SEPTEMBER 30, 2007


The quest for the perfect vulva

US gyn college to surgeons: Say no to vaginoplasty

Vaginal beautification surgery is not medically-indicated and claiming it enhances genital appearance or sexual gratification is deceptive, says the American College of Obstetricians and Gynecologists (ACOG) in a Committee Opinion in September's Obstetrics & Gynecology.

Cosmetic vaginal procedures — from rejuvenation to revirgination to G-spot amplification — are risky and their effectiveness is not scientifically proven, according to ACOG. Yet a growing number of surgeons are offering them to women, letting them think they're routine procedures, and not discussing all the risks, like infection, loss of sensation or pain during intercourse.

But Canadian surgeons who perform these procedures think the ACOG should get down off its high horse. "It's no different from breast enhancement," says Dr Bruce Allan, founder of the Allan Centre for Women, Canada's first vaginal rejuvenation clinic. "Cosmetic surgery is something one wants, not needs." As for the lack of scientific evidence — you don't need proof to tell you that a woman's breasts are bigger after an implant, he adds. The same goes for vaginoplasty.

Dr Robert Stubbs, a vaginoplasty pioneer and director of Toronto's Cosmetic Surgicentre, agrees. These procedures may not be medically necessary, but they can be psychologically necessary and they can enhance a woman's quality of life, he says.

Certain procedures can drastically improve a woman's sexual experience, insist the surgeons. The labia minora reduction for example, or the 'Toronto Trim,' as it's known among Dr Stubbs's patients, makes the clitoris more accessible. "I've had patients report a three-fold increase in sexual satisfaction," says Dr Stubbs.

Others, like hymen repair, are potentially life-saving, he claims. "I had a Middle-Eastern patient who fell prey to date rape. When she came to me, she was suicidal, she couldn't go home to her country like this. She's expected to bleed on her wedding night," he says. "I sent her to a psychiatrist, and the psychiatrist sent her back saying 'Do the surgery.'"

Even the ACOG admits there are genuine medical conditions that would warrant these surgeries. Pelvic prolapse, relaxation of the vagina due to childbirth or female circumcision are all good reasons to undergo cosmetic vaginal procedures. But going under the knife just to change the look of the genitalia is not, they say.

"Many women don't realize that the appearance of external genitals varies significantly from woman to woman," noted Dr Abbey B Berenson, member of ACOG's Committee on Gynecologic Practice, in a press release. Doctors should discuss the reason for the request of these surgeries and check for symptoms that would require such an intervention, the ACOG report suggests.

That's not news to Dr Stubbs. "If a woman comes in with perfectly normal genitals and wants me to reduce them, I read her the risk list. It's a very sensitive area, and the surgery shouldn't be taken lightly," he stresses.

Unrealistic expectations are another reason to discourage a patient, says Dr Allan. "If the patient has other problems and she thinks this surgery would change her life, I would say 'No, that's not realistic,'" he says. "I don't make promises as far as sexual functioning or success in life — but I would say all my patients are happy with the results."

Still, both doctors agree with the ACOG on the need for more studies involving these procedures. "There are no publications on exact outcome, or the impact on a woman's life," says Dr Allan.

And as the demand for these surgeries rises, there should be tighter regulations on the way the procedures are promoted by certain disreputable surgeons, Dr Stubbs adds. "It's about time [the ACOG] spoke out against the marketing of these procedures. The terminology associated with it is also deceptive. It's not the vagina that's involved in these procedures most of the time, it's the vulva," he says. The Society of Obstetricians and Gynaecologists of Canada agrees with the ACOG and strongly recommends against these cosmetic vaginal procedures, they told NRM in a written statement.

The current controversy reminds Dr Stubbs that women aren't the only ones to be targeted by unscrupulous marketing. "Back when penis enhancement surgeries first became popular, you had doctors who were advertising in Playboy or Penthouse, preying on men's insecurities. That's clearly inappropriate in terms of medical care."



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