CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(02): 285-286
DOI: 10.1055/s-0042-1744428
Communication

Labiaplasty and Insurance: To Cover or Not to Cover?

Mallory Rowley
1   State University of New York Upstate Medical University, Syracuse, New York
4   Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
,
Kometh Thawanyarat
2   Medical College of Georgia at Augusta University, Augusta University/University of Georgia Medical Partnership, Athens, Georgia
4   Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
,
Jennifer Shah
3   Department of Undergraduate Education, Stanford University, Stanford, California
4   Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
,
Rahim Nazerali
4   Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
› Author Affiliations
 

Labiaplasty remains a controversial procedure within the plastic and reconstructive surgery community given its role in patient psychosocial perceptions and sexuality. Similarly, ongoing debate as to the classification of labiaplasties as functional or cosmetic has historically skewed insurance coverage toward self-pay. Given the recent rise in studies that both demonstrate an improvement in physical, mental, and sexual well-being following labiaplasty and studies that refute the dogma that body dysmorphia and media are the primary drivers for seeking surgery, we sought to examine whether recent trends in labiaplasty insurance coverage reflect the shifting narrative on this procedure.

Patient-reported outcomes demonstrate that symptomatology significantly decreases following labiaplasty in relation to physical discomfort, self-esteem, and intimacy concerns.[1] Conversely, satisfaction significantly increases in relation to genital appearance, sexual satisfaction, and psychological well-being.[2] For sexuality outcomes, labiaplasty demonstrates significant improvement in pain and satisfaction domains.[3]

Motivation for seeking labiaplasty has also refuted the notion that most patients seeking labiaplasty have coexisting psychological diagnoses including depression, anxiety, or body dysmorphic disorder.[4] Additionally, pornography is not a significantly influential factor relating to patient decisions to seek labiaplasty. Rather, physical symptomatology predominates as a motivating factor.[5]

Given that recent studies have challenged the overarching narrative of labiaplasty existing as a primarily cosmetic procedure, insurance coverage remains virtually unchanged over the last 5 years and represents a small proportion of the labiaplasties performed each year ([Table 1]). We compared the number of annual labiaplasties available through American Society of Plastic Surgeons public data to annual commercial insurance claims for labiaplasty. The Clinformatics Data Mart Database is a deidentified commercial claims data warehouse. To date, no published commentary has been made on whether it is ethical to deny insurance coverage for a procedure that has demonstrated positive physical and psychosocial outcomes, especially in consideration of other forms of excess tissue removal that are covered by insurance such as breast reductions and lipoma excisions. While candidacy criteria should be developed to determine eligibility for the procedure, insurance coverage also needs to be reevaluated considering recent study findings.

Table 1

Comparison of yearly total labiaplasty volume versus insurance covered volume

Year

Total labiaplasties

Insurance labiaplasties

Percentage of labiaplasty coverage

2015

9,138

145

1.587

2016

12,666

218

1.721

2017

10,253

196

1.912

2018

10,246

218

2.128

2019

11,218

238

2.122

2020

9,725

213

2.190

Note: Annual labiaplasty volume data was extracted from publicly available information through the American Society of Plastic Surgeons. Information regarding commercial insurance claims was extracted from Clinformatics Data Mart Database. The percentage of annual labiaplasties performed that are covered by insurance remains around 2% despite an increase in literature that supports positive patient-reported outcomes following labiaplasty.



#

Conflict of Interest

None declared.

Author Contributions

M.R. wrote the manuscript. K.T. wrote the manuscript and extracted data. J.S. assisted with manuscript editing and data. R.N. is the corresponding author and mentor on this project.


  • References

  • 1 Sorice-Virk S, Li AY, Canales FL, Furnas HJ. Comparison of patient symptomatology before and after labiaplasty. Plast Reconstr Surg 2020; 146 (03) 526-536
  • 2 Sharp G, Tiggemann M, Mattiske J. A retrospective study of the psychological outcomes of labiaplasty. Aesthet Surg J 2017; 37 (03) 324-331
  • 3 Turini T, Weck Roxo AC, Serra-Guimarães F. et al. The impact of labiaplasty on sexuality. Plast Reconstr Surg 2018; 141 (01) 87-92
  • 4 Veale D, Eshkevari E, Ellison N. et al. Psychological characteristics and motivation of women seeking labiaplasty. Psychol Med 2014; 44 (03) 555-566
  • 5 Sorice-Virk S, Li AY, Canales FL, Furnas HJ. The role of pornography, physical symptoms, and appearance in labiaplasty interest. Aesthet Surg J 2020; 40 (08) 876-883

Address for correspondence

Rahim Nazerali, MD, MHS, FACS
770 Welch Road, Suite 400, Palo Alto, CA 94304

Publication History

Article published online:
06 April 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Sorice-Virk S, Li AY, Canales FL, Furnas HJ. Comparison of patient symptomatology before and after labiaplasty. Plast Reconstr Surg 2020; 146 (03) 526-536
  • 2 Sharp G, Tiggemann M, Mattiske J. A retrospective study of the psychological outcomes of labiaplasty. Aesthet Surg J 2017; 37 (03) 324-331
  • 3 Turini T, Weck Roxo AC, Serra-Guimarães F. et al. The impact of labiaplasty on sexuality. Plast Reconstr Surg 2018; 141 (01) 87-92
  • 4 Veale D, Eshkevari E, Ellison N. et al. Psychological characteristics and motivation of women seeking labiaplasty. Psychol Med 2014; 44 (03) 555-566
  • 5 Sorice-Virk S, Li AY, Canales FL, Furnas HJ. The role of pornography, physical symptoms, and appearance in labiaplasty interest. Aesthet Surg J 2020; 40 (08) 876-883