Wednesday, June 16, 2010

Should Female Cosmetic Genital Surgery Be Done?

I seem to be asked more often these days if I do vulva reduction surgery. I’ve even been asked if I “refresh” vaginas (refer them to their gynecologist). I am happy it is a extremely small part of my practice.

I’m actually happy to see that the current issue of the journal Reproductive Health Matters are taking a close look at cosmetic surgery, especially female cosmetic genital surgery.

Marge Berer (full reference below) says the following in her editorial:

The papers and Round Up summaries in this journal issue and their sources use the following terms for a mind-boggling list of procedures: labia reduction, labiaplasty (also called nynfoplastia in Brazil), genitoplasty, pulling the labia to make them longer, filling or replenishing of the labia majora, female genital reshaping, intimate surgery (translated from the Brazilian cirurgia intima), vaginal narrowing or tightening (e.g. after vaginal delivery or for increased pleasure for men), vaginal rejuvenation, hymen reconstruction, hymen repair (for restoration of virginity), clitoral lift, clitoral hood reduction, clitoral repositioning, breast reduction, breast augmentation, breast lifting, liposuction, and abdominoplasty (tummy tuck). And how about G-spot augmentation?

Then there is the terminology surrounding female genital mutilation – or cutting or circumcision or excision – and the reconstructive surgery that has developed to address the physiological problems it creates. This includes, according to Elena Jirovsky’s research in Burkina Faso, surgery to the vaginal opening if it has become too small due to adhesions, or the removal of perturbing scar tissue and keloids. More recently, she reports, a surgical procedure to reconstruct the excised clitoris has emerged, developed by a French surgeon. ……..

Too big, too small, too narrow, too wide, too high, too low, too flabby, too wrinkled. The permutations are endless. What a great way of making money!

In his 2008 article in the Journal of Plastic and Reconstructive Surgery, Dr Gary Alter, who is also featured on the E! Network series, "Dr. 90210," stated:

The most common female genital aesthetic procedure is a labia minora reduction (labioplasty).

Women have become more aware of differences in genital appearance as a result of explicit photographs and movies and the wide acceptance of genital hair removal. Most consider an aesthetic ideal as labia minora and clitoral hood that do not protrude past the labia majora, but individual aesthetic judgment varies.

If a woman considers her labia enlarged or deformed, she may have diminished self-esteem and be sexually inhibited. In addition, the vast majority of women with enlargement of the labia minora also complain of a variable amount of discomfort with clothes, exercise, and/or sexual activity. The large size can interfere with hygiene and can cause constant irritation. Demand for labia minora reduction has increased because of recent media coverage of this operation.

Are we plastic surgeons driving this or are the women? Is the media coverage? Is this truly a physical issue or do these women perhaps need to be seen and evaluated by a therapist first?

I don’t have the answers to my own questions, but I do feel strongly that we surgeons need to remember “First, do no harm.” Are the benefits of the surgery enough to outweigh any potential complications?

I do not think these are procedures we should be promoting or advertising.

REFERENCES

Cosmetic Surgery, Body Image and Sexuality; Reproductive Health Matters, Volume 18, Issue 35, Pages 4-10 (May 2010); Marge Berer

A poor prognosis for autonomy: self-regulated cosmetic surgery in the United Kingdom; Reproductive Health Matters, Volume 18, Issue 35, Pages 47-55 (May 2010); Melanie Latham

Activism on the medicalization of sex and female genital cosmetic surgery by the New View Campaign in the United States; Reproductive Health Matters, Volume 18, Issue 35, Pages 56-63 (May 2010); Leonore Tiefer

Aesthetic Labia Minora and Clitoral Hood Reduction Using Extended Central Wedge Resection; Alter, Gary J.; Plastic and Reconstructive Surgery. 122(6):1780-1789, December 2008; doi: 10.1097/PRS.0b013e31818a9b25

3 comments:

ER's Mom said...

I have done 1 labioplasty - a repair of a childbirth injury (hole in minora after it was poor primary repair by her previous provider). The hole aimed her urine stream sideways onto her pants.

I can remember an older attending repair epis with what he called "the husband stitch." As a woman, I find it offensive to think that it was necessary. And he wondered why the female residents loathed him.

I personally hate the idea for most women. I honestly think that they wouldn't consider it if it weren't for society's pressure on looking "perfect." I doubt that the very real risk of dysparunia is discussed in the pre-op visits.

Lauri Romanzi, MD said...

Hi Dr Bates,
I love this posting! As a reconstructive pelvic surgeon and urogynecologist in NYC, I find the term "vaginal rejuvenation" to be a lightning rod of concern and confusion. So much so, I had to blog it out in response. Here's one urogynecologist's Vaginal Rejuvenation Perspective for 2010:

http://www.urogynics.org/blog/2010/06/vaginal-rejuvenation-defined/

Best Regards,
Lauri Romanzi, MD

rlbates said...

Thank you Dr Romanzi.