Labiaplasty and Body Dysmorphic Disorder - Katrín Kristjánsdóttir and Andri S. Björnsson Landspítalinn University Hospital and University of ...
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Labiaplasty and Body Dysmorphic Disorder Katrín Kristjánsdóttir and Andri S. Björnsson Landspítalinn University Hospital and University of Iceland NFOG Educational Committee Course Stockholm, April 25th-26th 2019
CONFLICT OF INTEREST WE HAVE NO CONFLICT OF INTEREST
OUTLINE • CASE • “NORMAL” LABIA • LABIAPLASTY • BODY DYSMORPHIC DISORDER (BDD) • SCREENING FOR BDD
• 18 YEAR OLD FEMALE PRESENTS TO A
GYNECOLOGIST ASKING FOR LABIAPLASTY
• “DEFORMED” LABIA
• WILL NOT SHOWER AMONG OTHER
WOMEN
• WILL NOT UNDRESS/HAVE SEX WITH
LIGHTS ON
• THINKS ABOUT THIS ”DEFORMITY” MANY
TIMES A DAY
• SEXUALLY ACTIVE, BOYFRIEND THINKS SHE
LOOKS PERFECT
• Increasingly more common
• Controversial
• Ethical concerns
• Poor outcome data:
• Mostly case studies, and case series reporting customer
satisfaction
• Little or no description of methodology
• No prospective randomized controlled studies
WHAT IS NORMAL?
NORMAL
LABIAPLASTY THE SURGERY
RISKS INVOLVED IN LABIAPLASTY • Wound separation • Hematoma • Infection • Scarring • Pain
REASONS FOR LABIAPLASTY?
• Veale et al. 2013, 2014
• 55 women seeking labiaplasty (LP) vs.
70 not seeking surgery
• Aesthetic (71%; 21% sole reason)
• Functional (63%; 19% sole reason)
• Sexual (38%; 8% sole reason)WHO ASKS FOR SURGERY?
Veale et al. 2013, 2014
• LP less satisfied with genitals, lower sexual satisfaction,
poorer quality of Life
• LP more impairment in relationships and social life
• LP more likely to use safety behaviors
• LP more likely to have received negative comments
about appearance of labia
• Ten in LP group (18%) diagnosed with BDDWhat is body dysmorphic disorder? • Believe one or more body parts are ugly or even deformed • Look normal • Obsessions • Compulsive behaviors: • Safety behaviors: • Fear of being rejected by others • Avoidance of social situations
Most common body parts in BDD Skin: 65% Hair: 50% Nose: 38%
20%
18%
12%
20%
22%Outcome of Cosmetic Treatment for BDD
90
Percent of Treatments
80
70 Overall BDD
Body Part
60
50
40
30
20
10
0
Improved Same Worse
Total number of treatments = 890 N=450
Phillips et al, Psychosomatics, 2001; Crerand et al, Psychosomatics, 2005Outcome with Surgery • Of 50 BDD patients who had received medical consultation or surgery, 81% were dissatisfied or very dissatisfied with the outcome • After 50% of the procedures, the preoccupation transferred to another body area Veale, 1996; Veale 2000
Survey of Cosmetic Surgeons
• 40% of surgeons reported that a BDD
patient had threatened them:
29% Legally
2% Physically
10% Both legally and physically
Sarwer, Aesth Surg J, 2002 N=265In your practice ... • Gynecologists are important gate keepers on the road to plastic surgery • Little is known about labiaplasty for BDD • Important to screen for BDD
Screening for BDD
• Appearance concerns
• Preoccupation
• Distress and/or impairment
• Can be assessed with a screening
instrument (e.g., Body dysmorphic disorder
Questionnaire; BDD-Q) or in a brief,
informal, interview (1-3 minutes)BDD-Q https://www.lifespan.org/sites/default/files/lifespan-files/documents/centers/body-dysmorphic/bddq.pdf
Screening for BDD – 1. Appearance Concerns
• Start by normalizing the concern: “Many people are
unhappy with the way they look – is that true for you as
well?”
• Invite the patient to describe their concern by asking
“Can you tell me about your concern?”Screening for BDD – 2. Preoccupation
• Ascertain that the patient is preoccupied with these
perceived flaws by asking:
“How much time would you estimate that you spend each
day actively thinking about your appearance, if you
add up all the time you spend?”Screening for BDD – 3. Distress and
Impairment
• Ask: “How much distress do these concerns cause you?”
• Ask about effects of the appearance preoccupations on
the patientʼs life:
“Do these concerns interfere with your life or cause
problems for you in any way?”
• That´s it!SUMMARY AND QUESTIONS • Labiaplasty is increasingly common • Poor outcome data • Ethical concerns • What is the role of the gynecologist? • Screening for BDD • Refer patients to a psychologist or psychiatrist
Thank you
Functional Impairment
• Not working due to mental illness (current) 39%
• Receiving disability payments (current) 23%
• Dropped out of school because of BDD 25%
• Housebound due to BDD (lifetime) 29%
• Suicidal ideation (lifetime) 78% - 81%
• Suicide attempt (lifetime) 24% - 28%
N=141, N=507
Didie et al, Compr Psychiatry, 2008; Phillips and Diaz, J Nerv Ment Dis, 1997; Phillips et al,
Psychosomatics, 2005Cosmetic Treatment for BDD
80
70
Percent of participants
Sought
60 Received
50
40
30
20
10
0
Any Dermatologic Surgical Other Dental Para-
Treatment Medical professional
Phillips et al, Psychosomatics, 2001; Crerand et al, Psychosomatics, 2005 N=450You can also read
