesthet Surg J. 2024;44(11):NP798-NP808. PMID 38957153 — overall satisfaction of 94 % (CI 93-95 %) and dehiscence of 8 % (CI 5-13 %) in wedge resection.
- Alshiek J, Garcia B, Minassian VA, Iglesia CB, Clark A, Sokol ER et al. Clinical Consensus Statement: Vaginal Energy-Based Devices. Female Pelvic Med Reconstr Surg. 2020;26(5):287-298 — 40 statements assessed by a Delphi process, 28 with consensus and 12 without, largely for lack of evidence.
- U.S. Food and Drug Administration. FDA Warns Against Use of Energy-Based Devices to Perform Vaginal «Rejuvenation» or Vaginal Cosmetic Procedures. Safety Communication, July 2018 — the safety and effectiveness of these devices «has not been established»; reported adverse events: vaginal burns, scarring, pain during intercourse, and recurring or chronic pain. Text reproduced by Medsafe, New Zealand (the original FDA page no longer resolves).
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If there is a specific problem, the way to find out whether it has a surgical solution is an assessment with an examination. If no indication comes out of it, we say so.
Clinical confirmation by the surgeon
Reviewed and confirmed by Dr Elena García Vilariño, specialist in Plastic, Aesthetic and Reconstructive Surgery — medical council registration no. 46/4624503.
Registration no. 46/4624503
Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
