For Teachers & Professionals

Plastic Surgery and Discussion on Sexuality

The field of plastic surgery is dedicated to the reconstruction of bodily defects due to birth disorders, trauma, burns, and disease. Many plastic surgeons perform cosmetic surgical procedures as well, which are focused on enhancing a patient’s appearance. Plastic and cosmetic surgery treatments typically have a direct impact on aesthetic appearance and may also affect sensation. A lot of cosmetic surgical interventions are positively linked to sexuality, for example, the physical change and the new position of the clitoris in abdominoplasty may have a positive impact on sexuality, aesthetic breast surgery can augment one's self-confidence and labiaplasty in the case of labia minora hypertrophy shows a significant improvement with the physical discomfort and self-esteem. Those who undergo surgery report improvement in sex life, social life and romantic relationships following the individual's satisfaction with their body image and self-confidence after cosmetic surgery. Plastic surgery has a more reconstructive nature and is intended to correct dysfunctional areas of the body. Examples are breast reconstruction, burn repair surgery, a congenital defect, extremity defect repair, lower extremity reconstruction, hand surgery and so on. All these types of surgery may impact sexuality, but surgeons rarely discuss them. For example, some patients with upper extremity surgery have experienced a negative impact on their sexual well-being and many of these patients want their physician to discuss these negative impacts with them. In breast cancer patients, sexuality was found to be significantly impaired by surgical interventions to the breast. This relationship between symptoms or consequences of surgery and sexuality also applies to other types of plastic surgery patient groups such as the people undergoing genital reconstructive surgery (incl. transgender individuals) or burn surgery. 

Traditionally, (plastic) surgeons are primarily trained in the technical aspects of their profession. They are educated to deal with the physical problems of a patient, whether functional or cosmetic and their consequences for daily functioning. Addressing problems at another functional level, such as sexual function, requires additional knowledge, but also additional time. Plastic surgeons infrequently discuss sexual functioning with their patients, with genital and gender subspecialists as the exception. They instead assume that sexuality is not an issue within their patient population. 

Other barriers to talking about sexuality are inadequate training, lack of knowledge, insecurity, disbelief in treatment options, fear of causing distress and wrong assumptions like “sex is not related to the condition that I treat”.

In order to facilitate plastic surgeons in their discussion of this topic, it is essential to provide them with good patient information material that addresses the topic, lowers the threshold to discuss the topic, and provides all parties with good referral options. By initiating the discussion, clinicians have the potential to detect sexual dysfunction and to refer adequately when necessary, thereby improving the overall quality of life of their patients. 

REFERENCES

Asimakopoulou, E., Zavrides, H., & Askitis, T. (2020). The correlation of aesthetic plastic surgery with sexual, social, and romantic life in Cyprus. Plastic Surgical Nursing, 40(2), 100-105. 

de Brito, M. J. A., Nahas, F. X., Bussolaro, R. A., Shinmyo, L. M., Barbosa, M. V. J., & Ferreira, L. M. (2012). Effects of abdominoplasty on female sexuality: a pilot study. The journal of sexual medicine, 9(3), 918-926.

Fennell, R., & Grant, B. (2019). Discussing sexuality in health care: A systematic review. Journal of clinical nursing, 28(17-18), 3065-3076. 

Guimarães, P. A. M. P., Resende, V. C. L., Sabino Neto, M., Seito, C. L., de Brito, M. J. A., Abla, L. E. F., & Ferreira, L. M. (2015). Sexuality in aesthetic breast surgery. Aesthetic plastic surgery, 39(6), 993-999.

Krebill, C., Crozier, J., & Kalliainen, L. K. (2022). Patient-Provider Communication on Concerns Related to Sexuality Following Upper Extremity Surgery. HAND, 15589447221107698. 

Turini, T., Weck Roxo, A. C., Serra-Guimarães, F., Abreu, M. L., de Castro, C. C., Aboudib, J. H., & Nahas, F. X. (2018). The impact of labiaplasty on sexuality. Plastic and reconstructive surgery, 141(1), 87-92.