Abstract
Author(s): Hatem El Sahar*, Yumna Abdellatif Elgazzar, Fatma Khalil Abd Elhameed, Eman Mohamed Hassan, Laila Ahmed AboulNasr
Background: Postmenopausal women commonly experience labia majora atrophy, prolapse, and aesthetic concerns, which may negatively impact genital self-image and quality of life (QoL). Autologous fat grafting has emerged as a potential solution, though limited data exist on its psychosocial outcomes. This study aimed to evaluate the efficacy and safety of labia majora augmentation using autologous fat grafting in improving genital self-image and QoL among postmenopausal women. Patients and methods: This retrospective study included 40 postmenopausal women (mean age: 55.2 ± 7.3 years; BMI: 29.0 ± 3.4 kg/m²) with labial volume loss, wrinkles, or prolapse, treated between January 2021 and January 2022. The women were recruited from gynecology, geriatrics, psychiatry & mental health outpatient clinics in a big private hospital. Exclusion criteria included prior labial procedures or sexual inactivity. Fat harvested from the thighs/abdomen was processed into microfat (20–30 cc injected per side). Outcomes were assessed using the Female Genital Self-Image Scale (FGSIS) and SF-36 survey preoperatively and at 4 months postoperatively. Paired t-tests analyzed changes (SPSS v22; significance: p<0.05). Results: Total FGSIS scores improved significantly (17.56 ± 1.2 vs. 19.62 ± 1.4; p<0.001), driven by marked increases in satisfaction with genital appearance (p<0.001), comfort with partner viewing (p<0.001), and healthcare examinations (p= 0.003). No improvements were observed in perceptions of smell, function, or embarrassment (p > 0.05). SF-36 scores revealed significant gains in role limitations (physical: 20.5 ± 11.0 to 50.5 ± 9.5; emotional: 20.4 ± 13.5 to 54.5 ± 14.4), energy (32.5 ± 14.5 to 52.7 ± 18.4), social functioning (34.6 ± 21.4 to 68.5 ± 28.8), pain (24.8 ± 20.2 to 70.5 ± 25.5), and general health (40.8 ± 17.5 to 62.3 ± 16.4) (p<0.001 for all). Physical functioning remained unchanged (100 ± 0.0 pre/post). One patient (2.5%) experienced minor complications (edema/ecchymosis). Conclusion: Labia majora augmentation with autologous fat grafting significantly enhances genital self-image and QoL in postmenopausal women, with minimal complications. While aesthetic and intimacyrelated concerns improved, functional and olfactory perceptions remained unaffected. The procedure is a safe, effective option for addressing age-related labial changes, though long-term studies are warranted.