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Female Genitalia Surgery

Checked: 17-09-2024 by Vicky Ryan Next Review: 16-09-2026

Overview

Female Genitalia Surgery is not routinely available and is subject to the Female Genitalia Surgery Policy - Exceptional Funding Request. Funding will only be given in exceptional circumstances and requires approval by the exceptional funding panel.

This includes, but is not limited to, requests for :

Labiaplasty
Vaginoplasty
Hymenorrhaphy

The ICB will not approve funding for patients below 18 years of age and all requests for funding, where appropriate, will be shared with the designated ICB Safeguarding Lead.

Please note:

Chronically symptomatic Bartholin Cyst is routinely funded.
Vaginal repair following delivery is routinely commissioned.
Vulval surgery for conditions causing significant pain or disfunction directly related to childbirth are routinely commissioned (see criteria in sections below).

Female Genitalia Surgery and FGM

The Female Genitalia Surgery Policy does not apply in cases of FGM where the patient has been to the Rose Clinic who have recommended secondary care referral, as they cannot perform the required procedure. These patients can be referred to gynaecology via eRS without the need for EFR funding.

See the Female Genital Mutilation page for further details.

Surgery following childbirth

Female Genital Surgery following childbirth

Immediate vaginal repair following delivery or revisions post childbirth where there is evidence of pain or discomfort is routinely commissioned as part of obstetric care (UHBW up to 12 weeks post delivery. NBT up to 6 weeks post delivery).

For patients not requiring repair within the above timescales, the gynaecologists advise that it can take time (up to a year) for the area to heal and restore, particularly if the patient is breastfeeding. Oestrogen cream can help this process.

For a few women, excessive, raised or itchy scar tissue forms around the place where a tear happened or where an episiotomy was performed. A small operation can be carried out to remove the scar tissue. This is usually done at least six months after childbirth, when the tissues have healed from the stretching, bruising and tearing. This is commissioned as described in the policy.

If there is ongoing significant pain or dysfunction directly related to childbirth (i.e. symptoms started at, or shortly after childbirth) then patients can be referred without funding. Evidence from the medical records must be provided to support referrals.

Referrals not meeting above criteria

Referrals not meeting these requirements or requests for vulval or vaginal surgery for cosmetic reasons following childbirth will not be accepted. In these cases, there would need to be exceptionality and EFR applied for and approved before submitting a referral.

Referral for women post childbirth

Local clinicians have advised that women who need an opinion on pain or discomfort relating to tears, episiotomies or caesarean section scars following childbirth that meet the referral criteria outlined above, and in the funding policy, can be referred as below to the centre where they delivered or had antenatal care:

St Michaels

For women who have delivered within the previous 6 weeks referral is to the obstetric service via email to: obstetricmedicalsecretaries@uhbw.nhs.uk

For women over 6 weeks since childbirth, referral should be to the Gynaecology Emergency Clinic. Appointments for this Clinic are made through the Gynaecology Registrar on-call via UHBW switchboard.

Southmead

For women who have delivered within the previous 6 weeks referral is to the obstetric service via the on call obstetrics registrar or via email to: Maternityreferrals@nbt.nhs.uk

For women over 6 weeks since childbirth, referral should be to gynaecology via eRS if referral criteria are met.

Emergency Referral

If more immediate review is required the please refer to the emergency gynaecology clinic:

Emergency Gynaecology

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