“Response to Commentary on Female Genital and Vaginal Plastic Surgery (original) (raw)

Plastic and Reconstructive Surgery, 2020

Abstract

873e Reply: Female Genital and Vaginal Plastic Surgery: An Overview Sir: We are honored to respond to the submitted commentary by the venerable Dr. Sisti et al. We regret that we omitted the referenced works by Motakef et al. and Oranges et al. While not an excuse, we were limited in the scope of the article and a comprehensive review of all subjects in sufficient detail was not possible within the very specific confines of a 3500-word article. We leave these exhaustive reviews to textbooks or to the published reports focusing on isolated procedures or anatomy. We were also provided with explicit instructions to discuss and refer to sources with high levels of evidence to the best of our ability. This precluded us from even discussing the effectiveness of energy-based devices at the time of acceptance. We understand and appreciate the tremendous layperson appeal of the G-spot and the many other topics we briefly touched upon, but the G-spot remains a controversial subject among scientists and anatomists,1 as stated in our review.2 As Sisti et al. have mentioned in their earlier work, many investigators prefer to refer to this area of enhanced sexual stimulation as the “clitoris-urethra-vagina” complex.3 In this context, one must acknowledge that there is a distinction between a purported “vaginal” orgasm versus a “clitoral” orgasm and that this may relate to the internal versus the external portions of the clitoris, respectively.4 Furthermore, the area reportedly responsible for the “vaginal” orgasm, commonly termed the G-spot, has not been identified in all individuals in neither a magnetic resonance imaging scan (62 percent) nor an ultrasound (thickness correlation) study.5,6 Our diagram simply referred to the general anatomic area (colloquially known as the G-spot) and its “proximity to clitoral complex and urethral sponge” rather than digress into a discussion of the clitoris-urethra-vagina complex.2 We briefly mention that we believe it to be consistent with an erogenous zone (much as the ear can be) due to the lack of it being a consistent universal finding in all subjects studied.7 We have concerns that Sisti et al. are conflating G-spot augmentation with female genital mutilation, as have many others. We do not advocate nor denounce the procedure but state there is a “lack of data regarding a role of these products for enhancing sexual function.”2 We have addressed the controversy of female genital mutilation versus female genital plastic surgery in the article; however, we are surprised that Dr. Andrea Sisti, as a practitioner of female genital plastic surgery, would raise this criticism, because nearly all the other procedures discussed here could potentially fall into that realm.8 This First, the authors failed to cite two important reviews on labiaplasty surgical techniques: the article by Motakef et al.2 and the article by Oranges et al.3 Furthermore, the authors only briefly mention the G spot and its augmentation, without a proper narrative on these important topics. They correctly represent the G spot area in their Figure 4 without fully describing this anatomical area. On page 287e of their article, they mention how the clitoris may be involved in the orgasmic reaction started in the G spot area, without fully describing the current theories about it. We would add that the G spot has been recently described via sonogram as a unique area on the anterior vaginal wall,4 and its relationship to the vaginal and clitoral orgasm has been questioned. It seems that the G spot is in reality a part of the greater clitourethrovaginal complex: the mechanical pressure given by the penis on the anterior vaginal wall would be transmitted upward to the clitoris, where the orgasm would be finally generated. The augmentation of the G spot has been very controversial, with limited scientific evidence, and it has even been compared to a genital mutilation.5 DOI: 10.1097/PRS.0000000000006659

Otto Placik hasn't uploaded this paper.

Let Otto know you want this paper to be uploaded.

Ask for this paper to be uploaded.