Surgery down where? Cosmetic surgery on women’s vaginas and vulvas

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In recent years, cosmetic surgery on women’s genitals has been increasingly marketed and made available by doctors around the world. These include a vaginal tightening procedure and labiaplasty (a procedure used to reduce the size of the labia minora/inner vaginal lips). A difficult thing about these procedures is that there are very little published data about them. If you want cosmetic surgery on your nose, breasts, stomach or thighs you can information about safety and effectiveness. Not so much with the female genital cosmetic surgeries which has prompted critical pieces in SELF magazine, The New York Times (in 2004 and 2007), and the San Francisco Chronicle, among others. This September, the American College of OB/GYN (ACOG) took the unusual step of issuing a press release advising against cosmetic vaginal procedures. My stance on these procedures - as you can read in the latest article from SELF (reprinted in full after the jump) or the Chronicle piece is that we simply do not know. These procedures might enhance the lives of women who choose to have them or they might be damaging or perhaps they provide no real benefit at all. The only way to learn what happens to women who have these surgeries is to objectively observe these women over time – research that I hope to one day be a part of so that women can make decisions about their health and sexuality that are informed by science rather than speculation. Thanks to Jennifer Wolf of SELF and Justin Berton from the SF Chronicle, both of whom were great to work with during the development of their articles. Image via this site. Here is the original article text from SELF magazine:

Surgery where?

Hoping to pump up their sex life, women are having cosmetic surgery on their most private parts. But not all of these procedures end well. SELF investigates a disturbing beauty trend.

By Jennifer Wolff

From the October 2007 issue David L. Matlock, M.D., stands poised before Rosemary Staltare’s vagina, preparing to inject her G-spot with a dense dollop of collagen that will plump it to the size of a small stack of quarters. Through an opening in a plastic speculum of his own design, the gynecologist navigates a needle into Staltare’s frontal vaginal wall, pumping it up with his “secret” variation of the substance that for years has been used to swell women’s lips. Dr. Matlock, known for his appearances on the E! channel show Dr. 90210, insists that enlarging a woman’s G-spot renders it more accessible and sensitive to the touch for a period of up to four months. Staltare, a 33-year-old restaurant publicist who has had the $1,850 procedure twice before for free—and is getting it gratis again today in exchange for letting me watch—couldn’t agree more. “It’s like having a mini-heartbeat in my crotch,” she explains, a sensation that arouses her even during yoga and Spinning classes, or when she drives along bumpy roads. During sex, Staltare says, she has volcanic, multiple orgasms “like huge waves that keep lifting me higher and higher.” Can medical tinkering with your vagina really improve your sex life? That’s the promise plastic surgeons and gynecologists are now aggressively marketing. Dr. Matlock, who practices out of his posh Laser Vaginal Rejuvenation Institute of Los Angeles on Sunset Boulevard, has developed his own handheld laser and has licensed his institute’s name and techniques to some 170 doctors worldwide, about 60 of them in the United States. All of these gynecologists, urologists or plastic surgeons have paid Dr. Matlock $54,500 for a three-day course that includes training not only in the G-Shot but in other so-called sexual-enhancement procedures, including vaginal tightening, labia reshaping, liposuction of the mons pubis and reduction of the skin around the clitoris in pursuit of what anyone’s guess is the vision of perfection. “Women want to have the best sexual experiences possible,” Dr. Matlock says. “They want to look pretty in that area and not old and haggard just because they’ve had kids. If they look good, they feel good, and if they feel good, sex is better.” Unfortunately, there has been little scientific evidence published to substantiate these claims. In the case of the G-Shot, medical science has yet to confirm that the G-spot has any sexual powers in the first place. What is known is that a blob of tissue that may or may not have nerve endings running through to the clitoris may or may not be situated somewhere between the pelvic bone and the cervix along the frontal vaginal wall. Suggest any doubts to Dr. Matlock and he’ll look at you as a 5-year-old might had you just swiped his favorite toy. “Does God exist?” he asks, his voice tightening, his round brown eyes growing rounder. “Some people say no, but I know otherwise. The G-spot is absolutely real.” The G-Shot is just for fun. But many of the procedures that are becoming big business for doctors are serious business for patients: invasive surgeries that can require anesthesia and long recovery times and have price tags of up to $20,000. (Unsurprisingly, insurance does not cover medically unnecessary surgery on your vagina.) The number of vaginal-rejuvenation surgeries went up 30 percent between 2005 and 2006, the first two years that the American Society of Plastic Surgeons in Arlington Heights, Illinois, surveyed its members about the procedures. But not all customers are satisfied. In a malpractice complaint against Dr. Matlock filed in Los Angeles this year, a woman charged that several botched surgeries to reduce her labia and tighten her vagina led to “disfigurement of her body, including scarring and tightness of her vaginal vault” and left her unable to have sex. That is one of at least 11 malpractice suits lodged against Dr. Matlock. (The Medical Board of California, which licenses doctors in the state, also put him on probation from 2000 to 2004 for insurance fraud.) The doctor has denied responsibility in the current case and declined to comment on it or any other lawsuit. “Ethically, I’m concerned about this truly becoming a trend, because as doctors we [should be] focused on doing what is best for the patient,” says Erin Tracy, M.D., assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School in Boston. Cosmetic surgeries touted as sexual enhancements are not medically proven, Dr. Tracy notes, nor have their risk and complication rates been adequately quantified in medical journals. A 2004 study published in BJOG: An International Journal of Obstetrics and Gynecology suggested that rather than enhancing sex, genital surgery may sometimes impair sensation by disrupting nerves and blood vessels. “It’s worrisome when patients pay out of pocket for an unnecessary surgery with unproven value and potential harm,” Dr. Tracy says. “Just because we can do these procedures doesn’t mean we should do them.” “I can’t believe I let someone do this to me,” a 21-year-old college student named Beth tells me, digging into an egg-white omelet in a New York City diner. A pretty, petite woman from Long Island, New York (who asked SELF not to publish her full name), Beth is dressed in jeans and a T-shirt, her brunette hair in a messy ponytail. “I’ve never wanted my boobs done or any kind of plastic surgery,” she says. “But my labia made me very uncomfortable.” The self-consciousness began about two years ago, when she started having sex. She had previously noticed that her labia minora (the inner folds of the vagina) were longer than those of other girls. But lying naked with a man embarrassed her to the point where she would turn off all the lights and cover herself with blankets. Last summer, she asked the man she was dating what he thought. “Well, I’ve been with women whose labia are smaller,” she recalls him responding. Then he referred Beth to a magazine where he had seen advertisements for labiaplasty. Beth spoke with her regular gynecologist. “You’re obsessing. Don’t do it,” he told her, warning her that the procedure could be dangerous. Undeterred, Beth consulted with a gynecologist she had found through the advertisement. “She told me that my labia weren’t that long but that she could fix them, no big deal, and it would take 15 minutes and cost $5,000,” she says. Not telling anyone—her parents, her friends or even her boyfriend—Beth dipped into her student-loan money and returned to the doctor five days later. The procedure took 15 minutes, as promised, but left her in pain for much longer. Not only was she in agony afterward, “but I bled for days and was incredibly swollen. I couldn’t walk, and I could only sit cross-legged,” she remembers, adding that she was bleeding so much she had to change her sanitary pad every hour. The suffering might have been worthwhile had Beth liked the results. But she was horrified. “My right lip was completely gone, and my left lip was just hanging there, cut off at an angle,” she says. As she healed during the next month, her surgical scars became “rigid, bumpy and rough; they were painful and uncomfortable.” She told her boyfriend that she had a cyst and couldn’t have sex, and the two of them have since split up. “She was completely deformed,” confirms Gary Alter, M.D., the plastic surgeon in New York City whom Beth consulted to repair the damage. “Often a physician’s concept of doing a labia operation is to cut them off. As these surgeries are growing more popular, I’m seeing more disastrous results from cavalier doctors who aren’t paying attention to detail and symmetry.” And if someone is already self-conscious about her genitals, a botched surgery can make the problem much worse. “It can be very traumatic both physically and psychologically,” Dr. Alter says. “It can really screw up someone’s head.” Today, Beth is happy with her labia. Dr. Alter did his repairs by bringing together the upper and lower labia and sculpting them, a procedure Beth says was bloodless and pain-free. “They’re not perfect, but they’re also not mutilated,” she says. Now her biggest concern is how she’s going to recoup the money she spent—not only the $5,000 for the initial surgery but also another $8,700 for Dr. Alter’s reconstruction. “I don’t know why it mattered to me what my labia looked like; I mean, it’s not like they were a huge problem in my life,” she says, anger and remorse filling her light brown eyes. “If I didn’t learn that this kind of surgery was available, I never would have had it done, and I would have been fine. The surgery was totally unnecessary—and a really stupid thing to do.” What on earth is driving this trend? Vaginal surgery has long been performed on women to treat urinary stress incontinence or pelvic prolapse, when weakened muscles cause the uterus or other nearby organs to fall through the pelvic floor into, and sometimes out of, the vagina. (Both conditions can affect women after they bear children.) And gynecologists may recommend surgery if labia minora extend beyond two inches in length and cause discomfort during sex or exercise. But the procedures that today are growing more common have less to do with function than with form—how a woman’s genitalia look and feel as opposed to the way they work. In an unscientific poll of about 275 women at Self.com, more than 1 in 10 respondents said they’d consider surgery that made their private parts look and feel sexier. (On the other hand, 53 percent declared the idea “gross.”) “The cosmetic trend concerns me,” says Elizabeth G. Stewart, M.D., assistant professor of ob/gyn at Harvard Medical School and coauthor of The V Book: A Doctor’s Guide to Complete Vulvovaginal Health (Bantam). “There are bad reasons to do labial surgeries, and attempting to be pretty and homogenous is one of them,” she says. The BJOG study attributed the attention toward all things vagina to the everyday, online availability of pornography that portrays “idealized, highly selective images” of female genitalia. And with Brazilian waxing and laser hair removal more routine, women simply see more of themselves—and one another—than they did before. The problem with searching for the perfect genitals is that there is no such thing, says Virginia Braun, Ph.D., senior lecturer in psychology at the University of Auckland in New Zealand and one of the world’s few experts in the sociocultural aspects of women’s genitalia. Like faces, no two vaginas are exactly the same. Women seeking to model their private parts, particularly their labia, after pornographic images are fixating on “one end of a very wide spectrum of genital anatomy, one that might have been altered by surgery or airbrushing,” Braun says. “Some women do naturally look like that, but the majority don’t.” Dr. Alter—who, like Dr. Matlock, appears on Dr. 90210—argues that many women have long been uncomfortable with their labia, but until now didn’t know they could change them. “I’ve treated patients between the ages of 14 and 60 who cross every socioeconomic boundary, and all of them have been very self-conscious about how they look down there and won’t wear a bathing suit at the beach or shower in a communal setting,” he says. “Patients constantly tell me they don’t mention these issues to their regular gynecologists because they fear feeling trivialized and embarrassed. I get women who are so self-conscious, they wouldn’t have oral sex, and now they feel normal and not like a freak of nature.” Dr. Alter says he performs more than twice as many labiaplasties today as he did five years ago. “Doing these procedures on a hit TV show makes people aware that they are available to them,” he adds. “It’s become more acceptable.” It has also become highly profitable. At a time when professional liability premiums are soaring and insurance reimbursements are dipping, aesthetic genital enhancements are a lucrative business indeed. Dr. Matlock charges between $3,500 and $9,000 for each laser vaginal surgery; a combination of procedures can cost as much as $18,000. Or one can get Dr. Matlock’s trademarked Wonder Woman Makeover, which for around $45,000 includes the vagina overhaul plus breast implants, liposculpting and a “Brazilian butt augmentation.” In April, he began selling his G-Shot to colleagues in the United States, Europe, Japan and the Philippines for $450 per injection. Doctors may then sell the shots to their patients for as much as $1,850, a 300 percent markup. “Medicine is a business, and sex is what sells,” Dr. Matlock says. Like the face, breasts and virtually every other visible body part, the previously hidden vagina has fallen into the grip of a cosmetic surgery culture in which just about any “imperfection”—both real and imagined—can be nipped and tucked into the perceived ideal, regardless of how unrealistic. “People never used to ask for these surgeries,” says Wendy Lewis, a cosmetic surgery consultant in New York and London who charges $350 an hour to help clients decide which procedures and doctors are right for them. Lewis says her clients who request vaginal surgeries are often mothers in their 30s or 40s who miss the feel of their pre-childbirth vaginas; a few are middle-aged women who are divorced or getting divorced and have younger boyfriends they worry about satisfying. “In the last two years, I’ve gotten many more requests. Makeover television makes them ask, What more can I do? Women are so insecure about everything; now they have one more thing to be insecure about.” “I grew up with some of the same feelings a man with a small penis might have,” says Abby, a 31-year-old mother of two from Colorado Springs. Her labia were perfectly symmetrical, she says, but in her high school locker room days, she noticed that they were about a half inch longer than anyone else’s. As a woman married for 12 years, she says, her anxiety eventually faded: “What I may have felt about my labia when I was 15 was not what I felt when I was 30.” Still, intercourse sometimes pulled the labia into her vagina, which was painful. In the spring of 2006, she raised the issue with her gynecologist, who, she says “offered to make an appointment to scalpel them off right there in her office. That’s when I realized that these kinds of procedures were fairly common.” Curious, she began to research the idea on the Internet, where she stumbled onto another intriguing possibility: laser vaginal rejuvenation to tighten her vagina. “After two childbirths, my vaginal opening had gotten much bigger,” Abby says. She could achieve orgasm, “but there wasn’t as much friction. When I realized I could have the vagina of my early days, I thought, I’m going to love that; my husband is going to love that; this will be fun!” Abby sought out a specialist, gynecologist John Miklos, M.D., of Atlanta, who offered to reduce her labia and tighten her vagina but was clear that neither surgery was medically necessary. When Dr. Miklos (who trained with Dr. Matlock) was done with her, Abby says, “my vagina had basically been restored to its virginal state.” As for her labia, they “were icing on the cake…flat and flush and very juvenile-looking.” Her recovery was longer and more painful than she expected—”much worse than when I had my gallbladder removed,” she says. She knew she couldn’t have sex for eight weeks after the surgery; what she didn’t know was how uncomfortable it would be when that time was up. It took another two months of using a vaginal dilator before she could again have painless, “full, free-flowing penetration.” The pain was worth it, Abby says, as today with the increased friction “my sex life is definitely better. People say these kinds of surgeries demean women, but for me it was completely selfish and self-serving. I don’t get the controversy around this. If people don’t want to get it done, they don’t have it. But it’s there for them if they do.” For now, it’s impossible to know if vaginal surgery is more likely to improve a woman’s sex life or devastate it. One person who would love to answer that question is Debby Herbenick, sexual health education coordinator at the Kinsey Institute for Sexual Research in Bloomington, Indiana. During the past several years, she has approached specialists in the field of cosmetic genital surgery about gathering patients to participate in a long-range study of sexual enhancement related to these surgeries. Not one has agreed. So far, the only studies are two surveys by Chilean doctor Jack Pardo Schanz, M.D., another graduate of Dr. Matlock’s class. In surveys at the Clinica Las Condes in Santiago, he found that 90 percent of women who underwent vaginal tightening surgery said their sex life was either greatly or significantly improved. (He noted that the study had “several shortcomings.” There was no control group; the results were based on subjective experiences; and the follow-up period was only six months.) Dr. Matlock says that his patient surveys for the G-Shot show an 87 percent satisfaction rate, but that he could not share details of his unpublished research with SELF. “Surgeons insist most of their patients are very happy with the results,” Herbenick says. But she wants to know who these women are and to follow up over time to learn what, if any, impact these procedures have on arousal, desire and orgasm. “Some women will say that it’s easier for them to have an orgasm now or that they feel more aroused, more easily,” she says. “But is that 5 percent of patients or 70 percent?” Until there is medical proof, some doctors remain skeptical—and worried that cosmetic surgeons are profiting from women’s insecurities by promising a physical cure for what may not be a physical problem. “There are women who think that if they have a tighter vagina, their husbands will come back,” says Stephen B. Young, M.D., president of the Society of Gynecologic Surgeons in Germantown, Tennessee. Dr. Young has operated on women whose long labia interfere with daily life, but he draws the line at performing such surgeries for purely aesthetic reasons or tightening relaxed vaginas solely for sexual enhancement. “Very commonly men and women have issues that don’t allow them to have a good sex life,” Dr. Young says. “Rarely do these problems have anything to do with the size or shape of the woman’s vagina.”

Summerfield Press/Corbis

About Dr. Debby Herbenick

Dr. Debby Herbenick

Dr. Debby Herbenick is a sex researcher at Indiana University, sexual health educator at The Kinsey Institute, columnist, and author of five books about sex and love. Learn more about her work at www.sexualhealth.indiana.edu.

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  • patientinhemet

    This is in regards to artificially created vaginal stenosis following a cystocele repair. A S. Korean did this to me under general anesthesia without my permission. I was told that the general rule of thumb regarding vaginal clearance following this kind of surgery was to leave two fingers of vaginal clearance. Unknown to me this doctor left me with one and a half fingers of clearance. Eleven months after surgery I had intercourse and ripped a big tear into the vaginal wall. This same doctor left a friend with one finger of vaginal clearance following a vaginal hysterectomy. I have been told that this a cultural practice being perpetrated by Korean doctors. Does anyone have a similar story to tell? I was left in a position where I could have bled to death and the doctor missed a cancerous tumor in my bladder. There was enough blood to soak a few towels. The first menstrual cycle following surgery I found that I was unable to properly insert a tampon because I was hitting a wall of flesh that did not previously exist prior to surgery. It is as if the hours 4-8 are missing on the bottom of my vaginal clock. What this doctor did to me was to remove the inner mucosa. This is what gives a woman the stretch and comfort capability to accommodate her partner during intercourse. The amount of inner mucosa was not mentioned in the surgical report – it was missing. This is similar to removing the elastic band in a pair of pants, nipping the waist band to make it tighter, and then expecting it to “fit”. I am facing Vaginal Reconstructive Surgery in order to ever have intercourse in the future. Again, I reiterate, this was done without my permission. He told me in the final post-surgical visit that, “I made your new again.” My babies were born C-Section. I did not need to be made new again. No Medical Malpractice Attorney would take the case. Only married couples can sue for “Loss of Consortium”. The Statute of Limitation has expired for filing a legal malpractice case. I filed a formal complaint with the California State Medical Board. I’ve been turned down by a Uro-Gynecologist – with a statement from the receptionist stating that, “Doctors don’t like to fix the mistakes of other doctors”. This was not elective laser vaginal rejuvenation. It was a rogue doctor who surgically recreated me so that I am unable to have intercourse. A CASA Advocate accompanied me to the police station so that I could file a complaint of Sexual Assault/Sex Crime by surgical means. Can someone help me please? I am trying to find a plastic surgeon/Uro-Gynecologist team to do surgery.

  • patientinhemet

    This is in regards to artificially created vaginal stenosis following a cystocele repair. A S. Korean did this to me under general anesthesia without my permission. I was told that the general rule of thumb regarding vaginal clearance following this kind of surgery was to leave two fingers of vaginal clearance. Unknown to me this doctor left me with one and a half fingers of clearance. Eleven months after surgery I had intercourse and ripped a big tear into the vaginal wall. This same doctor left a friend with one finger of vaginal clearance following a vaginal hysterectomy. I have been told that this a cultural practice being perpetrated by Korean doctors. Does anyone have a similar story to tell? I was left in a position where I could have bled to death and the doctor missed a cancerous tumor in my bladder. There was enough blood to soak a few towels. The first menstrual cycle following surgery I found that I was unable to properly insert a tampon because I was hitting a wall of flesh that did not previously exist prior to surgery. It is as if the hours 4-8 are missing on the bottom of my vaginal clock. What this doctor did to me was to remove the inner mucosa. This is what gives a woman the stretch and comfort capability to accommodate her partner during intercourse. The amount of inner mucosa was not mentioned in the surgical report – it was missing. This is similar to removing the elastic band in a pair of pants, nipping the waist band to make it tighter, and then expecting it to “fit”. I am facing Vaginal Reconstructive Surgery in order to ever have intercourse in the future. Again, I reiterate, this was done without my permission. He told me in the final post-surgical visit that, “I made your new again.” My babies were born C-Section. I did not need to be made new again. No Medical Malpractice Attorney would take the case. Only married couples can sue for “Loss of Consortium”. The Statute of Limitation has expired for filing a legal malpractice case. I filed a formal complaint with the California State Medical Board. I’ve been turned down by a Uro-Gynecologist – with a statement from the receptionist stating that, “Doctors don’t like to fix the mistakes of other doctors”. This was not elective laser vaginal rejuvenation. It was a rogue doctor who surgically recreated me so that I am unable to have intercourse. A CASA Advocate accompanied me to the police station so that I could file a complaint of Sexual Assault/Sex Crime by surgical means. Can someone help me please? I am trying to find a plastic surgeon/Uro-Gynecologist team to do surgery.