February 11, 2013

Designer Genitalia: The Modification of Women’s Genitals

Is what's being called "designer genitalia", genital cosmetic surgery for women, a fad? Or is it here to stay as an option for those seeking cosmetic surgery?

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A growing trend in the cosmetic surgery arena these days is female genital cosmetic procedures. These procedures include options for “revirgination”, “g-spot amplification”, or “designer vaginoplasty” and they are all meant to “rejuvenate” women’s genitals. Who knew genitals needed rejuvenation?

An interview with Dr. Cheryl Iglesia, Director of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center and an Associate Professor of Obstetrics, Gynecology, and Urology at Georgetown University in Washington, DC was recently published in Medscape. The article was called “Designer Genitalia: Fad, Benefit, or Mutilation?” Dr. Iglesia provided some very interesting answers to questions that many of you may have related to this topic, and I’d like to take this opportunity to share some of the answers with you.

What is it?

Vaginal rejuvenation involves the dissection of tissue planes, changing the positioning of organs, and tightening connective tissue. It is a modification of the genital appearance that is sometimes sought out to make the vulva more youthful or in hopes of enhancing sexual response. According to the International Society of Aesthetic Plastic Surgeons, “more than 2,140 U.S. women underwent ‘vaginal rejuvenation’ last year,” with a total internationally of 5,200 women in 2010. However, these numbers don’t include those procedures conducted by gynecologists, so they are most likely an underestimation. Also, in England, numbers of these procedures jumped from 500 cosmetic genital procedures in 2001 to over 2000 procedures in 2010.

What’s the most common procedure?

According to Dr. Iglesia, labiaplasties are the most common procedure. These include lip reductions of both the labia minora and majora (but more commonly the minora).

Why do women do it?

Dr. Iglesia indicated that the reason mostly involved marketing and media. She credits the trend of full pubic hair removal as partially responsible because it exposes the genital area in a way that provides a clearer view than previously. Dr. Iglesia says “many of the images in the media, and certainly on the Internet and in pornography, feature no pubic hair, and the external genitalia appear to be uniform, almost Barbie-like.”

The overall function is to improve the appearance of the inner lips. Most of the time, this is sought out for aesthetic reasons, but sometimes it is for functional reasons such as the labia are getting in the way of exercise or are blocking urination.

Are there any complications?

Complication rates are reported anywhere from 4% to 18% and can include pain with sex, bleeding, scarring (which can be substantial and very problematic), and improper healing.

Do young women do this?

Dr. Iglesia said that due to the heavy marketing of these procedures, girls as young as 11 years old have had these procedures. This is certainly cause for concern, because “such children have not even finished puberty…[when] 11- to 14-year-olds are already so self-conscious about their intimate parts an image is already being set that something is wrong with them, when it’s highly likely that they’re completely normal.”

Are they any different from non-cosmetic procedures?

The difference is in the medical indication for the procedure. What Dr. Iglesia described was that she is a female pelvic medicine and reconstructive surgeon. But her idea of “reconstructive” is to put things back to normal, whereas a cosmetic gynecologist would place healthy women under the knife without medical need.

Another marked difference is in the cost. These cosmetic procedures cost an average of $4500 and usually aren’t covered by insurance. However, a non-cosmetic genital reconstructive procedure with medical indication would typically be covered by insurance.

Not surprisingly, the issue of women having a right to change their bodies, for cosmetic reasons or not, comes up. To this, Dr. Iglesia responds, “I can respect a woman’s right to undergo cosmetic procedures solely for aesthetic reasons. However, many cosmetic gynecologists’ websites have misinformation and false claims about outcomes of these procedures, with either no or very low-quality data to support the marketing claims.”

Do professionals endorse these surgeries?

In short, no. The American College of Obstetricians and Gynecologists’ (ACOG’s) is a large professional body that has indicated they are against any procedures that are not medically indicated or do not have data available about the safety and efficacy (and female genital cosmetic procedures fall into this category). Dr. Iglesia states, “ACOG feels that it is deceptive to give the impression that vaginal rejuvenation, revirgination, and G-spot amplification are acceptable and routine. The reality is that they’re marketed as such, and no evidence-based data have been published to support these procedures.”

How do we respond to this trend?

Dr. Iglesia noted that this is a problematic trend if women are getting these procedures performed because of feeling self-conscious about their genitals or feeling like they have to meet a certain standard based on the opinion of others.

It is important to educate women about how varied female genitals really are, and how that variation is part of the beauty of the vulva. The picture included on this blog post is just one example of many available that depicts the beauty of the uniqueness of the vulva, as is The Great Wall of Vagina, an art exhibition out of the UK. In this Medscape interview, Dr. Iglesia references the book Petals, another great source for demonstrating that there is a wide range of normal. Coffee table books such as 101 Vagina and guidebooks such as Read My Lips are also good examples of trying to celebrate vulva diversity.