Cosmetic gynecology continues to grow as more patients seek procedures that address both aesthetic concerns and functional improvements. While clinical interest expands, research in the field is still catching up. Many interventions lack long-term data and rely heavily on small, observational studies. This limits the strength of evidence guiding clinical decisions.
Understanding the current state of research methodologies in cosmetic gynecology is essential for advancing the field responsibly and ethically. This blog provides an overview of how research is conducted, what gaps exist, and where future efforts should focus.
Study Designs Used in Cosmetic Gynecology
Most published studies are retrospective and observational, such as case series and cohort studies. While these can identify patterns and report patient outcomes, they are limited in their ability to prove cause and effect.
Randomized controlled trials (RCTs), which offer the most reliable evidence, are rarely used in this field due to practical and ethical challenges. Systematic reviews and meta-analyses exist, but they are often constrained by the inconsistent quality of primary studies.
A 2011 review found that only two of 72 studies on cosmetic gynecology met Level II evidence standards, revealing a widespread lack of methodological rigor in the field.1
Standardizing Outcomes: COS and COMS
To improve comparability and strengthen study design, researchers are now developing Core Outcome Sets (COS) and Core Outcome Measure Sets (COMS). These tools define what outcomes should always be measured and reported in clinical studies.
A 2021 protocol outlines the development of COS and COMS using international Delphi surveys and stakeholder meetings.2 These sets aim to reflect priorities shared by patients, clinicians, and researchers.
Importance of Patient-Reported Outcomes
Objective measures like anatomical correction don’t always reflect how patients feel about their results. That’s why Patient-Reported Outcomes (PROs) and Patient-Reported Goals (PRGs) are gaining importance.
According to a 2025 review, there’s often a disconnect between surgical success and patient satisfaction. PROs and PRGs help researchers and clinicians measure quality of life, functional improvement, and individual patient goals—factors often more relevant to the patient experience than clinical outcomes alone.3
Ethics in Cosmetic Gynecology Research
Elective procedures involving intimate anatomy raise complex ethical considerations. Patients must give informed consent that goes beyond a single conversation. It should be continuous, realistic, and acknowledge the limitations of current evidence.
A 2020 ethics statement by FIGO emphasized that procedures lacking validated data on safety and efficacy are not ethically appropriate. Selection, reporting, and publication bias are also common in this field due to commercial influence and high patient expectations.4
To explore these issues further, read our article: Professional Ethics Handbook for Cosmetic Gynecology
Key Research Challenges and Opportunities
| Challenge | Description | Ongoing Solutions |
| Low-quality evidence | Most studies are small, short-term, and non-randomized | Conduct more RCTs and prospective observational trials |
| Inconsistent terminology | Use of non-scientific terms like “vaginal rejuvenation” | Adoption of consensus-based terminology |
| Outcome variability | Mixed use of subjective and non-validated tools | Development of COS/COMS with stakeholder input |
| Ethical complexity | Informed consent and bias often inadequately addressed | Stronger frameworks from FIGO and professional societies |
| Lack of long-term follow-up | Few studies track patients beyond several months | Encourage and fund multi-year follow-up studies |
Training and Certification for Evidence-Based Practice
Structured training plays an important role in improving both research and clinical care. ABCG’s multi-level certification programs include components on patient selection, ethical conduct, validated outcomes, and procedural safety.
Practitioners looking to deepen their evidence-based competence can explore:
Conclusion
Cosmetic gynecology continues to evolve, but research in this area is still limited in scope and consistency. Many procedures remain under-evaluated, and the tools used to measure success don’t always reflect what matters most to patients. As the field matures, researchers and clinicians have an opportunity (and a responsibility) to adopt stronger methodologies, prioritize patient-reported outcomes, and apply ethical frameworks that match the complexity of the care being delivered.
With standardized terminology, better study design, and long-term follow-up, cosmetic gynecology can move toward a more credible and patient-centered future.
Get certified with ABCG to advance your training and support the development of evidence-based practice in this field.
References
- Ostrzenski, Adam. “Cosmetic Gynecology in the View of Evidence-based Medicine and ACOG Recommendations: A Review.” Archives of Gynecology and Obstetrics, vol. 284, no. 3, Apr. 2011, pp. 617–30. https://doi.org/10.1007/s00404-011-1896-8.
- Doumouchtsis, Stergios K., et al. “Developing Core Outcome Sets (COS) and Core Outcome Measures Sets (COMS) in Cosmetic Gynecological Interventions: Protocol for a Development and Usability Study.” JMIR Research Protocols, vol. 10, no. 11, Sept. 2021, p. e28032. https://doi.org/10.2196/28032.
- Cichowski, Sara, et al. “International Urogynecology Consultation: Patient Reported Outcome Measures (PROs) Use in the Evaluation of Patients with Pelvic Organ Prolapse.” International Urogynecology Journal, vol. 33, no. 11, 2022, pp. 2603–2631. https://doi.org/10.1007/s00192-022-05315-1. Accessed 25 June 2025.
- “Ethical Concerns in Female Cosmetic Genital Surgery | Figo.” Figo, 16 June 2025, www.figo.org/news/ethical-concerns-female-cosmetic-genital-surgery.
