An Urgent Call for Regulation of Female Genital Cosmetic Surgery in Jordan: A Letter to Editor

Dear Editor-in-Chief, In the last several years, female genital cosmetic surgery (FGCS) has gained a huge demand among Middle Eastern societies, including Jordanian ones. Although it is increasingly popular, it remains an understudied, underregulated, and culturally sensitive matter. This letter aims to cast light on the sociocultural, legal, and medical features of FGCS in Jordan and demand ethical regulation and institutionalized professional pathways in order to ensure women’s health and rights. FGCS encompasses elective procedures such as labiaplasty, clitoral hood reduction, vaginoplasty, and hymenoplasty.[1] Within Jordan, the practice is especially shaped by sociocultural perceptions of virginity, honor, and female sexuality.[2] A 2023 regional ethics review performed by the Jordan population and Family Health Survey revealed that 43% of women queried as to why they had undergone hymenoplasty replied with family or marital pressure and 27% with cultural pressure to “correct” labial appearance before marriage – echoing the preponderant social pressure driving this practice.[3] Adding to the concern is the growing number of unlicensed or poorly trained practitioners who offer FGCS services.[4] In the absence of a recognized surgical subspecialty or certified training track in Jordan, these procedures are being performed by a heterogeneous group of plastic surgeons, obstetricians/gynecologists, general surgeons, and, in some cases, general practitioners without authorized cosmetic surgery licensure. This lack of specialization increases the risk of complications, malpractice, and ethical violations. Legally, while Jordanian medical malpractice legislation distinguishes between reconstructive and cosmetic surgeries in terms of surgeons’ duty of care and intended results to some extent, it is tainted by a significant absence of specific, procedure-driven legal guidelines for both plastic surgery and FGCS.[5] This omission creates legal ambiguities in the areas of licensure, informed patient consent, and surgeon culpability that could undermine patient safety and legal recourse in the event of malpractice. Public confusion of FGCS with female genital mutilation (FGM) complicates the issue. Although FGM is abhorred and de jure banned in Jordan, the absence of clear medical and ethical guidelines for FGCS leaves room for confusion.[6] FGCS that is well regulated would have the ironic consequence of possibly eradicating remnants of FGM ideology by institutionalizing evidence-based, voluntary, and safe care that focuses on patient autonomy. Furthermore, financial accessibility contributes to the increasing demand for FGCS. Figure 1 illustrates procedure charges in Jordan that are competitive with respect to regional standards, making them more sought after.[7]Figure 1: Female genital cosmetic surgery cost range in selected Middle Eastern countries (2024). FGCS: Female genital cosmetic surgeryTo address these issues, we propose the urgent establishment of national FGCS guidelines, ethical standards, accredited educational programs, and public health campaigns encouraging evidence-based female genital health and beauty discourse. Table 1 lists the priority areas that should be addressed promptly through regulation and education.Table 1: Priority issues in female genital cosmetic surgery practice and regulation in JordanThis letter calls for immediate multidisciplinary dialog and legislative prioritization to protect women’s reproductive rights and ensure the ethical, safe, and culturally appropriate practice of FGCS in Jordan. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.