The risks and rewards of vaginal aesthetic surgery
For years, female patients have sought out aesthetic surgeons to restore a more youthful look to the face and body. Now, add to that popular list the vagina, the labia majora, the labia minora, and the clitoral hood.
Vaginal plastic surgery is experiencing a growth spurt, as many women desire a more youthful look and more confidence about even the most private areas of their bodies. In addition, some are anxious to improve their sex lives in the process.
Historically, obstetricians and gynecologists have made repairs to the vagina and surrounding area due to childbirth-related injuries. Also, urologists, urogynecologists, and plastic and reconstructive surgeons have “gone there” to repair birth defects or perform sex-reassignment surgeries.
In the late 1990s, a few surgeons began offering similar procedures as a means to enhance a woman’s appearance and, in some cases, to improve sexual function. However, only a small but growing number of plastic surgeons continue to devise improved surgical techniques in this genre.
Perhaps the ultimate evidence of the evolving interest in vaginal surgery is this: the American Society of Plastic Surgeons (ASPS) started collecting data on the number of vaginal-rejuvenation procedures performed in 2005, which was 793 and 1,030 in 2006.
Plans are under way to capture this data for 2007 and beyond.
The Porno Connection
Whereas some women undergo labiaplasty and similar operations to improve comfort, many desire to conform to ideals of beauty and attractiveness set by the pornography industry.
The market is definitely driven by women, according to David Matlock, MD, MBA, FACOG. “Our mission is to empower women with knowledge, choices, and alternatives. Women are coming in under their own volition requesting the procedures. This is the only way we will do the procedures. If a man is pushing the woman, we won’t do the surgery. If there is a sexual dysfunction, we won’t do surgery either.”
Physicians may have to consider whether or not a patient’s request is reasonable or merely a symptom of an unhealthy body image. When it comes to female genitalia, the standard of beauty is still evolving, which makes it harder for cosmetic surgeons to determine who is a good candidate.
There is no one embodiment of “normal” that can be applied to every woman. Some surgeons encounter women who are insecure or unhappy with the look of their genitalia. They try to reassure women who are seeking vaginal procedures that they fall within the range of what is considered “normal,” even when they are lingering under the impression that their genitalia are aesthetically not up to par.
“Women want to have the best sex possible, and they want to look good as well. They want alternatives and solutions to these issues,” says David Matlock, MD, MBA, FACOG, founder of the Laser Vaginal Rejuvenation Institute of Los Angeles.
Laser vaginal rejuvenation (for the enhancement of sexual gratification) and designer laser vaginoplasty (for the aesthetic enhancement of the vulvar structures) have become very popular procedures, he adds, noting, “It is probably due to the open access to pornographic content via the Internet, satellite, cable TV, print, etc. Certain fashions may play a minor role as well.”
The whole topic of vaginal shaping is out of the closet, says Edward Jacobson, MD, FACOG, of the Laser Vaginal Rejuvenation Center of Greenwich, Conn. “Many women have desired these procedures for years but were unable to speak with anyone about them—either friends or medical professionals,” he says. “Now they learn vaginal rejuvenation is available, and with all the media attention more women are learning of its availability and are willing to seek out surgery.”
What motivates women to seek out these types of aesthetic surgery procedures?
Many are prompted strictly by the changes they have experienced after childbirth. Others complain about physical discomfort and urinary incontinence stemming from sagging labia, weakened vaginal walls, or an enlarged clitoris.
For some women, the vagina often becomes stretched after childbirth, which can make intercourse less pleasurable and, at times, uncomfortable. In some cases, physicians have largely ignored women who have voiced these complaints.
Kegel exercises are one method—frequently suggested by physicians—to strengthen the pelvic muscles. However, Kegel exercises have not been shown to be effective in repairing a pelvic floor that has collapsed.
In addition, some physicians recommend implanting a pessary, a supporting device that holds the uterus and other organs in place and prevents them from intruding into the vagina.
Some women want a vaginal-shaping procedure because their husbands, boyfriends or partners have voiced dissatisfaction about the way they look.
|Examples of labiaplasty in this article are shown here and below: Surgeons have made repairs to the vagina and surrounding area in order to repair childbirth-related injuries and birth defects, perform sexchange surgeries, and most recently to improve a patient’s self-esteem “down there.”|
A woman who is interested in having surgery for purely medical reasons and/or to improve her own self-confidence is different from someone who hopes to satisfy a man in her life. The latter type of patient can present a greater challenge for the surgeon who may feel uncomfortable delving into her psychological profile.
For many women, their sexuality is linked to the way they feel about themselves and how they look. Even the slightest suggestion that this delicate area is in need of some fine-tuning may trigger symptoms of dysmorphia.
Women will desire these procedures at different stages of their lives. “In the area of vaginal tightening, clearly women who have been altered by childbirth are most interested,” according to Jacobson. “These patients fall loosely into two groups: married women who want to improve their sex life, and recently single women (separated or divorced) who plan to start dating again and want to enjoy a better sexual experience.”
FUNCTIONAL VERSUS AESTHETIC
A woman’s labia comes in all shapes and sizes, with a very wide range of normality. However, even though her anatomy may fall within a so-called normal range, she may not be comfortable or happy with her appearance.
Oversized labia can also create functional problems. “Patients presenting for labiaplasty tend to be younger,” Jacobson says. “[They] are often very concerned about discomfort during exercise, as in spinning, riding, and running. My labiaplasty patients have included an equestrian instructor who could not ride her horse without great discomfort, professional dancers, aerobics instructors, and marathon runners. We also see a desire to wear thongs, leotards, and form-fitting bathing suits. Another group includes women who are unhappy with what they see after a Brazilian wax.”
Two of the most commonly requested surgical procedures are vaginoplasty and labiaplasty, and the category appears to be expanding rapidly. Procedures most often fall under two main categories: the functional and the purely aesthetic.
Functional includes reconstruction status post cancer or trauma, as well as correction of urinary incontinence. Surgeons will point out that procedures undertaken for aesthetic reasons may improve functional aspects and vice versa.
For example, those who request a vulvo-vaginal aesthetic procedure may be suffering from incontinence as well, which can be corrected by tightening and strengthening the base of the bladder. Similarly, during a hymen repair, because the vaginal walls are tightened in the process, women may experience greater sexual satisfaction as an added benefit.
Another aspect of vaginal shaping involves the mons pubis, the hair-bearing area of the pubis. Pubic sagging may be associated with weight gain, massive weight loss, pregnancies, and general aging.
“Whenever I do an abdominoplasty, I evaluate the appearance of the mons pubis to determine whether it needs to be lifted,” explains Z. Paul Lorenc, MD, FACS, an aesthetic surgeon in New York City. “In some patients, fat accumulation in the pubic area can be treated with liposuction alone. When a pubic lift is done in conjunction with an abdominoplasty, the pubis can be lifted through a transverse abdominoplasty incision placed just above the pubic hair. In cases where a pubic lift is done alone, a Caesarean-type approach right above the pubic hair is generally used. In both cases, the scar tends to heal well and patients are pleased with this technique. Many patients describe a heightened sexual experience due to the repositioning of the clitoris.”
Urogynecologists and aesthetic surgeons may be asked to perform a hymenoplasty or hymen repair to reestablish the appearance and sensations of virginity. In most cases, these procedures are performed only at the request of someone who needs the surgery for cultural or religious reasons. A woman can also tear her hymen accidentally by inserting a tampon, or during cycling, horseback riding, or gymnastics. Procedures exist to reduce the amount of hooding around the clitoris or to reposition a protruding clitoris.
Finally, there is an emerging category of in-office, nonsurgical techniques that are becoming increasingly popularized. One such treatment involves fat injections to plump up deflated labia majora.
Another more controversial procedure is touted to enhance the “G-Spot,” the hypersensitive area in the vagina that, when stimulated, can lead to orgasm. Fillers that are commonly applied to facial wrinkles and creases are being used to improve the sensitivity of the G-Spot. Requests for laser hair reduction and skin lightening of darkened areas in the genital region are also reported to be on the rise.
THE RISKS-REWARDS RATIO
There are always risks associated with any surgical procedure, and vaginal rejuvenation is no exception. With labiaplasties and vaginal tightening, patients run the risk of developing infection and scar tissue, which can decrease sensation or cause pain where incisions have been made.
The American College of Obstetrics and Gynecology (ACOG) makes its official position quite clear on this point. As stated in the Committee Opinion #378, “‘Vaginal Rejuvenation’ and Cosmetic Vaginal Procedures,” published in the September 2007 issue of Obstetrics & Gynecology, “ACOG recommends that women considering cosmetic vaginal procedures should be informed about the lack of data supporting the effectiveness of these procedures, as well as their potential complications, including infection, altered sensation, dyspareunia (pain), adhesions, and scarring.”
“We have seen inexperienced surgeons using electrocautery to perform a labiaplasty, resulting in poor healing and infections,” Jacobson claims. “Other potential problems include the incomplete removal of prepuce, with excess remaining tissue adjacent to the clitoris. There have been cases reported of overcorrection of the vaginal canal and a tight entrance resulting in tearing and bleeding, as well as perineal breakdown requiring revision, usually due to an occult hematoma or excessive straining during bowel movements.”
As experienced surgeons start performing these procedures more frequently, and training becomes well established, the incidence of complications will probably decline.
“The biggest recent developments in vaginal procedures are outpatient surgery, twilight anesthesia with regional anesthetic block, and negligible bleeding when the laser is used,” Jacobson claims.
Recovery from vaginoplasty and labiaplasty usually requires 2 to 4 days, with most patients able to return to work within 1 week and resume intimate relations within 6 to 8 weeks.
|See also “Something to Talk About” by Lesley Ranft in the November 2006 issue of PSP.|
“However, suboptimal outcomes can happen in the best of hands, as any experienced surgeon will admit,” Jacobson opines. “Proper selection of patients remains the key, and women should be properly advised of the potential risks.”
When will the seemingly never-ending quest for vaginal perfection max out? What will the future hold for merely “normal” females?
According to Matlock, “One thing is for certain—youth is ‘in.’ Women want to [feel] like 16, 18, or as if they did not have children. They want sex enhanced. Everyone wants the same thing. We get a number of patients stating that they want that Playboy look.”