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. (To read that article, click here.) 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.
