Evidence-based clinical practice national guideline for elective female genital aesthetic labiaplasty: recommendations from the pelvic floor and cosmetic gynecology (PETKOZ) association and expert consensus

The increasing global demand for elective female genital cosmetic surgery (FGCS), combined with substantial variability in clinical practice and patient counseling, highlights the need for standardized evidence-based guidance. This national guideline was developed by the Pelvic Floor and Cosmetic Gynecology Association to provide graded recommendations for the evaluation, surgical management, and perioperative care of women seeking elective FGCS, with particular emphasis on labiaplasty. A structured electronic database search was conducted across PubMed/MEDLINE, Google Scholar, Cochrane Central Register of Controlled Trials, and Scopus from inception through April 2026, supplemented by grey literature screening. Evidence grading followed the Scottish Intercollegiate Guidelines Network classification. Methodological quality was appraised using AMSTAR 2, Cochrane RoB 2, and Risk of Bias in Non-randomized Studies of Interventions. For clinical questions not sufficiently addressed by available literature, a three-round modified Delphi consensus process was conducted with 24 specialists, each with a minimum of 50 labiaplasty procedures. Of 1,514 records identified, 20 studies met inclusion criteria, comprising 8 systematic reviews and meta-analyses, 2 randomized controlled trials, and 10 observational cohort studies. Labiaplasty was associated with significant and reproducible postoperative improvements in genital self-image across all study designs, independent of surgical technique (grade B; evidence level 2+). Sexual function outcomes showed consistent improvement, predominantly in the pain and satisfaction domains, though overall certainty of evidence was very low owing to high heterogeneity and predominantly uncontrolled designs (grade C; evidence level 1-). Labiaplasty-seeking behavior was characterized by a multidimensional motivational profile; body dysmorphic disorder (BDD) criteria were fulfilled by 18.2% of candidates in controlled studies (grade C; evidence level 2+). Sexual partner coercion constituted a numerically minor direct pathway to surgery (6.9%), whereas partner-attributed negative genital comments were recalled by 36.7% of candidates in meta-analytic synthesis, representing a clinically relevant discrete vulnerability (grade C; evidence level 2+). Expert consensus yielded structured recommendations across patient selection, preoperative psychological screening, perioperative management, surgical principles, and complication prevention. This guideline provides the first national evidence-based framework for elective FGCS. Labiaplasty confers reproducible benefits in genital self-image and sexual function; however, the evidence base remains constrained by methodological heterogeneity and limited high-quality randomized data. Mandatory BDD screening, preoperative psychological evaluation, and standardized patient-reported outcome measurement are identified as critical components of ethical clinical practice.