# Attitude and knowledge of healthcare providers towards female genital cosmetic surgery: A cross-sectional study

## TL;DR

This study explores healthcare providers' attitudes and knowledge about female genital cosmetic surgery in Iran, highlighting training gaps and ethical concerns.

## Contribution

The study identifies specialty-specific variations in FGCS knowledge and confidence, emphasizing the need for targeted training.

## Key findings

- Obstetricians and gynecologists were most informed about short-term risks but showed low support for purely aesthetic FGCS.
- Plastic surgeons had the highest procedural confidence but lower recognition of ethical concerns.
- Most providers emphasized pre-procedure counseling despite gaps in long-term risk awareness.

## Abstract

Female genital cosmetic surgery (FGCS) has experienced increasing popularity over the past decades. This procedure includes surgical and non-surgical intervention to alter genital appearance, often without medical indications. As many women are unfamiliar with normal genital anatomy, healthcare providers play a critical role in guiding patients. Therefore, evaluating their attitudes and knowledge for identifying gaps in training and ethical issues could be valuable.

This cross-sectional study was conducted from 17 January 2023 to August 2024 among 320 healthcare providers in Iran. Participants included obstetricians and gynecologists, plastic surgeons, midwives, gynecology residents, urologists, and general practitioners. Data were collected using a validated web-based questionnaire about participants’ demographics, clinical experience, knowledge of FGCS, risk awareness, ethical considerations, and attitudes toward FGCS. SPSS version 27 was used for statistical analysis.

The majority of participants (57.6%) were obstetricians and gynecologists. Most respondents reported being approached by patients seeking FGCS, with body image dissatisfaction (65.4%) and partner requests (62.2%) being the primary complaints. Awareness of short-term risks varied significantly across specialties (p < 0.001), with obstetricians and gynecologists being the most informed. Confidence in performing procedures was highest among plastic surgeons, while ethical considerations were more recognized among obstetricians and gynecologists. Although most participants in all groups (68.6% of OB/GYN, 90.0% of plastic surgeons and 75.2% of others) reported formal training, long-term risk awareness and procedural confidence gaps persisted. Only a minority endorsed FGCS for purely aesthetic reasons (8.6% of obstetricians and gynecologists, and 1.6% of others). More than half of respondents (56.8% of obstetricians and gynecologists, 60% of plastic surgeons, and 55.6% of others) agreed that all women should undergo consultation before FGCS.

Healthcare providers demonstrated diverse levels of knowledge and confidence in FGCS, which is influenced by specialty and training. Attitudes towards performing procedures solely for aesthetic purposes, including for those under 18, were generally positive, although pre-procedure counseling was also emphasized. While ethical considerations were widely acknowledged, a targeted training program is needed to address gaps in risk awareness and improve providers’ confidence.