"Vaginal rejuvenation": comparative effectiveness studies are needed

We thank Dr. Dietz for his interest (1) in our commentary (2) on female genital cosmetic surgery (FGCS). He maintains that we have mixed up two distinct phenomena: introital cosmetic surgery and "vaginal rejuvenation" procedures. We agree with Dr. Dietz that the reasons for seeking these two types of surgical interventions might substantially differ: the former ones have more evident aesthetic goals and may represent the epiphenomenon of a mental disorder, such as body dysmorphic disorder, whereas "vaginal rejuvenation" procedures are used to treat vaginal laxity and have a functional (rather than aesthetic) objective, that is, sexual pleasure enhancement. However, both surgical procedure types have been defined as FGCS by the Royal College of Obstetricians and Gynecologists (3), and are not medically indicated.