INTRODUCTION
Social media encompasses websites and applications that enable users to create, share content, or engage in social networking.
In contemporary society, both the internet and social media have seamlessly integrated into the daily lives of patients 1, serving as pivotal channels for communication and information-seeking endeavors related to their medical conditions.
The perception of beauty is subject to variations influenced by cultural norms and social interactions, including exposure to social media platforms 2. This exposure bears significant implications, potentially exacerbating body image dissatisfaction and body dysmorphic disorders 2,3 concerning various anatomical regions, commonly labeled as “snapchat dysmorphia” and “selfie dysmorphia” 4.
A plethora of literature scrutinizes the role of the internet and social media in influencing patients’ decisions to pursue cosmetic female genital cosmetic surgery (FGCS) 5. Consequently, the principal objective of this study is to explore the influence of social media on female patients’ perceptions of their genitalia and their inclination toward undergoing surgery within this domain.
MATERIAL AND METHODS
A Google Form survey comprising 13 questions was distributed via various social media platforms, including Instagram, Facebook, and WhatsApp. Patients were recruited between June 2023 and February 2024, and their involvement was both anonymous and voluntary. Participants were requested to provide responses to multiple inquiries, as detailed in Table I.
Participation was contingent upon the acknowledgment and acceptance of an informed consent, which patients were required to review prior to commencing the survey.
RESULTS
The survey was conducted between June 2023 and February 2024, garnering a total of 1389 responses. A total of 1389 responses were obtained, with 1385 (99.7%) deemed eligible for inclusion in the study, while 4 (0.3%) were excluded due to not meeting the criteria, specifically, they were not female users. The age distribution of survey participants revealed that the most represented age group was 18-24, comprising 57.4% of respondents, followed by the 25-40 age group, constituting 38.1% of participants. These findings align with the demographic distribution commonly observed on social media platforms.
Respondents from all regions of Italy participated in the questionnaire, with a negligible proportion of 5 individuals (0.4%) hailing from abroad.
Of the participants, 39.7% reported having entertained thoughts at some point that their genitalia might exhibit abnormalities or pathology. Notably, only 14.2% attributed these thoughts to observations made by individuals in their close circles (Fig. 1), such as friends, partners, or healthcare professionals, while 31.8% (Fig. 2) stated that their contemplation stemmed from perusing online materials, including photos, videos, informative content, or pornography.
Regarding research behaviors, 51% of respondents indicated that they had not conducted any extensive investigation. Among those who did engage in additional exploration, 36.1% utilized web or social media platforms, 9.9% sought medical consultation, and the remaining 2.1% employed alternative methods.
Moreover, 14.7% of participants acknowledged considering undergoing (FGCS), with 9.6% expressing aesthetic motivations, 1.6% citing functional concerns, and 5% attributing their consideration to the perception of potential abnormalities in their genitalia.
Finally, participants were queried about their perspective on whether web and social media platforms could influence the perception of the normality of female genitalia. An overwhelming 89.1% responded affirmatively (Fig. 3).
Additionally, respondents were asked about the means through which they became aware of the survey. A significant majority, 95.2%, indicated that they accessed the survey through social media channels, predominantly Instagram (95.2%), with a smaller portion utilizing platforms such as Facebook or others.
DISCUSSION
In the digital age, social media has revolutionized communication, information seeking, and decision-making processes for individuals across various spheres. Notably, the healthcare sector has not been immune to this transformation. Social media platforms have significantly impacted the interaction between doctors and patients, as well as influenced the decision-making journey of patients considering surgical interventions 6.
In 2020, Rohrich conducted a survey that queried members of the public about the most influential online method for selecting a surgeon. Social media platforms emerged as the top-ranking choice among respondents 7. The objective of this study is to explore the escalating significance of social media within the medical domain, with a specific focus on how these platforms can impact patients’ self-perception and their decision-making processes concerning FGCS.
The realm of aesthetic surgery for the external genitalia in women encompasses various procedures, including labiaplasty, clitoral hood reduction, major labia fillers, and mons pubis liposuction 8. Over the past few decades, there has been a notable surge in the demand for these types of procedures 9. This trend could be attributed to the heightened accessibility of such procedures, coupled with a shifting perception among patients regarding their own bodies. Women opting for labiaplasty are frequently driven by a desire to enhance the appearance of their external genitalia to align with their notion of “normalcy” 10, with the belief that this alteration could potentially enhance sexual function and bolster self-confidence 11,12.
The present study utilized an online-based survey consisting of 13 questions, which was distributed via social media platforms including Instagram, Facebook, and WhatsApp.
Survey participants were queried about whether they had ever entertained thoughts about their genitalia possibly being abnormal after receiving observations from individuals in their close circles or after exposure to online content. Notably, the data indicate a significantly greater impact from online sources in this regard, with 31.8% attributing their doubts to online content compared to 14.2% from observations made by those close to them. This highlights the profound influence of the internet on the intricate dynamics of self-perception.
Participants cited various types of online materials that contributed to their doubts, including informational resources, explicit content, and before-and-after photos on social media platforms. Furthermore, when conducting supplementary research, the internet emerged as the primary resource, with 36.2% of users utilizing it as their main source of information, surpassing the utilization of medical consultations (9.9%).
An additional noteworthy finding is that 14.6% of respondents acknowledged considering undergoing FGCS. Among these individuals, approximately one-third expressed this consideration due to a belief that their genitals were somehow abnormal or pathological. In the existing literature, numerous studies delve into the impact of social media on prevention, information dissemination, and its role in influencing patients’ decisions to undergo medical procedures. In 2023, Cassalia et al. conducted a web-based inquiry, which underscored the potential utility of social media in preventing behaviors that could escalate the risk of skin cancer 13.
The final question posed to the participants aimed to gauge their perspective on whether social media could influence people’s perception of normality. Remarkably, the respondents unanimously agreed that web and social media platforms wield a significant influence in shaping the concept of normality, with 89.1% providing affirmative responses. The impact of social media on body image is profound, serving to both magnify prevailing societal beauty standards and introduce novel, often unattainable, ideals
CONCLUSIONS
While plastic surgery interventions on female genitalia can significantly enhance the quality of life for patients by addressing functional issues, it’s imperative to acknowledge that these procedures are not devoid of complications 14. Therefore, it becomes crucial for patients not to perceive “normalcy” through the lens of overly standardized models that pathologize anatomical variants. The perception of one’s body is intricately woven from a delicate interplay of personal relationships, societal influences, and the pervasive nature of online content. Recognizing the impact of these factors represents the initial step towards cultivating a positive and realistic self-image in an era dominated by digital influences.
Conflict of interest statement
The authors report no conflict of interest.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contributions
MGO: A
AP: D, W
GM: DT
DR: O (supervised the study)
Abbreviations
A: conceived and designed the analysis
D: collected the data
DT: contributed data or analysis tool
S: performed the analysis
W: wrote the paper
O: other contribution (specify contribution in more detail)
Declaration of AI and AI-assisted technologies in the writing process
During the preparation of this work the authors used ChatGPT in order to improve readability. After using this tool, the authors reviewed and edited the content as needed and takes full responsibility for the content of the publication.
History
Received: August 10, 2024
Accepted: September 10, 2024
Figures and tables
Figure 1. Patients were asked whether they had ever thought that their genitalia might have something pathological after receiving feedback from someone close to them, such as friends, partners, or professionals. Only 14.2% responded affirmatively.
Figure 2. Patients were asked whether they had ever thought that their genitalia might have something pathological perusing online materials, including photos, videos, informative content, or pornography. Notably, 31.8% responded affirmatively. Comparing the results from Figure, it seems that the web has a greater impact than close individuals in the respondents’ self perception.
Figure 3. In response to the question of whether web and social media platforms could influence the perception of the normality of female genitalia, a significant majority answered affirmatively.
| 01 | How old are you? |
| 02 | What gender do you identify as? |
| 03 | What’s your region of residence? |
| 04 | Have you ever thought your genitalia might have something pathological? |
| 05 | Do you had this thought after observations from someone close to you? |
| 06 | Do you had this thought after something you’ve seen on internet/social media? |
| 07 | If so, which kind of material? |
| 08 | If you thought that your genitals might have something pathological, did you do any in-depth research? |
| 09 | Have you ever considered undergoing FGCS? |
| 10 | If so, why? |
| 11 | Do you think that social media could have an impact on people’s perception of “normality”? |
| 12 | Did you find this survey using social media? |
| 13 | If so, which social media? |
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