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.
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.
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.
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.
