Female Genital Cosmetic Surgery in Saudi Arabia: A Systematic Review of Awareness, Attitudes, Satisfaction, and Clinical Outcomes

Abstract Female genital cosmetic surgery (FGCS) has gained international attention due to changing beauty standards, social media influence, and greater access to surgical services. While global evidence highlights rising awareness and uptake, data from Saudi Arabia remain scarce. This review followed PRISMA 2020 guidelines. A systematic search of PubMed, Google Scholar, the Saudi Medical Journal archive, and Index Medicus for the Eastern Mediterranean Region was conducted to August 25, 2025. Eligible peer-reviewed English-language studies were those conducted in Saudi Arabia that examined awareness, attitudes, satisfaction, complications, or ethical perspectives. Methodological quality was appraised using Joanna Briggs Institute checklists. Of 1,421 records identified, 5 studies met the inclusion criteria: four cross-sectional surveys and one case series. Awareness among Saudi women was moderate (∼50%), with 19% considering FGCS, while uptake remained low (7-8%). Satisfaction among women who underwent surgery exceeded 85%. Physicians and medical students expressed cautious, ethically concerned attitudes, particularly toward hymenoplasty and vaginal rejuvenation. Reported complications were infrequent (<10%) and minor, though one case series described clitoral hood hair-thread tourniquet syndrome in pediatric patients. FGCS in Saudi Arabia is an emerging field. The findings highlight persistent ethical debates among physicians and underscore the urgent need for larger prospective studies and culturally sensitive national guidelines to regulate practice and align patient autonomy with societal values. This review aimed to systematically gather and summarize existing studies on female genital cosmetic surgery (FGCS) in Saudi Arabia, with attention to awareness, attitudes, satisfaction, complications, and ethical concerns.