Labiaplasty and Vaginoplasty

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Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.


October 10 2007

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Cosmetic Labiaplasty and Vaginoplasty: Medicine or Marketing?

Cosmetic surgery has a long history of improving the aesthetics of the face, the bust, and the body. Often, women choose to have cosmetic surgery to fit what some segments of society say is the standard of beauty: thinner, younger, blonder, bustier, or whatever. And other portions of society say that we are letting vanity get the better of us and just who decided that "thinner, younger or blonder." was prettier in the first place?

The latest trend in cosmetic surgery—called variously cosmetic labiaplasty, cosmetic vaginoplasty, and cosmetic vaginal surgery —has generated a lot of controversy. Women are now having their vaginas and labia trimmed and tweaked to make them look "nicer." But isn't this a beautification that is unnecessary, or at least one that has never been necessary before? And how safe is it?

ACOG Position On Cosmetic Vaginal Surgery

The American College of Obstetricians and Gynecologists (ACOG) has come out strongly against cosmetic vaginal surgery and vaginal "rejuvenation." Such procedures as "designer vaginoplasty," "G spot amplification," and "revirginification" are being advertised on the internet. Laser procedures to trim the labia (the inner and outer folds at the entrance of the vagina) and tighten the vagina have been trademarked. Some gynecologists are injecting fillers into the area of the vagina called the G spot to enlarge it and make it more sensitive.

As with other forms of plastic surgery, ACOG's Committee on Gynecologic Practice draws a distinction between procedures that are medically necessary and those that are not, which would include cosmetic vaginal surgery. "Medically indicated surgical procedures may include reversal or repair of female genital cutting and treatment for labial hypertrophy or asymmetrical labial growth…." The committee stated that other procedures are not medically necessary and have not been proven safe or effective. In a statement, the committee also noted ethical issues associated with the marketing and franchising of these procedures, since franchising may prevent the dissemination of scientific knowledge about them.

Different Doctors - Different Opinions

Thomas Nolan, MD, FACOG, agrees with ACOG's committee. (FACOG means Fellow of the American College of Obstetricians and Gynecologists.) Dr. Nolan is chairman of the Department of Obstetrics and Gynecology at Louisiana State University Health Sciences Center in New Orleans and president-elect of the Society of Gynecologic Surgeons (SGS). "Most gynecologists think this is a giant scam," he said. "The bottom line is that there is no science behind this." This is his own opinion, he noted, since the SGS has not taken a position on cosmetic vaginal or labial surgery. However, he stated that the society's position would probably mirror his own.

Kevin Jovanovic, MD, FACOG, disagrees. Dr. Jovanovic is in private practice in New York City. He offers vaginal rejuvenation and labiaplasty using lasers as part of the obstetrics and gynecology practice that he shares with his father, Radoslav Jovanovic, MD. He had patients come to him asking for labiaplasty and vaginoplasty, he said. "My patients were coming in and asking for choices."

Some women complained that their labia were uneven or had stretched out, he explained. Or they said that they had hated the way their labia had looked all their lives and felt that their labia showed while wearing a bathing suit or interfered with intercourse.

"This was something bothering my patients to the point where they had the surgery elsewhere" Dr. Jovanovic said. "Because I did not respond, they found someone who did."

Other women came to him asking for a procedure to tighten an otherwise healthy vagina that had loosened due to childbirth. "It is a quality of life issue. They no longer feel intercourse they way they did before they had kids," he said. Pelvic strengthening exercises such as Kegel exercises can help, but do not do anything for the majority of patients, he added.

Dr. Jovanovic decided to train in laser labiaplasty and laser vaginoplasty and started offering the procedures in his practice. "I am not saying that ACOG is not right. I am a member, too," he noted. "This is an option for my patients who want it."

He added that he stresses to the patient the risks of any vaginal or labial surgery which can include excessive bleeding, scarring, and loss of sensation. There may be medical reasons why a patient should not have the surgery and psychological ones, he noted. "The best example is someone who comes in and their significant other is asking them to have the procedure done," he said. He refuses to perform vaginal surgery in such a case and strongly urges the woman to reconsider the idea. No one should have any cosmetic surgery unless they want it themselves, he noted.

But the problem is that the large bulk of these procedures are unnecessary, said Dr. Nolan. "People have the perception that somehow they need to have their labia or reproductive tract fixed." He noted that having labia so large that they interfered with intercourse or urination was extremely rare.

One possible factor in the rising request for labiaplasty is that women are watching pornographic movies and are comparing their labia to those they see on screen. But there is a variety in the shape of women's genitals that occurs normally. Trying to make them look "pretty" depends on who decided what is pretty. Another theory is that the popularity of shaving off the pubic hair is driving the increase. "That can make the labia more prominent and not hidden," Dr. Nolan noted.

But the biggest driving force behind cosmetic vaginal surgery is marketing, Dr. Nolan said. "This particular surgery has pretty much been done by a group of individuals who have done a lot of advertising and media events to try to enhance what they are doing," he said. "I have an MBA and I know this is basically marketing."

"Our society has tried to elevate gynecologic surgery as well as connect gynecologic procedures to a level where they are scientifically reliable," he added. Gynecologic surgery should be validated by research before it is performed widely, he explained.