She wanted her confidence back. The surgery left her numb — and the court awarded her just W3m.

She wanted to reclaim her confidence as a woman. What was once seen as purely cosmetic or sexual in nature has more recently been framed as a medically legitimate option — a way to address physical decline caused by childbirth or aging. After long deliberation, she went ahead with the surgery. The person she had been before was gone.

On March 27, 2019, a woman identified as B underwent vaginoplasty, labiaplasty and clitoroplasty at Hospital A, a facility under a medical foundation in Gimhae. Colloquially known as "pretty surgery," the procedure is commonly performed at obstetrics and gynecology or female urology clinics.

The surgery is generally understood to improve sexual function and satisfaction, but it is also performed to prevent gynecological conditions, alleviate urinary incontinence and guard against pelvic organ prolapse. For B, there seemed to be no reason to hesitate — and that is why she made the difficult decision to proceed.

Her daily life changed after the operation. Struggling with pain at the surgical site and reduced sexual sensation, B made another difficult decision: between July and August 2021, unable to bear the side effects any longer, she underwent corrective surgery.

But there was no going back. Even after the corrective procedure, the diminished sensation and other symptoms persisted — and gradually began to erode her mental health as well. The reduced sensation, and the fear, deprivation and self-reproach it brought, compounded into profound psychological suffering.

She could not stay silent. B came to suspect that the labia minora had been excessively excised during both the original and corrective surgeries, and that suture removal had not been carried out in a timely manner. She concluded that Hospital A's negligence had caused the side effects she was experiencing: pain at the surgical site, scarring, labial asymmetry and reduced sexual sensation.

Moreover, B said she had never been asked to consent specifically to the clitoroplasty, nor had she been given any explanation of the corrective surgery method. She had not been informed of potential complications or other side effects from the procedures, either.

Feeling wronged, B filed a claim against Hospital A for a total of 131.5 million won — comprising 80 million won ($53,200) in consolation damages, 45 million won in lost income, 5 million won in future medical expenses and 1.5 million won in past medical expenses.

The Changwon District Court's ruling, handed down by Judge Jang Jae-yong, fell far short of what B had sought. The court's reasoning rested on a Supreme Court precedent holding that the burden of proving negligence and causation in a medical act lies with the patient, not the hospital.

The court also declined to accept B's argument that Hospital A had been negligent during the surgeries, finding she had failed to present objective evidence to support that claim. It also rejected her assertion that the duty to explain had not been properly fulfilled at the time of either the original or corrective surgery.

The only point the court accepted — and only in a limited sense — was that no specific explanation of potential complications had been given at the time of the original surgery. That is why the damages award came to just 3 million won.

On the duty to explain, the court acknowledged the obligation. It held that a physician's duty to inform cannot be waived simply because the risk of aftereffects or side effects from a medical procedure is rare.

The court cited a Supreme Court precedent from May 31, 2007, which held that when aftereffects or side effects represent a risk typically associated with a treatment, or when they are serious and irreversible, they must be disclosed to the patient regardless of how rarely they occur.

However, the court rejected B's claim that the clitoroplasty had been performed without any explanation of the surgical method.

The court noted that the surgical consent form B signed before the original procedure listed only "vaginoplasty and labia minora" as the procedure names. It added, however, that "the clitoral area was marked multiple times in the description of the surgical content, which suggests that Hospital A would have explained that the clitoral area would also be operated on."

The court also said that "at the time of the corrective surgery, it can be confirmed that the surgical site was marked multiple times to explain the method, and that complications related to the labia minora surgery were explained with underlining."

Nonetheless, the court partially accepted B's position, finding that the hospital had violated her right to self-determination by failing to provide specific information about complications at the time of the original surgery.

The court said "there was no specific written explanation regarding complications at the time of the original surgery, and while reduced sexual sensation is a subjective symptom, it is one that can be anticipated in a patient following surgery," adding that "this is a factor that could weigh on a patient's decision to proceed with the operation, and there is no evidence that Hospital A provided a sufficient explanation."

The court set consolation damages at 3 million won, taking into account B's age, the degree to which Hospital A had violated its duty to explain during the decision-making and surgical process, and the symptoms B experienced as side effects and aftereffects of the surgery.

Cho Jin-seok, an attorney at law firm O'Kims, said the ruling reaffirmed the principle that the burden of proving a breach of the duty of care in a medical act — and of establishing causation — rests, as a rule, with the patient.

Cho also expressed regret that B's damages award might have been higher had she more actively argued, beyond the mere absence of explanation, that her right to self-determination had been violated.

According to Cho, physicians are obligated to explain to patients, before performing surgery or other procedures, the nature of the illness, the content and necessity of the proposed treatment, and the risks that can reasonably be anticipated. The purpose is to allow the patient to weigh the necessity and risks of the procedure and decide whether to consent.

If a physician proceeds with surgery or another procedure in violation of the duty to explain and the patient suffers a serious outcome such as death, the patient's right to self-determination has been infringed. In such cases, it is sufficient to prove only that the lack of explanation deprived the patient of the opportunity to choose.

In cases like B's, however, where damages are sought for a serious outcome, there must be a substantial causal link between that outcome and either the physician's failure to explain or the physician's fault in the consent process. Cho said the breach of the duty to explain must, in particular, rise to a level equivalent to a breach of the duty of care required in treating a patient's life and body.

"The court made clear that even if the surgical method was explained, a failure to provide sufficient information about complications — including subjective symptoms such as reduced sexual sensation that may arise after surgery — constitutes a breach of the duty to explain," Cho said.

He added that "even though reduced sexual sensation is a subjective symptom, it can be an important factor in a patient's decision whether to undergo surgery, and the court determined that a sufficient explanation is required to protect the patient's right to self-determination."

"The consolation damages the court recognized — 3 million won — can be seen as a low figure," Cho said. "B should have gone beyond simply proving the absence of an explanation and specifically argued and demonstrated the causal link between the violation of her right to self-determination and the harm she suffered — namely, that she would not have undergone the surgery had she been given sufficient information."