Our society attributes great importance to appearance and body image. In the recent past, cosmetic vulvar plastic surgery has been widely introduced in the western world. Modification of the cultural environment and increasing vulvar visibility have generated the erroneous identification of an ideally normal appearing vulva. The links between partner's relationship, sexuality, and body image have become more strict, and vulval morphology has become an important player in this complex scenario, especially at certain periods of the women's life, for example after delivery or during menopause, because of the changes and adaptations that the organs and the female genital system undergo normally. Cosmetic vulval surgery is therefore a natural evolution of our cultural environment. However, there are few papers addressing in detail this issue, indications, contraindications, and side effects. Clinicians who receive requests for cosmetic vulvar surgery should discuss with the patients the reasons for that request and perform an evaluation for any clinical signs or symptoms that may indicate the need for a surgical intervention. A patient's concern regarding the appearance of her genitalia may be alleviated by a frank discussion on the wide range of normal genitalia and reassurance that the appearance of external genitalia varies significantly from woman to woman and rarely is associated with functionality. On the contrary, any surgical intervention on the vulva can be the cause of worsening sexual function because of the scarring process, which is unpredictable in this area. Concerns regarding sexual gratification may be addressed by careful evaluation for any sexual dysfunction and an exploration of nonsurgical interventions, including counselling.
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