Vaginal Cosmetic Surgery

joanie (sxc.hu)

The Truth About “Designer Vagina” Cosmetic Surgery—Labiaplasty, Vaginal Tightening and More

Two years ago, I reported on a cosmetic surgery trend, called labiaplasty, in which the labia minora, the inner “lips” surrounding the vaginal opening, are surgically trimmed and shaped. (read that article below) After all, I cover the news—and this was news. But given that it is almost always done for strictly aesthetic reasons, I had hoped that labiaplasty and other so-called “designer vagina” procedures, including vaginal tightening, would prove to be fads that would soon go the way of pet rocks and hula hoops.

They haven’t.

In fact, such surgeries have become increasingly popular—despite the fact that The American College of Obstetricians and Gynecologists (ACOG) issued a strongly worded statement to members noting that female genital cosmetic procedures are not medically indicated and that there is no documentation of their safety and effectiveness. ACOG even admonished, “It is deceptive to give the impression that…such procedures are accepted and routine surgical practices.”

So when a recent study raised some serious concerns about the quality of information on the Web sites of surgeons who perform genital cosmetic procedures, I figured it was time to revisit the topic. Even if you would never have such surgery yourself, you may have a loved one who would consider it…and who should be duly cautioned about the dangers of the procedures and the sneaky marketing tricks used to sell them.

MEDICINE’S “WILD WEST”

Various operations are offered under the umbrella term of female genital cosmetic surgery, including labiaplasty, clitoral hood reduction, vaginal tightening, hymen repair and more. Such procedures do not come cheap, typically running from $2,500 to $8,000, depending on the procedure and surgeon—costs generally not covered by insurance.

So why are women flocking to have their nether regions redesigned? The study authors cited direct-to-consumer Internet marketing as the force behind the growth in demand and noted that there is scant medical scrutiny of this kind of advertising. Even cosmetic surgeons themselves have said that the current marketing environment is like “the old Wild Wild West: wide open and unregulated.”

To see what kind of information consumers typically get online, the study researchers Googled designer vagina (a familiar if erroneous term in popular culture), looking for private physicians who offer genital cosmetic surgery. Then they analyzed the top five Web sites that Google listed in the US plus the top five in the UK.

Results: The quality of information available for women considering such procedures was poor in most cases and downright inaccurate in some. Examples…

The Web sites often used terms that implied the existence of a medical abnormality needing treatment, even when there was no such abnormality. For instance, labial hypertrophy suggests that the labia are abnormally large—yet in the before-and-after photos, all of the “before” shots showed labia that were within the normal range.

All the sites claimed that surgery would have physical, psychological, social and/or sexual benefits (improved hygiene, restored confidence, enhanced sexual pleasure, improved relationships, even better career prospects!)—claims that are unsubstantiated by research.

Much of the information on the sites was “imbued with value judgment,” the researchers noted. For instance, one site said that “you should bleed on your wedding night” and recommended surgical hymen repair (also called revirgination) as a way to “keep your head high.”

There was no mention of less invasive ways of addressing concerns about body dissatisfaction, such as through psychotherapy.

The sites generally downplayed the risks of surgery, which include bleeding, infection, pain, scarring and/or altered sensation…and failed to mention that the long-term risks of the procedures are unknown.

Most sites gave no indication of success rates. Those that did claimed success rates of 95% to 100%—but offered no information on what constituted success or how the statistics were derived.

None of the sites gave a lower age limit for surgery, which the researchers deemed “most disturbing of all,” especially given that anatomy changes throughout a woman’s lifetime.

IF YOU ARE TEMPTED

Clear and detailed guidelines regarding genital cosmetic surgery are urgently needed, the researchers said, so that women can make fully informed choices. But until such guidelines exist, what should you do if you are interested in this type of surgery?

First, understand that there is wide variation in the appearance of normal female genitalia. Your gynecologist can tell you whether your genitals really do fall outside the normal range. It’s also worthwhile to consult a psychologist trained in assessing and treating problems related to body image and sexuality—because surgery is unlikely to fix such problems. As the ACOG statement pointed out, “Patients who are anxious or insecure about their genital appearance or sexual function may be further traumatized by undergoing an unproven surgical procedure with obvious risks.”

If you do decide to have an operation, understand that there are no specific training or licensing requirements for genital cosmetic surgery—so it is best to choose a board-certified plastic surgeon, board-certified gynecologist or board-certified urologist who has years of experience performing the specific procedure you’re interested in. Have an in-depth discussion with any surgeon you’re considering about his/her before-and-after photo gallery to satisfy yourself that the pictures are of procedures that this doctor actually performed…then ask for references from satisfied patients. With the doctor, discuss realistic expectations for results and review any possible risks and complications. If you perceive a patronizing or dismissive attitude (“Don’t you worry, sweetie, everything will be fine”), go elsewhere.

Source: Study titled, “An analysis of the content and clinical implications of online advertisements for female genital cosmetic surgery,” published in BMJ Open.

Original publication date:  September 26, 2011

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Labiaplasty: Cosmetic Surgery for Down There

Appeared originally as “Cosmetic Surgery… Down There”

It’s hard to believe that only four decades ago, when the book Our Bodies, Ourselves was first published, many women were discomfited by the authors’ suggestion to grab a hand mirror and become more intimately acquainted with their own private parts… yet, here I am today bringing you information about the growing number of women seeking cosmetic surgery to beautify those very same parts! We’ve come a long way, baby—or have we?

Surprisingly, there are various types of plastic surgery that women can have in their nether regions. Sometimes there are medical reasons (such as incontinence or injury from childbirth), and we’ll cover those procedures another day. But now I want to focus on a procedure that is primarily cosmetic—labiaplasty, in which the labia minora (the inner “lips” surrounding the vaginal opening) are surgically altered. Typically, it is done because a woman believes her labia are unusually large, asymmetrical or otherwise different than she desires.

WHAT’S UP WITH THAT?

You might wonder why so many women are even thinking about the appearance of their labia. Contributing factors: The sexual revolution changed how women think about their own bodies and increased the number of people likely to see them. Plus, it’s now common for young women (and older women who want to be hip) to shave or wax their pubic hair, leaving the labia more visible to themselves and their lovers.

I placed a call to Houston-based gynecologic surgeon Susan Hardwick-Smith, MD, who has done hundreds of these procedures and who confirmed that requests for this surgery have escalated. She told me that some women seek labiaplasty to relieve physical discomfort—for instance, if the labia get pushed into the vagina during intercourse or make it uncomfortable to ride a bike or wear snug pants. But in most cases, the surgery is purely cosmetic. Therefore, she said, it is essential that a woman first carefully review the before-and-after photographs that she and others who offer this surgery post online. At that point, Dr. Hardwick-Smith said, some women end up deciding that their labia are perfectly normal and fine just as they are.

In researching this article, I looked at many such photos. Some of the “before” images showed what seemed to me to be a range of normal labia… then surgery made them look sort of like Barbie dolls. But there definitely were cases in which, had the oversized labia been mine, I might have considered surgery, too.

WHAT THE PROCEDURE INVOLVES

Labiaplasty takes about 90 minutes and is done using a laser, scalpel or electric cautery. “I perform these surgeries in a licensed outpatient surgery center with board-certified anesthesiologists. If the surgery is offered at a clinic, the patient will want to make sure that the equivalent level of anesthesia is available,” said Dr. Hardwick-Smith. “Some doctors use local anesthesia, which does not require an anesthesiologist—but that is not my preference because it is impossible to make the patient totally comfortable.”

Most patients go home a few hours afterward with a several-day supply of narcotic pain medication and advice to make liberal use of an ice pack. While the procedure carries the usual risks associated with any surgery (bleeding, infection, wound separation), few patients experience problems. “Women’s bodies are designed to heal quickly from childbirth,” Dr. Hardwick-Smith said, noting that there are no major blood vessels in the labia and the tissue isn’t prone to infection. She advises patients to take a week off from work to recover and to abstain from intercourse and strenuous athletics for six weeks. Labiaplasty costs about $3,000 to $5,000 or more and typically is not covered by health insurance when done for cosmetic purposes.

WHY WOMEN DO IT

Dr. Hardwick-Smith has patients fill out a brief questionnaire designed to screen out women with certain psychological issues, such as body dysmorphic disorder (excessive preoccupation with minor or imaginary physical flaws). She also told me that she would never perform the surgery on a woman seeking it at the behest of her partner. Beyond that, she said, she doesn’t consider labiaplasty much different from breast augmentation.

I asked Dr. Hardwick-Smith whether she required patients to see a counselor or therapist prior to having the surgery. At that she bristled a bit, saying that she does not think a therapist is necessary since she considers labiaplasty to be a reasonable and valid choice for a woman who is self-conscious about and unhappy with the appearance of her labia. “The women I see are well educated and informed about what they are doing,” she said. “They’re seeing me because they don’t feel good about the way they look—and there is no question that this has an impact on women’s self-esteem and sexuality.”

Women considering labiaplasty should choose a highly experienced surgeon, Dr. Hardwick-Smith recommended—but she estimated that there are only about 10 to 20 such doctors around the country. Best: Have an extensive discussion with a surgeon about his or her photo gallery to satisfy yourself that the pictures are of procedures that this doctor actually performed. Look for testimonials and ask for references from satisfied patients. Other good signs include membership in the American Academy of Cosmetic Gynecologists (aaocg.org) and involvement in research and education on this topic.

Finally, I asked Dr. Hardwick-Smith if there was anything else she wanted to say to women considering labiaplasty. She said, “It is extremely important for women to understand that there is nothing wrong with the way we are and there is no such thing as ‘normal.’ I support women who want to do this, but honestly, I kind of wish they could just be happy with their bodies the way they are.”

I couldn’t have said it better myself.

Source: Susan Hardwick-Smith, MD, is a board-certified obstetrician and gynecologist in private practice at the Complete Women’s Care Center in Houston, where she focuses on cosmetic gynecology. She also is a clinical instructor at the University of Texas Medical School, an associate of the Laser Vaginal Rejuvenation Institute of America and winner of numerous professional awards. http://www.CompleteWomensCareCenter.com

Original publication date:  September 4, 2011

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