VAGINAPLASTY

What is labioplasty ?

2008-12-28T11:44:00.001-08:00

Labiaplasty also referred to as labioplasty, is a surgical process that will reduce and/or reshape the labia minora - the skin that covers the female clitoris and vaginal opening. In some cases, women with big labia can experience ache during intercourse, or feel discomfort during everyday activities or when wearing tight-fitting clothing. Others may feel unattractive, or wish to enhance their sexual experiences by removing some of the skin that covers the clitoris. The purpose of a labiaplasty is to better define the inner labia. During this process the urethral opening can be redefined, and if necessary improvements to the vagina may be made. The trouble can be caused by genetics, sexual intercourse or difficulties in childbirth

Labia Minora (inner lips) Reduction - Many women dislike the big protuberant appearance of their labia minora. This may cause severe embarrassment with a sexual partner. The overly great labia minora can also result in constant irritation in tight pants. Surgical labial reduction can greatly improve the cosmetic appearance of the abnormally enlarged labis. Some women are born with great labia, others may get this status with childbirth or age.

Labia Majora (outer lips) Reduction - This common anatomical references version may be worsened by childbirth or by weight gain or loss. They may sometimes be improved by liposuction. In more severe cases, surgical reduction is necessary.

Vaginoplasty Surgery

Vaginoplasty, sometimes referred to as rejuvenation of the vagina, is a procedure that can usually correct the problem of stretched vaginal muscles resulting from childbirth(s), and is a direct means of enhancing ones sexual life one time again. The process typically tones vaginal muscle, resulting in greater contraction strength and control, thereby permitting better sensation during sexual experiences.

Vaginal Prolapse

2008-02-26T13:22:00.000-08:00

The network of muscles, ligaments, and skin in and around a woman’s vagina acts as a complex support structure that holds pelvic organs, tissues, and structures in place. This support network includes the skin and muscles of the vagina walls (a network of tissues called the fascia). Various parts of this support system may eventually weaken or break, causing a common condition called vaginal prolapse. A vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall, out of their normal positions. Without medical treatment or surgery, these structures may eventually prolapse farther and farther into the vagina or even through the vaginal opening if their supports weaken enough. The symptoms that result from vaginal prolapse commonly affect sexual functions and bodily functions such as urination and defecation. Pelvic pressure and discomfort are also common symptoms.

Approximately 30-40% of women develop some presentation of vaginal prolapse in their lifetime, usually following menopause, childbirth, or a hysterectomy. Most women who develop this condition are older than 40 years. Many women who develop symptoms of a vaginal prolapse do not seek medical help because of embarrassment or other reasons. Some women who develop a vaginal prolapse do not experience symptoms.

Procedure may rejuvenate sexuality By Judith Salkin

2008-02-21T13:19:00.000-08:00

No matter how sophisticated we think we've been become as a society in terms of sexuality, we're not.

Books tell us that we're responsible for our sexual pleasure, and that healthy, active adults can enjoy sex long into their lives.
But that's not always the case. Our bodies change, and women (especially mothers) often experience vaginal relaxation - a gradual weakening of elasticity in the vaginal muscles - which can lead to a loss of sensation, and therefore satisfaction.
While there have been a number of significant advances for men, from surgical procedures to Viagra, doctors haven't paid nearly as much attention to women.
Until now.
Enter the G-Shot (or G-Spot amplification), an injection of human-engineered collagen into the Grafenburg spot, a small area behind the pubic bone on the anterior wall of the vagina.
"It's a relatively non-invasive way to enhance a woman's sexual pleasure," said Dr. Elliot B. Lander, a urologist with offices in Rancho Mirage, La Quinta and Del Mar.
As a urologist, Lander has performed more than 4,000 pelvic floor reconstruction surgeries and understands the causes of vaginal relaxation.
He was trained in the use of the G-Shot by its developer, Dr. David Matlock of the Laser Vaginal Rejuvenation Institute of Los Angeles. Matlock, who has appeared on the E! network's "Dr. 90210," trained in laser vaginal rejuvenation, anterior and posterior repair and vaginoplasty surgery.
"Years ago it was taboo to talk about these things," said Matlock. "Women were told that it was just a normal part of the aging process."
But with women living longer and expecting more out of life, "There were definitely questions that needed to be addressed."
The G-Shot does that, according to Lander and Matlock, in a relatively non-invasive and non-permanent way.
With the exception of the numbing shot and the 28-gauge needle (the same gauge needle used for daily insulin shots) used to inject the collagen, there are no other disturbances to the patient's body.
While the collagen itself is FDA approved and comes from a qualified medical supply company, the G-Shot is patent pending.
The shots, according to Matlock are $1,850 for a single shot and $2,500 for a double.
"Some feel they need more or want it to last a bit longer (than the normal four-month period of a single shot)."
Enhancing sensation
Tara is a tall, pretty woman who works in the Wright Building on the Eisenhower Medical Center campus where Lander also has his office.
"I heard about it and I was curious," she says. In her early 30s, Tara decided to try it and evaluate it "for the future."
Following instructions on how to manually locate the G-spot with her finger, "because it's a little different for every woman," and showing Lander where it was, "the whole thing took about a half hour from start to finish."
Once a woman's G-spot has been located, the measurements are noted in her chart and do not need to be repeated on subsequent visits.
A local anesthetic then numbed the area before Lander injected the collagen.
"I really noticed a difference," Tara said. "The feeling was much more intense, much more pleasurable. I'll definitely do it again."

FAQ Vaginoplasty

2008-02-02T14:12:00.000-08:00

Can vaginoplasty assist with bladder incontinence and sexual satisfaction for a 33-year-old woman with three children?

Vaginoplasty is an operation performed to repair structural damage to the pelvic floor. The supporting tissues that keep the pelvic organs in proper position are vulnerable to injury in childbirth and with aging. Loss of support results in the condition called prolapse. Prolapse can affect any of the pelvic organs, including the bladder, uterus, vagina, and rectum.
The symptoms of prolapse depend on the precise location of the damage in a given individual. Some women are aware of pressure or an uncomfortable bulge of tissue at the opening of the vagina. This is like having a hernia of the vaginal walls. The walls of the vagina become stretched and loose, resulting in impaired sexual function. When the supports of bladder neck are prolapsed, urinary incontinence can result.
Good bladder control and sexual satisfaction are both complex functions that depend on many factors. Not all of these factors can be addressed with surgery. However, to the degree that a woman's symptoms are caused by the anatomic disruption of prolapse, relief of symptoms can often be achieved by surgical repair.

FAQ Vaginoplasty

2008-02-02T14:06:00.000-08:00

Q: I am interested in having the procedure, can you explain more about it. A: Because we offer numerous services it is hard to respond to a general question such as this. We have made every attempt to have a comprehensive, descriptive site with visual aids to assist you in identifying and determining your concerns and interest.

Q: I have had a child or a number of children and since, things just aren't the same vaginally. My vagina isn't like it was before I had children. Sex just isn't as gratifying as before. For me, having children resulted in vaginal enlargement, with loose, weak, vaginal muscles. My vaginal muscle tone is poor and the support outside the vagina at the bottom is poor also. I performed Kegels until I was blue in the face and they didn't help me at all. I didn't know about this procedure. But I am happy to know that something can be done. Please explain to me how Laser Vaginal Rejuvenation can correct my problems and enhance sexual gratification. A: Many women have your exact same problem, share your self conscious concerns, and desire to enhance sexual gratification. Women are very concerned about their sexual health, sexual gratification, and procedures to enhance sexual gratification.Laser Vaginal Rejuvenation for the enhancement of sexual gratification is a modification of a standard gynecologic surgical procedure. The laser is used to perform, precise, aesthetic surgical incisions. The techniques that we have developed result in a relatively bloodless procedure performed on an outpatient basis. In brief we will tighten the vaginal muscles and support tissues, as well as reduce redundant vaginal mucosa (relaxed vaginal lining). The procedure will enhance vaginal muscle, tone, strength, and control. It will effectively decrease the internal and outer (introitus) vaginal diameters, as well as build up the perineal body (the area immediately outside the vagina and above the anus. According to Masters and Johnson, sexual gratification for the female is directly related to the amount of frictional forces generated. The procedure can also provide an aesthetic enhancement of the external vaginal structures, resulting in a more youthful look. As with all of our surgical procedures you are an integral part of the team and we listen to you and abide by your wishes. In this procedure the woman determines how tight she wants to be. In our survey: Guess what 100% of the women said?

Q: I have had several children. I have vaginal relaxation and I also lose urine when I laugh, cough, sneeze, or exercise. This problem has really impacted on my life, it is socially embarrassing and hygienically unacceptable. Can I correct my urinary problem and enhance sexual gratification all at once?A: Your urinary problem is called stress urinary incontinence. It is caused by the vaginal relaxation of the top part of the vaginal wall. Laser Vaginal Rejuvenation can correct your problem with stress urinary incontinence and enhance sexual gratification all at the same time.

Q: How long does Laser Vaginal Rejuvenation take? A: The surgical time depends on the extent of the procedure. In general the procedure takes about one and a half hours.Q: Where is the procedure performed? A: These procedures are performed at the Orlando Surgery Center in Orlando or the Bougainvillea Clinique of Winter Park.

Q: I have vaginal relaxation of the bottom floor of the vaginal and the perineal body. Can I have laser vaginal rejuvenation? A: In this case we only need to repair the lower floor of the vagina and the perineal body (area immediately outside of the vagina). Usually in this case vaginal relaxation is less extensive. Laser vaginal rejuvenation will also enhance sexual gratification.

Q: I haven't had any children but I have some vaginal relaxation and I would like to enhance vaginal muscle tone and strength as well as decrease the vaginal diameter. Can I have the procedure? A: Depending on your circumstances you can be a candidate for the Laser Vaginal Rejuvenation. Such procedures primarily involve the bottom part of the vagina and the perineal body.

Q: What types of anesthesia are available? A: You can be provided with your choice of anesthesia by our board certified anesthesiologist or certified nurse anesthetist. (local, nerve block, epidural, spinal, IV sedation, general). Some types of anesthesia are procedure dependent.

Q: When can I resume sex after Laser Vaginal Rejuvenation? A: We ask that you abstain from sexual intercourse for 6 weeks. Oral sex may be resumed much earlier.Q: When can I return to work after laser vaginal rejuvenation?A: In general returning to work is dependent on the type of work you do. Most patients can return within 5 to 7 days.

Q: I am from out of town. How long do I have to remain in Orlando after Laser Vaginal Rejuvenation? A: You can return home in 4 days. We will be happy to help you arrange accommodations.

Q: How much discomfort will I have after Laser Vaginal Rejuvenation?A: With our technique of submucosal tumescence, pudendal block with long acting local anesthetic, you will be pain free for the first 18 to 24 hours. After this, patients report mild to moderate discomfort which can be controlled by analgesics and cold packs to the area.

Q: How much does Laser Vaginal Rejuvenation cost?A: Fees are all inclusive of the surgical center, anesthesiologist, surgical assistant, surgeon, and follow-up. The initial consult is $250.00. The fees depend on the type of procedure and the extent. A fee range can be provided once we know your particular needs. The initial consultation fee is then deducted from your final cost.

Q: What are the surgical risks for laser vaginal rejuvenation?A: Laser Vaginal Rejuvenation is a safe procedure with low risk. To put the risk in perspective, pregnancy is associated with far more risk than any of these procedures. Like any surgery the risks are hemorrhage and infection. These are less than 1%. If one requires work on both the upper and lower vagina then there is risk of injury to the bladder and the rectum. This is exceptionally rare and in many years of our surgical experience we have not encountered any of these complications. With any surgery one can encounter scarring. Over correction can potentially result in painful sex. Although rare there are anesthetic risks also depending on the type of anesthesia.

Q: Can Laser Vaginal Rejuvenation be combined with Designer Laser Vaginoplasty?A: Laser Vaginal Rejuvenation can be combined with Designer Laser Vaginoplasty such as laser reduction labioplasty.

Q: Can Laser Vaginal Rejuvenation or Designer Laser Vaginoplasty be combined with other cosmetic surgical procedures? A: Yes, they can be combined with most cosmetic surgical procedures such as breast, nose, eye, or tummy tuck surgery.

Q: My inner vaginal lips (labia minora) are too long. Can I have them reduced?A: The labia minora can be aesthetically sculptured to your specifications with laser reduction labioplasty.

Long-Term Results in Patients after Rectosigmoid Vaginoplasty.

2008-02-01T05:08:00.000-08:00

Many methods are used for vaginoplasty, including the split-thickness skin graft, full-thickness skin graft, and inverted penile skin flap. However, these procedures are not entirely satisfactory in cases of reconstructed vaginal stenosis, inadequate vaginal length, or poor lubrication. The small intestine, ascending colon, and sigmoid colon can be used in the intestinal flap method, and the authors modified the operation first described by Baldwin in which a loop of rectosigmoid is isolated, closed at one end, and brought down on its vascular pedicle as a neovagina and then anastomosed to the perineum.
Vaginoplasty using the rectosigmoid was performed in 36 patients (28 male-to-female transsexual patients, five patients with congenital vaginal atresia, and three with cervical cancer). The follow-up period ranged from 1 to 10 years. The postoperative results were analyzed through physical examination and interview regarding the patient's functional status and satisfaction during sexual intercourse. The mean depth and width of the vaginal cavity were 12.5 cm and 3.9 cm, respectively. Excessive mucosal discharge was seen in 8.3 percent, and malodor was found in 8.3 percent. All patients who had partners were able to have sexual intercourse; 2.8 percent of patients used lubricants and 5.6 percent used dilators before intercourse for more than a year postoperatively. During intercourse, 88.9 percent of the patients experienced orgasm. The cosmetic and functional results of rectosigmoid vaginoplasty were excellent. Thus, the advantages of rectosigmoid vaginoplasty are (1) rare contraction of the reconstructed vagina, (2) vaginal width and depth maintained without long-term vaginal stent, (3) spontaneous mucus production facilitating sexual intercourse, (4) avoidance of the malodor frequently accompanying skin graft, and (5) texture and appearance similar to that of the natural vagina. The authors concluded that rectosigmoid vaginoplasty is the best choice for transsexual patients who have previously undergone penectomy and orchiectomy, patients with unfavorable previous vaginoplasty, those with short vaginal length after cervical cancer surgery, and patients with congenital vaginal atresia.

Kwun Kim, Seok M.D.; Hoon Park, Ji M.D.; Cheol Lee, Keun M.D.; Min Park, Jung M.D.; Tae Kim, Jeong M.D.; Chan Kim, Min M.D.

MAKING SURGERY MORE INTIMATE WITH VAGINAL RECONSTRUCTION

2008-01-17T12:32:00.001-08:00

You’ve heard of people requesting Sharon Stone’s nose and Pam Anderson’s breasts? Well, now many women are now taking copies of Playboy to their plastic surgeons, saying: ‘I want one like that.’ Why the recent demand, you may ask, for perfection in the most intimate of areas? The reasons are as varied as the women who ask for the procedures. Desiring higher levels of sexual gratification, a more aesthetically pleasing look, the ability to exercise without discomfort and the ability to wear all kinds of clothing are the most common reasons.

The most common procedures, the vaginoplasty (large vagina surgery) and labiaplasty, have been around for decades, but have more recently come into prominence as elective surgeries. Dr. Ronald Blatt, Medical Director of The Center for Vaginal Surgery in Manhattan, is a Board Certified OB/GYN who reconstructs the "optimum structural architecture" of the vagina for the most aesthetically pleasing and comfortable result.

Vaginoplasty is a surgical procedure that involves the tightening of vaginal muscles and support tissues as well as the reduction of redundant vaginal mucosa (relaxed vaginal lining). Childbirth, trauma and even simply aging may cause the vagina to become stretched and the surrounding muscles lose their strength and tone. This loose feeling that many women feel is often noticed not only by them, but by their partners during sexual intercourse. “Vaginoplasty decreases the diameter of the vagina, which results in increased friction during intercourse. After surgeries, women and their partners often report increased levels of sexual gratification,” says Dr. Blatt.

The surgery is a standard gynecologic vaginal procedure where the vaginal vault and pelvic floor are made tighter and the foundation muscles of the vagina are made stronger. The G-spot which lies in the anterior proximal vagina is not affected by this procedure Labiaplasty refers to the trimming of labia minora, more commonly known as the lips of the vagina. Having enlarged, or irregular labia minora may adversely affect the quality of life for patients, resulting in lowered self-confidence, discomfort with wearing clothing, exercising, or having sex.

The enlarged labia can have a protuberant and abnormal appearance that can be bothersome and distressful. More specifically the unsightly appearance of excessive skin can cause psychological damage and may decrease the sexual desire in both partners. Women who have this excessive skin are often so embarrassed by it that it may take years before they discuss it with a friend and even longer before they seek correction of the problem.

If you have these problems, they can be remedied! Each procedure takes approximately 60-90 minutes to perform. An additional hour is spent in Dr. Blatt’s recovery room under the supervision of a Registered Nurse. Dr. Blatt recommends general anesthesia for his patients so they will not feel any pain during the surgery. Patients can, however, expect to have discomfort at the surgical site for the first few days after the procedure.

This discomfort is greatly reduced by pain medication and antibiotics that Dr. Blatt prescribes. Full healing and a return to normal sexual activity takes approximately six weeks. All sutures used are absorbable and therefore do not need to be removed. Insurance usually does not cover these surgeries because they are considered elective. The end result of these procedures may not only be a more youthful appearance, improved sensation and a more comfortable and confident sex life, but an overall improvement in the quality of life.

PART TWO: GENITAL LANDSCAPING, LABIA REMODELLING AND VESTAL

2008-01-14T00:57:00.000-08:00

Vaginal relaxation can indeed be a medical problem, says Dr. Linda Brubaker, chief of uro gynecology and reconstructive pelvic surgery at Rush Medical College in Chicago.''I see a number of women with pelvic- oor problems who have satisfying sex lives," she says. ''Prolapse (the bladder and or uterus dropping into the vaginal canal) may need to be treated surgically, but to claim that sexual enhancement occurs is scienti cally unproven." She feels that peer review and scienti c documentation are necessary to validate Matlock's claims, and that if this is
such a major breakthrough for women, he should be sharing it with his fellow gynecologists in published articles. Designer vaginoplasty, and another of Matlock's services-hymen reconstruction- are considered elective surgeries. Only if there is a functional problem like prolapse or stress urinary incontinence will a patient be covered by insurance for the surgery, which costs between $4,000 and $8,000. In Matlock's office on a recent day is a 56-year-old Filipina whose English is not strong. She is here because of the eye-catching ads she has seen. Matlock's ads-featuring a luscious young thing in a bikini who looks like she's in the throes of orgasm- appear frequently in local papers. The older woman has checked o on Matlock's brochure problems she wants corrected-stress urinary incontinence and labia minora she feels are too big. ''I have no problem with sexual grati cation," she laughs shyly. Matlock explains
the surgical procedures, pointing to a plastic diagram of the female organs. He repeatedly rolls out his catch phrases, like ''laser vaginal rejuvenation for the enhancement of sexual grati cation" and ''designer laser vaginoplasty."
After a brief exam by the doctor, the woman returns to the consulting room. ''Your labia aren't too bad," he says. ''We can reduce those if you like." He recommends an operation called an anterior colporrhaphy to restore the bladder to its normal position and ease her incontinence. ''This procedure is 94, 95, 96 percent e ective in correcting the problem of stress urinary incontinence," he says. The surgery, done on an outpatient basis in the doctor's office, will take no more than an hour, but the patient must wear a catheter for four days afterward. Colporrhaphy is indeed standard for treating stress urinary incontinence, according to Brubaker. But she warns: ''Making the vagina tighter doesn't necessarily improve female sexual response. This surgery can produce scarring and painful intercourse"{an opinion shared by a prominent Westside urogynecological surgeon who prefers not be named in order to avoid a ''pissing contest" with Matlock.
Dr. Malcolm Lesavoy, a professor of plastic surgery at UCLA and chief of plastic surgery at Harbor-UCLA Medical Center, says adamantly, ''Vaginoplasty is for reconstruction, not for aesthetics." He cautions that there also can be a loss of sensation in the labia after such surgery, an opinion echoed by other plastic and reconstructive surgeons. Matlock minimizes the possibilities of scarring and pain. ''Scarring- you can't look at it as scarring per se," he says. -The body heals by scarring. If you look at this procedure, you can't see anything, there's a thin line. The vagina, the mucous membranes, heal so well. It heals by scars, it heals by retraction."
He insists that any scarring that occurs would in no way interfere with sexual enhancement or grati cation. Matlock claims to have performed 1,000 of these surgeries over the past decade
and says the proof of his work is in the happiness of his patients. Moreover, he claims, his surgeries (half of which were to enhance sexual grati cation) produced no complications from scarring or pain. -Everybody enjoys what has been done," he says.
Dr. Brubaker is incredulous. -If that's the case, he should de nitely present this for peer review. That's an amazing statistic for any surgeon." Her sentiments are echoed by others who are stunned at such assertions. -That's beating the odds," said one L.A. plastic surgeon.
Though his peers may not be reading about him in scienti c journals, Matlock is enjoying a lot of media attention. He cites an appearance on Howard Stern's radio show, an upcoming article in Marie Claire, and a mention in the L.A. Times business section. Later this year, women also will have a book from Dr. Matlock entitled ''What The Gynecologist Didn't Tell You." He's excited about the book's potential. ''Hopefully I can bring a lot of attention to these issues," he says. ''My colleagues are interested." Of course, the book won't be aimed at his colleagues in the American College of Obstetricians and Gynecologists, but at women who worry whether their labia are symmetrical{and if an hour in Matlock's hands could really enhance their sex lives.
And what do men think about the concept of tightening? To quote one 37-yearold single male publicist, ''I never met a pussy I didn't like." Though now, thanks to Dr. Matlock, he may be meeting more than a few that look alike.

PART ONE:GENITAL LANDSCAPING, LABIA REMODELLING AND VESTAL VAGINA: FEMALE GENITAL MUTILATION OR FEMALE GENITAL COSMETIC SURGERY?

2008-01-13T04:59:00.000-08:00

Dr. Tight
Hey, girls! A Beverly Hills gynecologist says he can juice up your sex life with some quick, below-the-belt surgery.But some medical experts have reservations.
Lisa Derrick
New Times Los Angeles Online \Dr. Tight".
04/30/1998
First it was hair color, with women being told that blondes have more fun. Then came breast implants, liposuction, collagen, and Gortex. But now women are informed that they should make some internal modi cations as well. And though they may not be what kind of changes Deepak Chopra has in mind, a Beverly Hills gynecologist says his one- hour laser procedure to resculpt and tighten the vagina will result in better sex. Dr. David Matlock is selling an operation normally used to relieve stress urinary incontinence{leakage of urine from the bladder during coughing, exercise, or sexual intercourse. But he's marketing the surgery as a way to enhance sexual gratification, a claim that has yet to be proven in clinical studies.
According to Matlock, ''sexual grati cation" doesn't necessarily equal orgasm.''Sexual grati cation is sexual pleasure," he says. Orgasm is just a part of that; it's the pinnacle of that." To the doctor, who cites Masters and Johnson repeatedly, sexual grati cation means an increase in ''frictional forces." That is achieved, he explains smoothly, by decreasing the diameter of the rst third of the vagina. To accomplish this, he makes incisions in the top and bottom of the vaginal canal using a laser, overlaps the muscle, stitches it in place with absorbable sutures, and removes excess surface tissue. ''I get patients that say they are not satis ed sexually, that they desire to have a more aesthetic appearance. They want to be tighter," he explains. Some patients, the husband and wife, come in together and say, We're not sexually satis ed."The woman has to come in here initially without anorgasmia (the inability to achieve orgasm)," Matlock continues. ''We don't want to deal with that; that's in the realm of dysfunction." Instead, he wants to enhance the sex lives of ''normal functioning women" who have no serious problems sexually. Traditionally, gynecology{even gynecological plastic surgery{has concerned itself with issues of physical function such as incontinence rather than sexual pleasure. But Matlock feels this needs to change.''You're not here to make an ethical judgment; you're here to help people," he says. ''And if [women] feel this will help their sex life, okay, we can go ahead and enhance these things." Among the enhancements Matlock is betting women want is ''designer laser vaginoplasty," a cosmetic remodeling of the labia. ''It's called `designer' vaginoplasty because the woman is the designer," says Matlock. ''The doctor is just the instrument." He cites the airbrushed women of Playboy as examples of what is aesthetically pleasing in labia. ''Honestly, if you look at Playboy, those women, on the outer vagina area, the vulva is very aesthetically appealing, the vulva is rounded," he says. ''It's full, it's not at...Women are coming in saying, `I want something dierent, I want to change things.' Then look at Playboy, the ideal woman per se, for the body and the shape and so on. You don't see women in there with excessively long labia minora." The glossy brochures that share space with Vogue, Cosmopolitan, Allure, and a bouquet of arti cial owers in Matlock's beige-marble offices on Sunset Boulevard contend that 30 million American women ''suer" from symptoms of vaginal relaxation, primarily stress urinary incontinence, a gure other gynecologists interviewed for this article supported. But Matlock claims that, after surgically treating women for this problem, his
patients reported an astounding side eect. ''They would call me and say, `my sex life is greatly enhanced.' I had husbands calling. Patients would tell their friends who may not have had functional problems, saying, `well, Suzy had this done.' I thought, if the patient wants this and we can oer it, let's do it. I changed my concepts and oered it to patients who wanted it. Laser vaginal rejuvenation for the enhancement of sexual grati cation is a laser surgical procedure designed to enhance sexual grati cation."
Another Beverly Hills gynecologist who declined to be named says that he has performed this surgery on women with stress urinary incontinence and they, too, said it improved their sex lives. But would he recommend the operation to a woman purely for sexual enhancement? \Not at this stage, no," the physician says. ''What Dr. Matlock is doing is very avant garde and on the cutting edge. I prefer to be in the middle of the pack."

Plastic Surgery and the Materialization of Gender Norms ByKaren McNamara

2008-01-13T02:51:00.001-08:00

While the discourses of medicine and the media function to disseminate and reinforce “regulatory norms of sex,” plastic surgery procedures give those norms a material reality by reshaping the flesh of the body. Most labiaplasty procedures eliminate the “excess” tissue that hangs below the labia majora in many women. The removal of this dangling flesh, which hangs between a woman’s legs like a phallus, serves to further distinguish the female genitalia from the male. The female body must be distinguished from the male body because it is in contrast to the female that the male has meaning. The system of gender is relational, operating through binaries: a “man” is “not woman,” just as “masculine” is “not feminine.” The two concepts are locked in an interdependent relationship. If the binary begins to break down, the salience of each of these categories breaks down as well. Therefore, to prevent such a degradation, the rigidity of the categories “man” and “woman” and the strict boundary that exists between them is fiercely protected. Because of this, in contemporary Western culture, ambiguity of the genitalia is culturally unacceptable. If a baby emerges from the womb with anything less than a body clearly marked as either male or female, medical technology and expertise rush in to give precision to the anatomy. Suzanne Kessler, who has done extensive research on gender reinforcement surgery on intersexed individuals, says, “Genital ambiguity is corrected not because it is threatening to the infant’s life, but because it is threatening to the infant’s culture” (25). The “in-between-ness” demonstrated by fleshy or hanging labia is threatening because it complicates the strict gender binary that underpins the Western social fabric. Consequently, society marshals its forces—economic, cultural, and political—to bring those aberrant bodies in line. In this case, the female body must be appropriately feminized. Thus, the female genitals, generally thought to be the marker of womanhood, are in many cases “not female enough.”
This removal of labial tissue does more than simply sharpen the distinction between the female body and the male body, however. The excision of tissue deemed “excessive” functions on a symbolic level as well, for it reflects broader societal norms that forbid a variety of excesses among women, particularly inordinate sexual appetites. Simone Weil Davis historicizes the association between large labia and heightened sexuality, noting, “at least since the sixteenth century they have indicated to doctors the alleged presence of hypersexuality, onanism, and possible ‘tribandism’ or lesbian tendencies” (37). Through labiaplasty, both her body and behavior are “civilized,” metaphorically reigned in to meet society’s insistence on female restraint and discretion. Saartjie Baartman, or the “Hottentot Venus,” perhaps best illustrates this type of phrenology by illustrating society’s attempt to draw a link between the physical appearance of the woman’s genitals and her character. Baartman was an African woman whose body was put on display through a touring exhibition across Europe for five years in the early part of the nineteenth century (Gilman 232). Her labia were of particular interest to the Europeans, who were eager to seize upon physical characteristics that could be used to make classificatory distinctions between the races. European travelers of the eighteenth century had returned from Africa with reports of the “Hottentot Apron,” a “hypertrophy” of the labia found among some tribes (232). Western colonialists used the “primitive” nature of the black woman’s sexual organs as evidence of a corresponding “primitive” sexuality, generally defined by “excesses,” including lesbianism (237). The Hottentot Venus provided a contrasting image for bourgeois European women’s genitals and sexuality. Unlike the untamed excess of the Hottentot, white women demonstrated a properly modest, civilized sex. Those highly gendered notions of the proper female body can still be detected in the modern practice of genital plastic surgery, which aims to reduce women’s sex—and sexuality—to more acceptable proportions.
Other surgical procedures besides labiaplasty are also tasked with sexing female bodies. For example, physicians’ promotional materials hail vaginal rejuvenation surgery (or vaginoplasty) as an “essential service” for women to enhance their physical sensation during sex, with advertisements touting “You won’t believe how good sex can be!” (Gorov C1). However, many doctors have voiced skepticism about such claims. A New York Times piece from 2004 quotes Dr. Thomas G. Stovall, president of the Society of Gynecologic Surgeons, as saying that no scientific evidence exists to support the claim that women experience enhanced sensation during intercourse after the procedure (Navarro 9.1). In fact, he claims the opposite, as some women actually experience pain after the surgery as a result of the muscles being too tight. Other risks include nerve damage leading to loss of sensation, a buildup of scar tissue, or infection. Despite some plastic surgeons’ repeated insistence that the women they treat seek the procedure to enhance their own sexual satisfaction, others concede that many women have a consultation at the urging of their husbands, boyfriends, or partners who want increased sensation for themselves. Thus, by surgically altering the vagina toward the goal of enhancing male sexual pleasure, vaginoplasty reinforces the instrumental function of the vagina in normative heterosexuality. Being a site of pleasure for the male sexual organ is a primary function of the vagina under the heterosexual matrix of gender. If the vagina fails in this capacity and is no longer able to deliver adequate stimulation to the phallus, a cultural intervention is required. Underscoring Butler’s theory, the vagina itself does not qualify one as a woman. Being a woman, a condition that under the normative heterosexual culture of contemporary society includes accommodating the phallus, requires medical assistance. As Simone de Beauvoir famously said, “One is not born a woman, but becomes one.” In this case, one is not born a woman, but is made one: Her sex is brought in line with her gender.
In addition to the function of the vagina being important under the heterosexual imperative, the appearance of the vagina is important as well. A desire for youthfulness stands as a key motivation for genital surgeries, as it does for plastic surgery in general. In her article “Vulva Goldmine: How Plastic Surgeons Snatch Your Money,” Julia Scheeres quotes UCLA psychology professor Paul Okami, who says, “These procedures are designed to approximate that of a pubertal vulva or vagina.” And, as other feminist critics have done, Scheeres points to the infinite number of Web sites promoting images of “teenage sluts” or “barely legal babes” as additional evidence of patriarchy’s sexual obsession with young, barely pubescent girls (75). Aside from having vaginoplasty to “rejuvenate” the genitals, some women have fat injected into their labia to give them a plumper shape. Feminist health expert Judy Norsigian, as quoted in the Los Angeles Times, situates this trend in the context of men’s obsession with barely pubescent young girls. She attributes the popularity of Brazilian waxing—in which nearly all of the pubic hair is removed—as further evidence of this. In the context of the heterosexual imperative, the female must be ever vigilant to keep herself alluring and hold the male’s sexual interest. Physicians point out that older women may be in a losing battle against gravity as they begin to notice their nether regions increasingly “on the move.” As Davis says, “It is woman’s work to make sure her genitalia are snug, not wayward” (15). Sustaining a youthful, feminine body, as necessitated under the heterosexual matrix of gender, requires constant attention and maintenance.
Hymenoplasty, in which the hymen is surgically reconstructed to mimic the virginal state, is yet another example of how the female genitals are produced to support heterosexual normativity. The procedure is not new. However, it has historically been performed on women from Middle Eastern or Latin American cultures that would themselves or their families suffer physical harm or shame if they were discovered not to be virgins upon marriage (Masterson 7). The small operation would erase physical evidence of prior sexual activity or rape. Although the number of women seeking these procedures is considerably less than those pursuing labiaplasty or vaginoplasty, its popularity has begun to take hold in the U.S., primarily among white, affluent, urban women. To distinguish it from the aforementioned cultural context, those in the industry have dubbed the procedure “recreational” hymenoplasty. A Philadelphia Daily News article quotes one woman who is having the $5,000 surgery as a “gift” for her husband who, she says, “deserves everything” (Armstrong 1). Other women undergo the procedure to mark anniversaries or other special occasions. Unlike vaginoplasty, though, in which some doctors still make the case for enhanced female pleasure (despite evidence to the contrary), hymenoplasty guarantees women’s discomfort. Again, if the vagina no longer meets a key requirement of womanhood under heterosexual society—keeping the phallus endlessly stimulated and entertained—then action must be taken to create proper bodies.
These various practices—vaginoplasty, labiaplasty, hymenoplasty—and a range of others, highlight the constructedness of the sexed female subject because her body requires constant maintenance to adhere to gender requirements. Dominant gender ideology enlists her to become a sentinel, watchful for aberrations or abnormalities that cause her body to slip beyond the boundaries of acceptable womanhood. Thus, responsibility for the enforcement of norms rests within the individual subject herself. Just like the docile bodies of Foucault’s Panopticon, bodily surveillance has been internalized: “We are neither in the amphitheatre, nor on the stage, but in the panoptic machine, invested by its effects of power, which we bring to ourselves since we are part of its mechanism” (217). With gender, there is no center of power that enacts rules and then punishes transgressors. Rather, the gender binary is so strong and so pervasive that no external policing is necessary. On our own, as sexed subjects, we accomplish the disciplining of our bodies to fulfill the requirements of gender categories.
However, because the very definitions of these categories are cultural creations, they are subject to change over time and space. As the gender norms shift, so must our disciplining practices. The variance that exists among norms becomes apparent when examining the practice of labiaplasty in the West alongside the practice of female genital operations (or FGO) in Africa. According to Davis, both cultural practices are underpinned by the idea that “the genitalia are cultural terrain that must conform to identificatory norms” (17). Nonetheless, most American women who seek labiaplasty would no doubt be horrified at the comparison between their own procedure and the practice of FGO in Africa. However, Davis asserts that the distinction between the two is not so great. Since the mid-1990s, ten U.S. states have passed anti-FGO laws. Although the nature of the operations criminalized in these laws would easily apply to the kinds of procedures being performed in the offices of Beverly Hills plastic surgeons, the laws include language to address specifically “the custom and belief-based cutting of African immigrants” (21). Consequently, the parents of intersexed American infants are free to have the genitals of their children cut or excised, as are women who have made the determination that their labia stand in need of some corrective measures, without concern for legal ramifications. Yet, the distinction between Western practices of plastic surgery and African practices of FGO is one figured along cultural, racial, and national lines. In practice, the difference is not so pronounced: “Among the key motivating factors raised by African women who favor female genital surgeries are beautification, transcendence of shame, and the desire to conform; these clearly matter to American women seeking cosmetic surgery on their labia, as well” (Davis 23). Davis goes on to quote Soraya Mire, a Somali filmmaker, who says “In America, women pay money that is theirs and no one else’s to go to a doctor who cuts them up...Western women cut themselves up voluntarily” (21). In this way, one could see Western female consumers who consent to the procedures (and even finance them) to be even more oppressed and bound by normative gender than their African counterparts.
The comparison between practices in the U.S. and Africa shows that although the specific methods may vary across space and time, normative gender imprints itself upon the body. In the U.S. context, the discourses of Western medicine and the media work together to reinforce messages about normative gender and the female body. Plastic surgery then functions as the means by which those gender norms are translated into flesh, transforming women’s bodies into “properly sexed” female subjects that are better able to fulfill their duties in the service of imperative heterosexuality. The process of “sexing” the female body, however, does not end when the anesthesia wears off. Rather, under the matrix of gender relations, women exist in a constant state of monitoring and correcting, forever striving to hit the moving target that is “woman.”

Discourse and the Dissemination of Gender Norms By Karen McNamara

2008-01-13T02:48:00.000-08:00

One of the key ways in which these “regulatory norms” operate is by using institutions and discourses of power to produce messages about how gender is properly expressed through the body. Perhaps most obviously, the institution of Western medicine uses a discourse of disease to pathologize the female body and encourage adherence to gendered notions of normalcy.

The plastic surgery industry in particular has developed a new lexicon to classify even healthy bodies as abnormal. For example, in the early 1980s, the American Society of Plastic and Reconstructive Surgeons launched a media and educational campaign claiming that women with very small breasts were suffering from the disease “micromastia.”

The society submitted petitions to the Food and Drug Administration (FDA) in which they asserted that breast implants were essential to “correct physical deformities.” The physicians also targeted female consumers directly, promoting implants as a solution for flat-chested women to look “more normal.” The literature touted the implants as feeling both “real” and “natural,” underscoring the possibility for “realness” and “naturalness” to be qualities that one can achieve or even purchase (Bloom 95).

Doctors have used similar strategies in advertising genital plastic surgery procedures. Dr. David Matlock, a Beverly Hills-based plastic surgeon, is one of the most outspoken proponents of vaginoplasty, a surgical technique in which incisions are made in the vaginal muscles before resuturing them to achieve a tighter opening.

Generally, the procedure is marketed to women who have experienced a relaxation of the vaginal muscles after childbirth. His office’s publicity materials claim that his “laser vaginal rejuvenation surgery” (an $8,000 procedure which he has trademarked) is an “essential service for women with a certain physical dysfunction” (Gorov C1, Healy F1). Here, the typical and nonpathological condition of a woman’s genitals after childbirth has been elevated to the status “dysfunctional” and requiring surgical intervention.

Rhetoric of “the normal” figures prominently in the power of medical discourse. In interviews with women who have sought out these surgeries, the women emphasize that they are not pursuing some idealized version of bodily perfection. Rather, they simply want to look and feel “normal.” In a New York Times article, journalist Mireya Navarro interviews a 39-year-old woman from Boston who underwent labiaplasty, cosmetic surgery to reduce or reshape the labia. She says, “Now I feel free. I just feel normal.” Similarly, a 34-year-old woman from Long Island, who underwent the procedure to reduce her inner labia, says, “I look down and I say, that’s the way it should be” (9.1). Julia Scheeres’s research on the marketing strategies used by this niche of the plastic surgery industry reveals the prevalence of this discourse of normalcy as well. She cites an advertisement from a Los Angeles newspaper that addresses itself to women who “suffer from low self-esteem due to abnormal vaginal appearance.”

Appropriating second-wave feminists’ messaging about empowerment through bodily self-discovery, a press release urges women to “take out [their] hand mirrors” and inspect themselves for defects (71). The message is clear: Simply having female primary sex characteristics in no way ensures that one is a normal woman. Yet, when surgery is promoted as the path to achieve normalcy, the constructedness of the very idea of “normal” is revealed. Although many women may understand “normal” to mean the way their bodies should have been, the notion might more accurately be understood as the way in which culture dictates their bodies must conform.

Alongside the rhetoric of “the normal” is that of “the natural.” The aptly named Dr. Gary Alter is a pioneer in labiaplasty, a procedure sought by many women whose labia minora hang below their labia majora or are asymmetrical in size or shape. He has developed his surgical technique around this very notion of naturalness. In his interview with Fabula, a feminist magazine, he says that in the past doctors would simply “cut off” the offending tissue. However, Dr. Alter found the resulting suture line to be “very unnatural.”

Thus, in an attempt to achieve the all-important quality of “naturalness,” Alter developed a new procedure by which the labia are reduced, but their original edges are left intact (Loy 26). Likewise, some women claim to have sought surgery in the first place because they found their large or asymmetrical labia to be “unnatural.”

Again, this example effectively highlights how this idea of naturalness, although conventionally thought to be a pure condition that exists before any type of cultural intervention, in fact denotes the mark of culture itself. In practice, a body regarded as “natural” is a body that has successfully modified itself to earn such a classification.

Similarly, rhetoric of “hygiene” is often called upon as justification for labiaplasty, as well. Nearly every report of this trend that has appeared in mainstream media publications has quoted doctors and patients alike describing the new beauty standard for the vulva as one of looking “neat” and “clean.” For example, in a Boston Globe article, a 25-year-old student from California, a patient of Dr. Matlock’s, describes her post-surgery genitalia as “cleaner” and “more hygienic” (Gorov C1). Women’s eNews quotes Crystal, who says, “I had labiaplasty and now I love the way I look; nice and neat and new” (Kobrin).

Dr. Matlock offers a similar vision for what he considers the definition of vulvar beauty—specifically, a “nice, clean look” (Healy F1). These descriptions of the ideal of feminine cleanliness recall the shame with which the female “dark continent,” the site of Freud’s castration horror, has long been associated. As Davis writes,

The same social world that generated the mythos of the delicate, proper lady has also continually spawned and recycled dirty jokes about ‘vaginal dentata,’ fatal odors, and other horror-story imagery about female genitalia. The off-color disgust has always been tied in a complex way to a vast, off-color desire, and these both have been concomitant with the prescription to stay dainty (8).

The ideal of the clean, delicate, discreet vaginal slit so widely used in industry discourse functions to cast those bodies that have not undergone these procedures as necessarily dirty and unsightly. Thus, plastic surgery of the vagina becomes a kind of ritual of purification by which the dark, dirty, shameful female body can finally achieve a sense of decorum.

Other discourses are also hard at work to encourage women to bring their bodies in line with gender norms. In the case of genital plastic surgery, the media/entertainment industry factors heavily into how gender norms are perpetuated. Media representations of women with extremely thin bodies and large breasts promote ideals that women want to emulate. However, these images often cannot be achieved without plastic surgery.

A similar phenomenon operates with representations of the female genitals as well. Scholars have noted that in years past, women rarely had the opportunity to see other women’s vaginas and thus had no sense of how a typical vagina might look. However, with the mainstreaming of the adult entertainment industry, that situation has changed. Now, a beauty standard has emerged, one established primarily through porn actresses, nude models, and strippers. According to surgeons, women are bringing in pictures from magazines and adult Web sites, pointing out whose vaginas they want to recreate.

However, the irony of this situation is that in pornographic films and photographs, everything from eye color, to stretch marks, to genitalia can be digitally modified. Gary Rohr, who does image retouching for Flynt Publications says, “The easiest thing to do is to replace genital shots. You take one you prefer and paste it over the one you don’t” (as quoted in Scheeres 73). Similarly, Sharon Mitchell, of the Adult Industry Medical Healthcare Foundation, claims that asymmetrical or wrinkled labia are routinely airbrushed (Healy F1). Thus, the pictures that women bring in to their doctors’ offices and point to as the “ideal” female genitals often depict bodies that never actually existed. In a process that suggests Baudrillard’s simulacra, women are remaking their bodies to become copies of copies that in fact reference no original.

Genital Plastic Surgery and the Production of the Sexed Female Subject By Karen McNamara

2008-01-12T12:42:00.000-08:00

For decades, American women have turned to plastic surgery to make their breasts larger, their stomachs flatter, and their thighs smoother. Recently, more and more of them also want their vaginal openings tighter and their labia smaller. Although no official data are available on how many of these procedures are performed annually, industry experts estimate that plastic surgery of the female genitals is the fastest-growing area of plastic surgery in the United States. How should cultural critics interpret this phenomenon? One useful approach to examining this trend is to consider it as evidence of Judith Butler’s theory that gender actually produces sexed bodies. From this perspective, how might genital plastic surgery serve to transform the bodies of women into “properly sexed” female subjects that are better suited to meet the criteria of the label “woman” under the heterosexual imperative?
In Gender Trouble, first published in 1990, Butler radically challenges the long-held idea that gender is a social construct that imprints itself upon stable, “natural,” sexed bodies. Conventional thinking presumes that gender, particularly the myriad of ways in which people “perform” their role as a man or a woman, is an effect of having one of two kinds of sexed bodies. Butler’s work inverts this assumption, demonstrating how sex is actually a gendered category. As such, gender is therefore a cause rather than an effect, and the mark of gender brings the sexed body “into being” . Butler emphasizes how sexed bodies are created toward a particular end: normative heterosexuality. In Bodies That Matter, published three years after Gender Trouble, Butler continues her investigation of this topic:
The regulatory norms of ‘sex’ work in a performative fashion to constitute the materiality of bodies and, more specifically, to materialize the body’s sex, to materialize sexual difference in the service of the consolidation of the heterosexual imperative. Recognizing Butler’s understanding of the body as a discursive construct, one can begin to consider how even those born with the sexual organs of a female might determine that, nonetheless, they do not “measure up.” Simply having a vagina, it seems, may not be sufficient qualification for membership in the category “woman.”

Sigmoid Vaginoplasty Is Effective In Treating Females With Vaginal Atresia

2008-01-12T11:23:00.000-08:00

BERKELEY, CA (UroToday.com) - The creation of a neovagina is challenging. Although not a common procedure, this may be necessary in those who have vaginal agenesis, vaginal loss, or undergo genital reassignment.
A number of different techniques have been described in the creation of a neovagina; however some methods suffer from technical difficulty or poor postoperative outcomes. Kapoor and colleagues from Uttar Pradesh, India describe their use of sigmoid vaginoplasty in those with vaginal agenesis secondary to Mayer-Rokitansky-Kuster-Hauser syndrome.
They reviewed the charts of 14 patients with Mayer-Rokitansky-Kuster-Hauser syndrome. The average age at the time of surgery was 16.8 years (range 13-22). 13 of the cases were diagnosed at menarche, while one occurred later. The procedure is performed in an extended lithotomy position to allow access to the perineum and abdomen. A simultaneous abdominoperineal approach is used. A 10-15 cm segment of sigmoid colon is isolated on its vascular pedicle to be used as the neovagina. An H shaped incision is made in the perineum and dissection is performed between the urethra and rectum. An abdominoperineal tunnel is created that is large enough to pass at least 2 fingers and the bowel segment is then pulled through the tunnel. The distal bowel segment is attached to the vulvar mucosa using absorbable sutures. The proximal portion of the neovagina is secured to the sacral promontory to prevent future prolapse. The neovagina is packed with petroleum gauze for 48 hours. Patients are taught self dilation and irrigation of the neovagina for mucus. This is performed daily for 8 weeks and then weekly.
The mean follow up of these 14 patients was 4.1 years (range 6 months- 7 years). Perioperative morbidity included one ileus and one superficial wound infection. . All the patients were compliant with dilation and there were no cases of stenosis. At the most recent follow-up, there were no complaints of irritation, dryness, excessive mucus production, or dyspareunia. The subjective satisfaction rates were 8.01 on scale of 0 (very disappointed) to 10 (satisfied).
The authors conclude that sigmoid vaginoplasty is an ideal treatment for vaginal atresia. It can be done safely with minimal morbidity. The sigmoid neovagina is functional, with low rates of dyspareunia, and patients have high satisfaction rates.

Irish doc critical of genital surgery By Irishhealth.com

2008-01-12T11:22:00.000-08:00

While female genital mutilation has been condemned by many developed countries, the issue of 'aesthetic' genital surgery in rich countries garners no such criticism, an Irish doctor has said.
Genital mutilation, sometimes referred to as female circumcision, is a traditional practice in some developing countries. It is generally condemned by the western world.
However writing in the British Medical Journal, Dr Ronán Conroy of the Royal College of Surgeons in Ireland (RCSI), insisted that genital surgery in the developed world should be tackled before other traditional practices are criticised.
"The practice of female genital mutilation is on the increase nowhere in the world except our so called developed societies. 'Designer laser vaginoplasty' and 'laser vaginal rejuvenation' are growth areas in plastic surgery, representing the latest chapter in the surgical victimisation of women in our culture", he wrote.
Furthermore, this burgeoning industry is able to operate without the slightest attention being paid to it by medical researchers, he said.
He pointed out that the literature on female genital mutilation is 'long on polemic and short on data'.
"European and American writers often assume that it is forced on unwilling young girls, but this is at odds with the high social value placed on it in societies that practise it", he said.
He suggested that 'our own sexually repressive use of female genital mutilation may be at the root of our misunderstanding of its role in other countries'.
Dr Conroy believes that the 'high moral tone' with which those in richer countries criticise female genital mutilation would be more credible 'if we in the rich countries had not practised it and did not continue to practise it'.
"It is western medicine which, by a process of disease mongering, is driving the advance of female genital mutilation by promoting the fear in women that what is a natural biological variation is a defect, a problem requiring a knife", he added.

The Most Private of Makeovers By MIREYA NAVARRO

2008-01-12T11:16:00.000-08:00

HE 39-year-old yoga instructor was like a lot of women these days: she was unhappy with her body and thought that a little sculpturing by a plastic surgeon would help. But her goal was not the usual smoothing out of facial wrinkles or expanding her bust.
Instead she wanted to achieve her beauty ideal in the most private part of her anatomy — her genitals.
"I was very, very self-conscious about the way I looked," said the woman, who lives in Boston and spoke on the condition that her name not be used, to protect her privacy. "Now I feel free. I just feel normal."
As millions of women inject Botox, reshape noses, augment breasts, lift buttocks and suck away unwanted fat, a growing number are now exploring a new frontier, genital plastic surgery. They are tightening vaginal muscles, plumping up or shortening labia, liposuctioning the pubic area and even restoring the hymen, sometimes despite their doctors' skepticism about the need for such cosmetic measures.
Procedures that once were reserved for problems like incontinence, congenital malformations or injuries related to childbirth are now being marketed by some gynecologists and plastic surgeons as "vaginal rejuvenation," surgical techniques to enhance sexual satisfaction and improve the looks of the genitals.
Even doctors who do not advertise say they get inquiries from patients every month.
"There's remarkably amazing patient interest in this," said Dr. V. Leroy Young, chairman of the emerging trends task force for the American Society of Plastic Surgeons. "This is at that early stage where there's a lot of enthusiasm for it." Dr. Young said his group, the largest organization of plastic surgeons, has not yet started tracking how many doctors are making "gynecologic cosmetic care" or "vaginal rejuvenation" their specialty, but he said that anecdotal evidence suggests that while the numbers may be relatively small compared with other surgeries, demand for genital procedures is growing rapidly.
The most popular of those are tightening of the vaginal muscles, or vaginoplasty, and reduction of the labia minora, called labiaplasty. Doctors who perform the surgeries, which are usually done on an outpatient basis in less than two hours and can cost from $3,500 to $8,000, say that the reasons for the procedures are not always purely cosmetic; some women with large labia, the surgeons said, suffer discomfort wearing tight pants or during activities like bicycle riding.
But primarily, doctors say, aggressive marketing and fashion influences like flimsier swimsuits, the Brazilian bikini wax and more exposure to nudity in magazines, movies and on the Internet are driving attention to a physical zone still so private that some women do not dare, or care, to look at themselves closely.
"Now women shave," said Dr. Gary J. Alter, a plastic surgeon and urologist with offices in Beverly Hills, Calif., and Manhattan who has come up with his own "labia contouring" technique. "Now they see porn. Now they're more aware of appearance."
Dr. Bernard H. Stern, a gynecologist in Fort Lauderdale, Fla., began to focus exclusively on genital cosmetic surgery four years ago and said he had seen his business quadruple this year, to four to five surgeries a day on patients who come from all over the United States and abroad.
"It is lucrative and it has patient appreciation," said Dr. Stern, who has a Web site and runs ads in strip club magazines.
Other doctors who perform genital surgeries as part of broader medical practices say they are seeing at least a handful of patients a month concerned with the aesthetics of the vagina.
Some procedures, like hymen reconstruction, are relatively rare and confined to a minority of women who need to conform to religious or ethnic rules on virginity, doctors said. A greater number of patients complain of stretched vaginal muscles because of childbirth and aging, or inner labia that are too big, too uneven or unsightly.
"The women feel undesirable or unpretty," Dr. Stern said. "Even if nobody sees it, they see it."

The yoga instructor from Boston, who flew to Dr. Alter in Beverly Hills for a labiaplasty four years ago, said she was "asymmetrical": part of her inner vaginal lips extended about half an inch beyond the outer labia.
"The only women I could compare myself to was women in pornographic movies," she said. "They were tiny and dainty and symmetrical. Nobody looked like me."
A 34-year-old housewife from Long Island said a similar problem nagged her through adolescence, marriage and three children. Like other women interviewed for this article, she would speak only on the condition of anonymity because of the private nature of the subject and fear of ridicule.
"It never bothered my husband," she said, "but it was always like `Yuck!' All I know is that what I had I didn't like."
Just two years ago, she said, she could not find a doctor in her area with experience in labiaplasty or who would not play down the problem and try to keep her from seeking a surgical solution.
Last year she went online and found Dr. Edward Jacobson, a gynecologist in Greenwich, Conn., who performed a labiaplasty using a laser technique.
Now, she said, "I look down and I say, that's the way it should be."
But, some doctors warn, buyer beware. Vaginoplasties are often touted as a way to improve sexual satisfaction for women, but Dr. Thomas G. Stovall, president of the Society of Gynecologic Surgeons, the principal group for gynecologic surgeons with academic appointments, said there is no scientific data to back up the claim.
The opposite is true, he said; painful intercourse can result if the vaginal muscles are too snug.
Other possible risks from genital procedures are painful scarring or nerve damage that could result in loss of sensation or hypersensitivity, according to some doctors. But they added that the procedures have a low rate of complications and that their happy customers reject those qualms.
A 41-year-old police officer in Fort Lauderdale who saw Dr. Stern for vaginal surgery last June said that after having four children she thought her vaginal muscles needed improvement, both for her and for her partner.
Like many other genital surgery patients, the officer has had other plastic surgeries, including breast augmentation and liposuction.
"I just felt that I keep myself in shape everywhere else, and this would make me feel better," she said, adding that the surgery has given her more intense sexual enjoyment.
One patient, a 22-year-old college student from Toronto, said she had never had intercourse until after her labiaplasty because she felt "insecure and ugly" about excess labia tissue.
"It's just that when you feel bad about your body, especially this part of your body, it's kind of impossible to let your true feelings and passions show," she said.
Now, after the surgery last May, she said, "I have nothing to hide."
Some sex therapists are troubled that the emphasis on a youthful look in the doctors' ads are creating demand. And some pointed out that there are dissatisfied customers as well.
Dr. Laura Berman, director of a treatment clinic for female sexual dysfunction in Chicago, the Berman Center, said some of her patients complained that they ended up with pain or could no longer be sexually aroused after undergoing some of the procedures. Unlike most other cosmetic procedures, she said, genital plastic surgery has the potential to harm function.
"Any time you're having surgery that involves any kind of intervention in the genitals you're asking for trouble in regard with your sexual function," she said.
Dr. Berman, who this year completed a national survey on the effect of women's "genital self-image" on sexual function, said most women "walk around with a feeling of anxiety about their genitals" because women are not usually brought up feeling confident about that part of the body. "These surgeries kind of play into that," she added. She said her research showed that a woman's comfort level with her genitals affects her sexual enjoyment.
But she and other sex therapists say they recommend less drastic measures, like Kegel exercises to strengthen pelvic muscles, as a way to deal with any insecurities.
Some plastic surgeons, who note that there is no such thing as "normal" female genitals, are scratching their heads.
"It doesn't make a lot of sense to me, to be honest," said Dr. Young, of the American Society of Plastic Surgeons, who said he does a small number of labiaplasties in his practice in St. Louis. "I try to discourage most patients."
Even people in the pornographic film industry say there is no universal standard of beauty for genitals and that, in any event, men fantasize about the woman, not any one body part.
Mark Kernes, a senior editor with the trade magazine Adult Video News, said, "I really don't think most men care."
Some doctors said men would be flocking to their offices for their own genital surgery if such procedures as penile enlargement were not fraught with complications and unintended outcomes.
Dr. Alter, the plastic surgeon and urologist, who performs genital surgery on both women and men, said, "With female genital surgery it's predictable, and women are extremely happy."
The housewife on Long Island agreed. "I'm not saying you should do it on a whim," she said. "But if you think it'd make you feel better, why wouldn't you do it?"

Intimate perfection By By Daphna Berman

2008-01-12T11:07:00.000-08:00

When women come to Dr. Bernard Stern's office for plastic surgery, they aren't seeking larger breasts, fewer wrinkles or even a flatter stomach. Instead, they've come to him for help in reshaping their most intimate body part, an area hardly anyone - including themselves - ever even sees: their vaginas. Stern, an American physician visiting Israel this week, is at the forefront of this new, lucrative and controversial trend in genital cosmetic surgery, often marketed as "vaginal rejuvenation." The trend, still relatively new in the United States, has yet to make serious forays in Israel. But American women, it seems, are no longer just injecting Botox, getting liposuction or turning to silicon to carve out a more perfect body. New surgeries now also allow them to tighten vaginal muscles, trim or plump their labia and make cosmetic changes to their most intimate body parts in what some pundits have referred to as the making of "designer vaginas." Stern, an obstetrician/gynecologist by training, has performed about 750 of these surgeries from his office in Ft. Lauderdale, Florida. He specializes in labiaplasty, reshaping the labia (the lips surrounding the vagina); as well as vaginoplasty, a procedure that tightens the vagina. He also performs hymenoplasty, which restores the hymen to its "pre-sexual state." The prodecure is done mostly for Muslim women who want to appear like virgins on their wedding night, even if they've already had sex.

"The demand is definitely growing," Stern, here on vacation, said of the surgeries. "I make it very clear to my patients that they don't need this, that it is an elective cosmetic procedure. But this isn't about vanity. My patients aren't strippers and dancers. These are educated women." The trend in vaginal plastic surgery, blasted by feminists, also has received a tepid response from the established medical community. The American College of Obstetricians and Gynecologists advises women against the procedures, citing a lack of "documentation of their safety and effectiveness." In a statement issued by the organization in September, the doctors also warned, "It is deceptive to give the impression that any of these procedures are accepted and routine surgical practices." In Israel, Prof. Rami Neuman, the head of plastic surgery at Hadassah University Hospital in Jerusalem, says he refuses to perform the surgery. "If there is a growth there, we will operate," Neuman said. "Anything else is stupid." But that hasn't stopped women from flocking to Stern and the hundreds of doctors in the U.S. who now advertise the procedures. Indeed, this newest rage is considered the fastest-growing sector of American cosmetic surgery. Stern says he performs about five surgeries a day on busy Fridays, and that most of his patients come from out of state. He's been featured in The New York Times, the Chicago Tribune and Bloomberg news, as well as Hustler, the pornographic magazine. "Just like women have larger than average ears, they can have labia sizes," Stern explained. "They can have labias that are four times as large or as thick. Even though nobody else sees it, they know it's there and it bothers them." Stern, 61, spent most of his career delivering babies, specializing in high-risk cases. He worked closely with the Chabad community in South Florida and was its unofficial chief obstetrician for many years. But in 2001, Stern shifted gears, to put it mildly, and began performing the vaginal plastic surgery procedures. In his first year, he worked with 17 patients; now, he'll see that many patients in a week. "It's a matter of exposure," he said of the explosion in interest. "Women are just now finding out that these kinds of operations exist." He also points to television programs like Nip/Tuck and the reality show Dr. 90210, as well as women's more "heightened knowledge of their anatomy" as additional influences. "It's a very private surgery and many women seek this but won't tell anyone about it," he said. "Vaginal plastic surgery is still taboo, the way that breast augmentation was 20 years ago. Women are now open about getting face lifts, but 25 years ago, they'd just disappear for six weeks." Some 11.5 million cosmetic surgical and nonsurgical procedures were performed last year in the United States, according to the American Society for Aesthetic Plastic Surgery (ASAPS). Although the trend in Israel is obviously on a smaller scale, it, too, is growing. More than 11,600 cosmetic procedures were carried out this year, according to the Israel Society of Plastic Surgeons, compared with 10,000 in 2005, an increase of 16 percent. In the U.S., the cosmetic procedures are advertised mostly online and come with promises of increased sexual fulfillment. Vaginoplasty, for example, which costs some $6,500 and is popular with women in their late 30s who have had children, is designed to restore vaginal tightness. The surgery, according to Stern's Web site, "can usually correct the problem of stretched vaginal muscles resulting from childbirth(s), and is a direct means of enhancing one's sexual life once again. The procedure typically tones vaginal muscle, resulting in greater contraction strength and control, thereby permitting greater sensation during sexual experiences." "Women ask, 'Will I have an orgasm if I never had one before?' and I tell them no," Stern says. "This operation will restore the vagina to the way it was when you were 18 or 20 years old, before you had children." Equally popular is labiaplasty, which costs some $5,500. Stern says women come to him distressed by large or disproportionate labias and though he admits there's no real need for "pretty labia," he says that the operation can also have a functional aspect. Some women, he says, wish to rid themselves of the discomfort from wearing tight pants or horseback riding. His Web site, www.cosmeticsurgery2.com, includes before and after pictures of patients who have undergone the procedure. Stern also specializes in hymenoplasty, performed mostly for ethnic and religious reasons, on patients who wish to re-rupture their hymen on their wedding night as a sign of virginity. Some married women have reportedly sought the procedure as a kind of "ultimate gift" to their husbands - an intimate and painful take on the traditional watch or necktie wedding anniversary present - though Stern says he refuses to conduct the procedure in those cases. Critics, meanwhile, are disturbed by the surge in demand for these unnecessary and costly surgeries. Increasingly exposed to pornography that is often digitally altered, they say people don't realize that female genitalia can vary significantly from woman to woman. And in a culture where beauty is becoming increasingly standardized, it is unclear where this latest craze will lead. Stern, for example, says he's been approached by three Israeli physicians who have expressed interest in studying with him in order to import the procedure. But he nevertheless rejects claims of fueling the craze, insisting that he is simply boosting women's self-confidence in intimate areas. "You won't see me on late-night television or on billboards," he says. "People don't know I exist until they come looking for me." "I delivered babies for many years as an OB/GYN and I brought so much joy and happiness to my patients. I have the same joy now doing what I do. For those who want the surgery, it is crucial. I restore a sense of normalcy and am changing lives, one woman at a time." Still, he admits that he won't casually discuss his specialty with strangers he meets at dinner parties. "People don't feel comfortable talking about it," he explains. "I'll just say I'm a cosmetic surgeon, without going into the specifics."

Designer Vagina Chat Transcript

2008-01-11T08:51:00.000-08:00

O.k. this topic popped into my head this morning. I am having an uncomfortable day today (almost a feeling like everything is swollen) and after weeks of not checking I couldn’t help myself and after my bath had a feel around! My cervix to my surprise was sitting a good inch higher than normal but where it has moved up it has revealed more than ever my saggy front wall which I am terrified is going to continue to sag and eventually my bladder will fall with it (if it hasn’t already to some extent). I kept thinking to myself that although we can reposition our organs and pin them in a better place keeping everything tucked up inside there is absolutely nothing we can do to re-tone this sagginess. I don’t expect to be like I was when I was 18 after having had a traumatic birth experience and I can put up with some sagging but you are lead to believe this just is not the norm and that makes me feel freakish
I had no reason to examine myself prior to prolapse so have no idea what was going on up there before so have nothing to compare it with.
Anyway (sorry I am waffling on here) I starting thinking about the latest trend of designer vaginas. Having googled it and read a little bit about it, it says and I quote “surgeons are offering a growing range of operations to change the size and shape of the vagina and/or labia. Some use scalpels, others lasers, to tighten the vaginal muscles and support tissues and reduce flaccid or floppy vaginal linings (vaginoplasty). They can also build up the area between the vagina and the anus and repair any internal damage following childbirth which may have resulted in urinary or faecal leakage.”
Now surely this can lead to POP?
It is frightening that there are loads of young and not so young women out there undergoing this surgery who do not have POP but are now putting themselves at an increased risk.
Am I wrong?

You are not wrong. Unfortunately I believe you are right on target. It is bad enough women (younger and younger!) are falling for the pressure to get nose jobs, boob jobs, and other purely cosmetic procedures to try to achieve "perfection" (WHY???) but in most cases these other procedures do not by mere construction wreck the underlying natural support system. The youngest generation today has NO concept of being able to survive without over-technologizing everything. It is absolutely terrifying if you stop and think about it; they're being programmed from birth to look to the massive industrialized medicine machine for now, not only treatment for disease, but for unnecessary crap like this. Excuse my language, but I find it disgusting the way young women more and more submit themselves to risky major surgery for pure vanity. Nothing against modern medicine per se! Thank god we have these procedures for mastectomy patients, accident victims and so forth. And I certainly believe in individual liberty; you want to drop several grand on bigger boobs go for it. But personally, I am making damn sure my two girls get a motherlode of information from me about the risks of going down this idiotic, self-absorbed pathway. Beautify your inner self a little more ftw and I don't mean the vagina.
I don't mean to offend anyone if you have had a cosmetic procedure. If it made you happy and you paid for it yourself (not my tax money) then more power to you. My beef is with how society is pushing very young women into this sort of thing. Even teenagers. It is dangerous and misleading to allow them to go under the knife under the illusion that bigger boobs will fix their social life or god-forbid, enhance their (unmarried) sex life.

Designer vaginas grown in lab By Stephen Brown (Reuters)

2008-01-11T08:45:00.000-08:00

An Italian doctor has reconstructed vaginas for two women born with a rare congenital deformation, using their own cells to build vaginal tissue in the lab for the first time. Professor Cinzia Marchese of University Sapienza in Rome says a 28-year-old woman who underwent the first such operation a year ago now has a healthy vagina. "She has got married and is living a normal life," says Marchese, a professor of clinical pathology and biotechnology whose study is published in the journal Human Reproduction. The second operation was on a 17-year-old girl. The researchers took cells by biopsy from where her vagina should be and say the cells should grow in the lab to provide mucosal tissue, from which to 'build' a new vagina.Mucosal tissue is found inside the vagina, the mouth and elsewhere in the body and has important attributes distinct from ordinary skin. The two women have a condition called Mayer-von Rokitansky-Küster-Hauser syndrome, or MRKHS for short, which affects an estimated one in 4000 to 5000 female infants. Girls with the syndrome are born with no vagina. They often have a normal uterus, ovaries and external secondary sexual organs such as breasts, but cannot have sexual intercourse or give birth. "Usually the syndrome is diagnosed when they are young and they try to have sexual intercourse for the first time and it hurts," says Marchese. Women with MRKHS are often embarrassed to talk about it with their parents when they are young and often "live the rest of their lives with no normal sexual life, even though they are normal women with normal feelings", she says. Alternative to surgerySo far, surgeons have been able to correct the condition by reconstructing a vagina out of grafted skin or from intestinal tissue. But the surgery is highly invasive, lengthy and painful. And it takes a long time to grow a normal mucosal wall. Such women, if they have healthy ovaries, have been able to achieve pregnancy by artificial insemination but would then need a surrogate mother to carry the fertilised eggs and give birth.But the Italian researchers take a different approach. "What we do is to take a little biopsy of 0.5 centimetres from the place the vagina should be," Marchese says.The researchers then used an enzyme to break down the tissue and let the immature cells, called stem cells, generate new, mucosal tissue on their own. It takes about 15 days to get a thick enough layer to transplant into the patients, Marchese says. Marchese studied using stem cells to build sheets of skin in vitro to provide skin grafts for burn victims at Harvard Medical School with the technique's pioneer Professor Howard Green."When I came back to Italy I modified this technique for mucosal vagina tissue," she says, adding that its success could be good news for women with cancer and other vaginal complaints.

Designer Vagina By Jamye Waxman

2008-01-11T08:43:00.000-08:00

RELATIONSHIFTS:When I first read the phrase “to be feminine is to have a tight, well-toned vagina” I wanted to tighten my fingers around someone else’s tight, well-toned neck, preferably the someone who wrote the stupid fucking phrase in the first place. In a country where thin is always in and self esteem is, for a lot of women, lower than the “you must be this tall to ride” sign, it’s never a good time for some half wit to start spewing his stupid beliefs about what is and isn’t beautiful or feminine, when feminine is not for any one person, or website, to decide.I hate that there are websites called the Vagina Institute and another for vagina enhancement, both subscription based services that provide women with what they describe as “the best insight” into their own vaginas, that tout mottos like small is beautiful, and encourage women to reclaim the vagina of their virginal youth. I can’t tell you what’s going on in the Vagina Institute because I will not chalk up the $17.95/month ($18.95 for the vagina enhancement site that will provide me with the secrets to non-surgical size reduction) so they can tell me how to fix my possibly imperfect vagina, even if I believe my birth canal is just fine, thank you very much. Perhaps whoever created the Vagina Institute has a really small penis and that’s why this “gender neutral” site is around in the first place. Oh, and I’ll let you in on what may be the vagina enhancement secret, it’s called kegel exercises, so there go spend you $18.95 on a new vibe for your vulva.
Of course you can still take the “how does my vagina measure up” quiz, and ask yourself does your vagina look “good and appealing,” or “ugly and unsightly.” Or you can just ask yourself, who thought up this question, and what is their problem? Okay I know that some women really do have problems with overly loose vaginas, especially after lots of childbirth, and that some women really do need to find a way to make their vagina’s tighter, but most women do not need to hear any of this trash talk from a site that has a self help book whose cover portrays a woman with an obviously warped boob job. Yes, a woman’s vagina does loosen up over time. It is after all a muscle and muscle’s need exercise in order to stay strong and in shape. That means it’s mui importante for women to do kegel exercises, just as it’s important for each and every woman to love the curves, folds and crevices that are our cunts. Now, once the love fest is over (and you better have spent at least a minute or two looking at and loving the vulva in your life even if it doesn’t belong to you) start your kegels, and do the exercises at least four times a week for the rest of your life.
To do your kegel exercises, sit on the toilet and pee, then stop the flow and start again, and do this until you know the muscles you’re using to make it all happen. And then, don’t do that again because it’s not good for you to stop your stream of urine all the time, but use those muscles, those pelvic floor muscles and hold in and release at least 100 times a day. If you can hold for three seconds each time, great, if not it’s still great that you’re doing the exercises. To make sure you’re working the right muscles, put a finger inside your vagina and squeeze. If you can feel the sensation of your finger getting sucked on, then you’re probably doing it right.
Kegels are great because the strengthen your pelvic floor muscles. They help you to not pee when you laugh or sneeze (it’s technically called incontinence). They can help a woman through childbirth and they definitely help you improve your orgasmic potential and therefore sex life. And yes men can do them too, although they won’t help him with through childbirth.
Again, some vaginas are larger than others, just like some penises are smaller than my middle finger, but that doesn’t mean I think he should find a way to plump his pinky dick up just so he can be more masculine. A penis does not make the man, so why should a vagina define the woman?

VAGINOPLASTY

2008-01-10T07:59:00.000-08:00

An enlarged vagina is frequently a problem after childbirth, especially after multiple children, vaginal delivery of a large baby or a difficult delivery. Birth-giving, aging, and genetic factors often cause the vaginal muscles to loosen and weaken, sometimes even tear. The result can often be loose, weak, vaginal muscles.

The diameter of the vagina gets bigger and there is a loss of feeling. Sexual gratification is directly related to the amount of frictional forces generated. The loose and unsatisfying feeling that many women feel can also be felt by their male partner during intercourse. It is not, however, a solution for sexual dysfunction, lack of interest or arousal, or orgasmic inadequacy. Many women find that while the experience of childbirth may be the most rewarding of their lives, sometimes the after effects for both their sexual partner and themselves is not as satisfying as it once was.

A woman’s feel, in her vagina has a significant importance in a woman’s life. It is closely related to her self-esteem, and to the actual and expected excitement involved with her sexual life and desire. Discomfort in a woman’s vagina can severely affects both her and her partner’s psychological state. Many women with grown children are now seeking renewal of vaginal tissues, both to increase their feeling, sexual satisfaction, and to enhance the sexual experience they have with their loving mate.

Vaginoplasty, is a surgical technique that strengthens the vaginal walls. Generally, anyone in average physical condition or good health can be a candidate for vaginoplasty surgery. Vaginoplasty tightens vaginal muscles and surrounding soft tissues, by reducing excess vaginal lining. It will also effectively decrease the internal and external vaginal diameters (tighten the vagina) as well as build up and strengthen the perineal body.The result is an immediate decrease in the size of vaginal muscles, resulting in more friction during sexual experiences. Surgery is done in a hospital under general anesthesia. It usually takes 40 minutes. You may leave hospital the same or the next day after surgery.

Surgery may cause slight pain which can easily be controlled by medication. After surgery, the patient is usually able to walk comfortably within a day, most people can return to their jobs within a few days and may return to sexual activities within 3 weeks.
Vaginoplasty can increase friction during intercourse and can enhance intimacy. Most patients are very happy after vaginal tightening surgery. Their regained vaginal muscle tone significantly improves their quality of life in general, and the quality of their intimate sex life in particular.

INNER LIP SURGERY

Many women dislike the large protuberant appearance of their labia minora. Labioplasty is a procedure performed on women who dislike the large size of their labia minora, which may cause embarrassment with a sexual partner or discomfort in tight pants, with sports, or during sexual intercourse. Some women are born with enlarged labia and therefore opt to have labiaplasty; whereas others develop the enlargement with age or from child-birth. Occasionally, a woman is self-conscious of her labia since childhood. A labia reduction procedure can be performed to reduce the labia minora.

Women who are self-conscious and unhappy with the length or shape of their labia minora - the inner lips around the vaginal opening - may feel as if they have no one to talk to because the subject is so personal and private. They may keep their thoughts about their bodies to themselves, even while it makes them self-conscious in the bedroom and uncomfortable during many different physical activities such as bike riding or horseback riding. In some instances, women with large labia can experience pain during intercourse, or feel discomfort during everyday activities or when wearing tight-fitting clothing. Others may feel unattractive or wish to enhance their sexual experiences by removing some of the skin that covers the clitoris. The overly large labia minora can also result in constant irritation in tight pants. Medical reasons for labioplasty include discomfort or irritation with tight pants, sports, cycling or other physical activities. In many instances, women are born with large labia; others may develop the condition with childbirth or age.

Aesthetic (beautification) reasons include self consciousness and self-esteem issues and a desire for sculpting to achieve a better look for ones self. Candidates for labioplasty who are either experiencing sexual dysfunction, embarrassment, or pain because their labia are over-sized or asymmetrical. Also, women who dislike their large labia or shape of their labia, which may cause inelegance or awkwardness with a sexual partner. Although the procedure is usually aesthetic, in order to improve vaginal self-image, it may also be indicated because of pain during intercourse.
The surgery is usually performed on an out-patient basis using local anesthesia.

Surgery takes 30 minutes. Neither the clitoris nor the urethra is affected when the labia is made smaller. The labia will either be shortened or a small triangular-shaped wedge will be removed with the sides sutured together to form smaller skin folds. During this procedure the urethral opening can be redefined and if necessary improvements to the vagina may be made. Retaining a natural shape along with all normal sensation is paramount. Most patients feel fine immediately after surgery. After the procedure you wear a panty liner. A daily bath or gentle shower ensures quick healing.

The sutures dissolve spontaneously so there is no need for physical removal. You can resume sexual relations in about 10-14 days after a labia reduction.Long labia can make a woman self-conscious about her body and can make some physical activities uncomfortable or even painful. By shortening the labia, discomfort and irritation can be greatly reduced if not completely eliminated. Women who before were self-conscious in the bedroom (some women avoid sex all together before the surgery because they are so self conscious) often feel relieved and have more sexual self-confidence.

Labioplasty can also make personal hygiene easier to maintain, as well as helping to simplify such activities as urinating and sexual intercourse. Most patients are very happy after labia reduction. They often wish to have had surgery much earlier. Their regained comfort and self esteem significantly improves their quality of life.

OUTER LIP SURGERY

The vulva encompasses the external female genitalia. The labia are the visible parts of a woman's genitals, commonly called lips. The labia majora are folds of skin, or fatty tissue, covering a thin layer of smooth muscle lying along each side of the vaginal opening. These are two rounded folds of fatty tissue that are covered with skin and extend downward and backward from the mons pubis. After repeated childbearing, the labia majora become less prominent, and in older women begin to shrivel. The labia area is a sensitive issue for women. Shape of the outer lips of the vagina may cause discomfort, embarrassment, or adversely affect sexual intimacy.

The labia majora may be enlarged from birth, secondary to childbirth, or due to aging. The outer lips of the vagina can be enlarged with excess skin and tissue. This enlargement causes an embarrassing bulge in pants or swimsuits. Meanwhile, there are some women than develop very full and large outer lips as a result of weight gain.

This becomes a noticeable nuisance when wearing tight pants, shorts, or bathing suits. It also traps moisture and causes skin irritation, rash, or even promotes yeast infection. Overgrowth of the outer lips may be due to a congenital condition, aggravated by pregnancy, or generalized aging. Early or less severe degrees of labia majora hypertrophy without skin laxity can be managed with liposuction if the primary problem is fatty or puffy labia. Vulvar liposuction can completely remove the unsightly fatty bulges of the pubic area and labia majora.

The fatty accumulations in these structures produce clothing, undergarment, and bathing suit irregularities and bulges. In some cases it can prevent women from wearing clothing of their choice. More advanced hypertrophy can be treated with labia majora reduction which is accomplished by excising an elliptically shaped section from the inner or hidden surface of each labia majora.

The incision is concealed in the valley between the labia minora and majora. Fully developed young women and adult women who are in good health are the best candidates. Labia majora remodeling is a female genital surgery to reduce the size of enlarged outer lips of the vagina. This is a relatively minor procedure and is not painful. General anesthesia is usually used, but sedation with local anesthesia is possible if you choose. A portion of each inner labium is removed.

The scar is hidden in the concavity between the inner and outer labia. This surgery is minor and takes about one hour. Sexual intercourse is restricted for about 2-3 weeks. The incidence of complications is low and manageable. You can resume light duty work in 1-2 days. None of the patients have complained of any loss of sensation or any decline in the ability to have orgasms.Atrophic (sunken, empty, deflated) appearing labia majora may be a consequence of genetic factors, weight loss, or aging.

This results in a loss of the youthful fullness of the labia majora. Augmentation of the labia majora can be achieved by lipoinjection (fat grafting from the abdomen or thighs). This is easily corrected by injecting fat taken from another area of the body. This is collected using liposuction techniques. The surgery is relatively minor and is not very uncomfortable. This surgery is typically is scheduled for 1 hour and performed under sedation with local anesthesia or general anesthesia. It is commonly combined with other female genitalia cosmetic surgery procedures. If performed as an isolated procedure, you should be able to resume sexual activities in about two weeks. None of the patients have complained of any loss of sensation or any decline in the ability to have orgasms.

PUBIC LIFT

A woman may have unsightly fat deposits in her pubic region, which causes a bulge in clothes. This deposit may have been present since birth or acquired with weight gain or puberty. Aging or weight gain may cause the pubic and vaginal regions to descend, resulting in an aged appearance. Following massive weight gain and subsequent loss or a prolonged pregnancy, it is not uncommon for a woman to report dissatisfaction with her loose, sagging, or prominent mons pubis. Occasionally there is an associated skin laxity which creates the illusion of an aged or collapsed appearance due to loss of support. This excess skin and fat may obscure or put excess weight on vaginal area.

These areas can be rejuvenated and lifted by excising excess skin above the pubic hair and removing excess fat in the pubic region. There are many aspects to genital rejuvenation and one of these is mons pubis rejuvenation. The mons pubis is the hair-bearing area of the pubis. Pubic sag may be associated with weight gain and weight loss, pregnancy and aging. A lift or suspension of these tissues is accomplished by excising an elliptical shaped piece of skin immediately above the pubic hairline and removing excess fat in the pubic region. This elevates and rejuvenates the genitalia in combination with liposuction.

These procedures are most commonly performed under general anesthesia in our fully accredited surgical center. In individuals concerned about postoperative discomfort, a pain pump can be inserted but is not typically requested.

The incidence of complications is low and manageable. You can resume light duty work in few days. Sexual intercourse is restricted for about 2-3 weeks. When a pure pubic lift is done, a caesarian type scar just above the pubic hair is used as the approach for lifting the pubis. This scar heals well as a horizontal scar just above the pubis. Surgery is done under general anesthesia and takes about 1 hour. Little pain is present after the surgery. Bruising and swelling may persist for 7 to 10 days. The pubic liposuction and pubic lift procedure may be combined with a tummy tuck or requested after having a tummy tuck. A pubic lift results in a more attractive, streamlined pubic area. Eliminating the sagging skin results in rejuvenation of this area.

Vaginoplasty surgeon lists

2008-01-10T07:55:00.000-08:00

Finding the right plastic surgeon by Over The Rainbow [via archive.org]
European surgeon list by Kate Kira has the most up-to-date info on European surgeons, including dozens not listed elsewhere.
Transgender in Thailand: Links by Andrew Matzner is a great overview of the Thai surgical resources. [via archive.org]
Lynn Conway has a selective list of vaginoplasty surgeons with commentary and photographs of results.
Anne Lawrence has a partial list of vaginoplasty surgeons with commentary and photographs of results.
Trasek.net has an annotated list of vaginoplasty surgeons.
GenderCare has a partial list of vaginoplasty surgeons.
Pamela Sexton has a list of vaginoplasty surgeons, with a focus on Europe.
Susan's Place Transgender Resources has a list of surgeons with reader ratings and comments.

* Asian surnames (last names) are the first word in their names unless westernized.
See also list of surgeons by location.

Travel advisory: Those planning to travel outside their country of residence for vaginoplasty should make preparations with your government's agency in charge of documentation well in advance of their expected travel date. See my legal issues page for details.
• Alter, Gary (Los Angeles, California, USA)
• Bellringer, James (London, UK)
• Bhumsak Saksri (Bangkok, Thailand)
• Biber, Stanley (Trinidad, Colorado, USA) [retired]
• Bowers, Marci (Trinidad, Colorado, USA)
• Brassard, Pierre (Montreal, Quebec, Canada)
• Brownstein, Michael (San Francisco, California, USA)
• Chen CF (Taipei, Taiwan)
• Chettawut Tulayaphanich (Bangkok, Thailand)
• Cholon, Annette (Menlo Park, California, USA)
• Choomchoke Janwimaluang (Bangkok, Thailand)
• Corman, Marvin (Los Angeles, California, USA)
• Dalrymple, James (London, UK)
• Daverio, Paul (Potsdam, Germany)
• Edgerton, Milton (Charlottesville, Virginia, USA)
• Falces, Edward (San Francisco, California, USA)
• Fang RH (Taipei, Taiwan)
• Futrell, J. William (Pittsburgh, Pennsylvania, USA)
• Granato, Roberto C. Sr. (Elmhurst, New York, USA) [retired]
• Greenwald, Daniel (Tampa, Florida, USA)
• Greechart Pornsinsirirak (Bangkok, Thailand)
• Haertsch, Peter (Epping, NSW, Australia)
• Hashmat, Azid (Manhasset, New York, USA)
• Huang, Ted (Galveston, Texas, USA)
• Jirapong Poony (Chonburi, Thailand)
• Kamol Pansritum (Bangkok, Thailand)
• Kenney, John (Charlottesville, Virginia, USA)
• Kirk, Sheila (Pittsburgh, Pennsylvania, USA) [retired]
• Krueger, Michael (Potsdam, Germany)
• Laub, Donald Jr. (Williston, Vermont, USA)
• Laub, Donald Sr. (Palo Alto, California, USA) [semi-retired]
• Lee, Sun-Kyu (Seoul, South Korea)
• Leis, Sherman (Bala Cynwyd, Pennsylvania, USA))
• Mac Millan, Guillermo (Valparaiso, Chile)
• Maldonado, Pablo (Buenos Aires, Argentina)
• Manders, Ernest K. (Pittsburgh, Pennsylvania, USA)
• Meltzer, Toby (Scottsdale, Arizona, USA)
• Menard, Yvon (Montreal, Quebec, Canada)
• Myung, Soon-Chul (Seoul, South Korea)
• Narongdet Jiarapipan (Bangkok, Thailand)
• Nguyen, Tuan A. (Portland, Oregon, USA)
• Paiboon Chitprapai (Bangkok, Thailand)
• Paisarn Asavapakuna (Bangkok, Thailand)
• Pichet Rodchareon (Bangkok, Thailand)
• Preecha Tiewtranon (Bangkok, Thailand)
• Reed, Harold (Miami, Florida, USA)
• Rohatgi, Sheila (Calcutta, India)
• Royle, Michael (Brighton, UK)
• Ruch Wongtrungkapon (Bangkok, Thailand)
• Sáenz de Cabezón y Chico, Jesús (Barcelona, Spain)
• Sáenz de Cabezón y Martí, Jorge (Barcelona, Spain)
• Sanguan Kunaporn (Phuket, Thailand)
• Schrang, Eugene (Neenah, Wisconsin, USA) [retired]
• Seghers, Michel (Brussels, Belgium) [retired]
• Sharma, Manohar Lal (New Delhi, India)
• Somsak Kunachakr (Bangkok, Thailand)
• Suporn Watanyusakul (Chonburi, Thailand)
• Terry, Timothy (University Hospital, Leicester
• Thep Vechavisit (Bangkok, Thailand)
• Thomas, Philip (Hove/Brighton, UK)
• Vesely, Jiri (Brno, Czechoslovakia)
• Vichai Surawongsin (Bangkok, Thailand)
• Walker, E. Peter (Christchurch, NZ)
• Witoon Wisuthseriwong (Bangkok, Thailand)
• Surgeons no longer performing vaginoplasty via IndigoWiki (2005)

Vaginoplasty “Designer vagina”

2008-01-09T05:59:00.000-08:00

The term ‘female genital mutilation’ is usually used to highlight the seriousness of the gynaecological surgery carried out on girls or young women who do not choose to undergo such procedures. It is against UK law and also illegal for any UK resident to take young women out of the UK for FGM. However, it is not illegal for surgeons in this country to carry out labiaplasty and vaginal and vulvar cosmetic augmentation or reduction procedures on adult women choosing to have such surgery, prompting critics to say that “female genital surgery” is the fastest-growing area of plastic surgery.

Private clinics advertise such procedures in the context of “alleviating pelvic floor disorders”; however, much of the promotional material offers women vaginal rejuvenation for the “enhancement of sexual gratification”. Some even offer hoodectomy (removal of the prepuce or vaginal hood), which constitutes Type I FGM, and illegal – even with consent – although they get around this by framing it as “corrective” surgery. While clinics claim that women desire aesthetically enhanced and “youthful” labia, and are concerned about whether the inner or outer lips project sufficiently or too much, it is clear that they are offering medically unnecessary procedures, based on perceived norms of female genitalia dictated by the increasing availability of pornography. It is surely time to question whose desires are being catered for by this surgery.

The clinics sometimes acknowledge that women seeking such procedures may below in confidence about their image or appearance, and that decisions should not be hurried. However, clinics clearly have no reason to acknowledge the pressures and expectations on women’s sexuality and appearance which might lead them to seek such drastic “solutions”, and have no reason to offer any alternative support or advice. They simply claim that the surgery will lead to better sex – i.e. better and longer orgasm – as if a positive sex life is only related to “the amount of frictional forces generated”.

Laser Vaginoplasty, Questions and Answers (Repeat Text)

2008-01-08T05:00:00.000-08:00

Dr. David Matlock is the undisputed leading surgeon for vaginoplasties and laser rejuvenations, having pioneered these procedures over a decade ago. While few women openly discuss vagina-related cosmetic issues, many women wonder about how they can enhance the aesthetic look of their vaginas and increase sexual gratification. In this interview, Dr. Matlock discusses a wide variety of vaginal cosmetic procedures that treat all common imperfections (see full description of procedure options at end of interview)…giving women hopes everywhere.
MMH: What is vaginoplasty and what problems and imperfections does it address?Dr. Matlock: At the Laser Vaginal Rejuvenation Institute we perform two categories of procedures, laser vaginal rejuvenation (LVR) for the enhancement of sexual gratification and designer laser vaginoplasty (DLV) for the aesthetic enhancement of the vulva structures. LVR is primarily for women who have had children and as a result of childbirth they are experiencing vaginal relaxation. This vaginal relaxation results in decreased sexual gratification for the female. LVR enhances vaginal muscle tone, strength and control. It also decreases the internal and external vaginal diameters and builds up the perineal body (the area outsets the vagina and above the anus). DLV consist of numerous aesthetic procedures of the vulvar structures. The most requested is laser reduction labioplasty of the labia minora. The laser procedure sculptures down the labia minora. Women state that they don’t want the labia minora to project beyond the labia majora (large outer lips). We can perform most anything one desires of the vulvar structures (reduction of the labia majora, liposculpturing of the fatty mons pubis and labia majora, autologous fat transplant to the labia majora to enhance them, correct deformities, combination procedures (LVR plus DLV).
MMH: Please discuss the different types of vaginoplasty procedures and what problems and imperfections each treats (i.e. laser reduction labioplasty, augmentation labioplasty, reduction of prepuce).Dr. Matlock: Women want the skin of the clitoris to hug it like a piece of paper is draped over a pencil; this can be done via reduction of the prepuce [excess skin along the sides of the clitoris]. The majority of women have this done with the laser reduction labioplasty of the labia minora., vulvar labioplasty, etc.).
MMH: Which of these procedures is the most common?Dr. Matlock: The most common DLV procedure is laser reduction labioplasty of the labia minora.
MMH: Please describe how the procedure is performed as far as incisions, anesthesia, and other technical details. How long does a vaginoplasty take to perform?Dr. Matlock: LVR is a one hour outpatient laser surgical procedure. One can have their choice of anesthesia from local to general anesthesia. Everyone gets a special block which results in an 18 to 24 hours pain free period after surgery. You can return to work in 7 days and get back to the gym in 2 to 3 weeks. Sex can be resumed in 6 weeks. The laser is used to perform all the cutting and dissecting. The muscles are tightened with sutures. I have treated patients from all 50 states and over 30 countries. Most patients say that they want to be like 16 or 18 years old again. With LVR we can accomplish this. In our DLV procedures the laser is used to perform all the cutting. The same above info also applies to DLV.
MMH: How is the future of vaginoplasty looking and are there any innovations on the horizon that can improve the aesthetic outcome of the procedure?Dr. Matlock: I pioneered and developed LVR and DLV eleven years ago. To date I have treated Patients from all 50 states and over 30 countries. I have 140 surgeons (gynecologist, plastic surgeons, and urologist) trained in my trademarked techniques in over 21 countries. The future of this field is bright. I have just developed a new procedure called a lip/tuck where I lift the sagging vulvar structures. I am also just launching my G-Shot procedure (G-Spot Amplification). This procedure amplifies the G-Spot and enhances sexual gratification.
MMH: When did vaginoplasties start to become popular?Dr. Matlock: The procedure became really popular 11 years ago.MMH: Is there a specific age range for a woman seeking a vaginoplasty, or can a woman of any age have a vaginoplasty? Please specify if there are any ages of patients beyond which or before which one should not have a vaginoplasty?
Dr. Matlock: My patient population is 20s to 40s.
MMH: Are there any special considerations for women who intend to be pregnant as far as when a vaginoplasty is safe to have?Dr. Matlock: With DLV there is no problem if one wants to become pregnant. With LVR the pregnancy can damage the LVR. These patients can have a C/S. This is rare and most patients for LVR have completed their family.
MMH: What types of doctors (i.e. gynecologists, urologists, or plastic surgeons) typically perform vaginoplasties?Dr. Matlock: All the ones you mentioned are good choices.
MMH: Who do you think are the best qualified to perform vaginoplasties?Dr. Matlock: LVR-gynecologist; DLV gyn and plastics.
MMH: What should a patient desiring a labioplasty look for in a physician?Dr. Matlock: Training in the techniques and experience.
MMH: How long do the results of a vaginoplasty last? What can a patient expect 4-5 years and then 10 years after a vaginoplasty?Dr. Matlock: For LVR as long as they don’t have children they should be fine. The cause of the problem in the first place was children.
MMH: How is the recovery like from the various types of vaginoplasties?Dr. Matlock: The patients can return to work in one week. They can resume sex in 6 weeks. The main post operative symptoms are mild swelling and pain which is controlled by pain meds.
MMH: What symptoms can a patient expect to have (i.e. bruising, swelling, numbness) and for how long do they persist?Dr. Matlock: The majority of the discomfort is gone in 7 days.
MMH: Can a patient walk, sit, or use the bathroom easily following a vaginoplasty?Dr.Matlock: The patient will walk into surgery and after the recovery period in the recovery room she will walk out. These are outpatient procedures and the patients can ambulate immediately.
MMH: Can a patient experience permanent loss of sensation following a vaginoplasty?Dr. Matlock: No.
MMH: What are the risks associated with a vaginoplasty?Dr. Matlock: The risks are bleeding, infection (these are the main risk and they are less than 1%); hyposensation, hypersensation, scarring, uncomfortable sex. These are safe, bloodless outpatient procedures with very low risk and high satisfaction.MMH: Are there any scars following a vaginoplasty?Dr. Matlock: No.
MMH: Are there physical exercises, personal care products and routines for the vagina that can help reduce its aging process?Dr. Matlock: Not really. It is a good idea to maintain a normal weight (ideal weight).
MMH: What level of improvement in sexual gratification can a woman expect from vaginal rejuvenation? Does the partner of the woman also benefit from this procedure?Dr. Matlock: Our primary concern is to enhance sexual gratification for the woman but it also enhances sexual gratification for the male.

What is Vaginal Rejuvenation? By Red M. Alinsod, M.D., FACOG, FACS, ACGE

2008-01-08T04:51:00.002-08:00

One of the fastest growing segments of cosmetic surgery is female genital surgery. Many phrases are used to describe what is surgically done and the catch-all phrase lay people have seen with increasing regularity is “vaginal rejuvenation.” The branded name “Laser Vaginal Rejuvenation” has even gained national attention in print and television. In reality, vaginal rejuvenation is a marketing term referring to vaginoplasty, or the surgical tightening of the vaginal canal. Birth trauma, tissue stretching, and improper surgical healing are the usual reasons for requesting vaginoplasty. Vaginoplasty usually entails a modification of a standard gynecologic procedure called “posterior repair” along with rebuilding of the perineum (the space between the vagina and rectum). This procedure was traditionally performed for a fallen or prolapsed rectum, or rectocele. A rectocele is a bulge of rectum going into the vagina. A similar appearing vaginal bulge is an enterocele. It is a bulge of small bowel going into the vagina. Gynecologists and urogynecologists have the most training performing these types of surgery. Lasers, scissors, cautery units, knives are used in surgery. Excellent results have been achieved by all these methods.

Another surgery rapidly gaining social acceptance and widespread growth is labiaplasty. This is when the labia minora (the “minor lips”) are sculpted to look more pleasing and less prominent. The usual reasons for having this surgery done are complaints of large and unappealing labia minora. Many complain of pain and irritation from pulling and rubbing caused by wearing tight clothing, horseback riding, and sexual intercourse. Teens and young women complain of the inability of wearing swimsuits for fear of their labias protruding out and causing severe embarrassment. At times, the labia majora can also be altered by excision of excess tissue, resurfaced and shrunk with CO2 lasers, or injected with fat to make it look more plump and appealing. Others want liposuction done in this area and also above it in the Mons Pubis to make the region less prominent. Labiaplasty and vaginoplasty have been referred to as a “vaginal face-lift.” Gynecologists have performed these procedures for years. Plastic surgeons have recently showed interest in this rapidly growing ultra-sub-specialty surgery.

Modern pelvic and vaginal surgery often requires the use of strong new materials to replace loose and damaged tissues. Urogynecologist are usually the specialists with the most advanced training in these types of advanced repairs. Vaginoplasty typically takes about 60 minutes to complete depending whether or not a rectocele or enterocele has to be repaired and if mesh or tissues are used to repair the vaginal hernias. Labiaplasty takes about 60 minutes to perform. A combination of both surgeries will take two hours to finish. A full pelvic reconstruction involving mesh or tissues will take three hours.

In recent years reconstructive pelvic surgeons and urogynecologist, with specific training in pelvic and vaginal surgery, have popularized these aesthetic genital procedures and have helped provide it legitimacy. It was only several years ago when cosmetic vaginal surgery was attacked vigorously by many medical practitioners as barbaric, unnecessary, and frivolous. However, baby boomers drove the acceptance of these procedures and fueled the growth of this subspecialty. Women did not want to live with unflattering, sagging, and large labias, nor did they want to live with gaping open vaginas and lack of sensation when having sexual relations. Both young women wanting a sleeker appearance of their genitals and older women wanting to repair the ravages of childbirth and time are in the forefront of demand to look and feel young again. Southern California became the birthplace of this movement.

There is great controversy whether or not vaginal rejuvenation can improve the pleasure of intercourse or increase sexual desire. There are no randomized controlled studies showing that narrowing the vaginal canal improves orgasms or dramatically alters a woman’s sex life. Reports of improved sexual sensation from increased friction are by anecdotal experience and less scientific surveys. However, many couples do report more satisfying lovemaking, more tightness, and a belief that surgery has helped their sex lives.
There are only a handful of surgeons who perform these surgeries in adequate volumes to be proficient and adept. Technical skill is of paramount importance but having an artist’s eye is of equal value. The cost of a vaginoplasty is approximately $6,000 with labiaplasty commanding a $5,000 price tag. Combining the surgeries will average $10,000. Insurance companies do not typically cover labiaplasty and vaginoplasty. However, repair of cystocele, rectocele, enterocele, fallen uterus, and slings for incontinence are usually covered by medical insurance. Cosmetic labiaplasty and vaginoplasty can be combined with pelvic prolapse repair at the same time. Some women even have their tummy tucks and breast augmentations done concomitantly as part of their “extreme makeover.”

Medical Study Case:Colpectomy After Vaginoplasty inTranssexuals

2008-01-03T11:03:00.000-08:00

From the Departments of Plastic and Reconstructive Surgery and Pathology, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.
Address reprint requests to: J. Joris Hage, MD, PhD Antoni van Leeuwenhoek Hospital Department of Plastic and Reconstructive Surgery Plesmanlaan 121 NL-1066 CX Amsterdam The Netherlands E-mail: j.jorishage@inter.nl.net
Background: Penile amputation, vaginoplasty, and clitoroplasty help male-to-female transsexuals accept their bodies and increase psychosocial function. Subsequent colpectomy is unusual.
Cases: We report three patients in whom complicated, long-term problems subsequent to vaginoplasty led to total colpectomy in one case of neovaginal overgrowth of condylomata acuminata, and in two cases of colitis in rectosigmoid transplants used for neovaginoplasties.
Conclusion: Before inversion of penile skin, in cases in which the genital skin has condylomata, the risk of condylomata overgrowth might be anticipated. Rectosigmoid vaginoplasty might result in therapy-resistent colitis, which also could lead to colpectomy.

Genital Surgery

2008-01-03T10:05:00.001-08:00

Women and even men may want to have their genitals changed. In women it is usually vaginal surgery, surgery of labia minora and majora and the hymen reconstruction surgery.

Genital Surgery
Vaginoplasty
Labiaplasty
Labia minora
Labia majora
Hymenoplasty – Hymen reconstruction surgery
Vaginoplasty
In general it represents modification of female vagina. Most frequent procedure is the narrowing of vaginal opening, eventually specific narrowing of the vagina, which can lead to its partial firmness.
The aim of the surgical procedure is to return, eventually enable better sexual life to the patient.
This surgery is usually performed in women of middle age that gave birth already and when it came to loosening of vagina and vaginal opening caused by deliveries and increasing age.
The procedure is performed under general anesthesia, it lasts usually 45 minutes. It is performed with following technique: In the area of vaginal opening, on its back side, an excision of a tissue in various extents (according to the wish of the patient, anatomical finding and so on) is made. Then the wound is sutured. It is better to make the extent of the excision bigger and therefore narrow the opening more because consequently during the life it is usual that the vaginal opening widens again slightly.
If the incision is expanded even to the back vaginal wall and into different distances, we can contract the whole vagina like this. This surgery is also performed under general anesthesia, it lasts around 1, 5 hours.
The surgery does not involve only the mucosa, but it intervenes even into the muscle layer of vaginal wall. At first the vaginal mucosa is excided in needed (chosen) extent, next the muscle layer of vagina is firmed and shortened and the last phase of the surgery is to suture the vaginal mucosa. The same is valid about the extent of the excision as it is mentioned in correction of vaginal opening. During this surgery a big prudence and experience of the surgeon is necessary because of the near vicinity of vagina and terminal part of colon to prevent the creation of so-called rectovaginal pouch.
Both methods of the surgeries use absorbable suturing material, we do not recommend sexual intercourse, sometimes even for 6 weeks.

Labiaplasty
Labia minora
This term means surgical modification of inner and outer lips in women.
The labia minora in women often protrude between the labia majora and many times reach unbelievable size. The aim of the surgery is to reduce such protruding inner lips, sometimes even almost completely remove. According to their function we do not recommend their total removal.
The surgery is not usually difficult, it can be performed even under local anesthesia, analgosedation, or eventually under general anesthesia. We use absorbable material and we do not recommend a sexual intercourse for about one month.

Labia majora
Atrophic labia majora, when the fat tissue and elasticity reduce in time and therefore the labia loose their fullness.
There are several ways of solution:

Filling of labia with own fat. The procedure is usually often repeated because own fat can be very soon absorbed according to the frequency of sexual activities.
Another method is the skin reduction of labia majora, when the incision is usually made in the inner side to labia minora.
The combination of both methods.
It is possible to perform all the surgeries even under local anesthesia, although it is better under analgosedation or general anesthesia.
Hypertrophic (excessively large) labia majora
Most often in young women, there are also several ways of solution:

D Magazine Story on Laser Vaginal Rejuvenation, Laser Reduction Labioplasty and Hymenoplasty

2008-01-03T09:35:00.000-08:00

Dallas women are—ahem—opening up to a plastic surgery procedure that some doctors are calling the new boob job.
It’s gotta be a joke. That’s what Shay Gibson thought. Her husband called from the road one night last spring, saying he’d heard a comedian on the radio talking about a plastic surgery that tightens vaginal walls. “I thought there’s no way the procedure can be real,” Gibson says. But, with her interest piqued, she turned to the Internet. That’s where she learned it wasn’t a joke—and that this wasn’t the only operation, either.

Gibson, a 28-year-old mother of three who lives in Dallas, could also have her labia trimmed or even her hymen reattached. Doctors across the country regularly perform the surgeries. And the more web sites she visited, the more FAQ pages and testimonials she read, the more, actually, Gibson thought an operation could be right for her.

Truth was, sex for her had become less enjoyable after the kids were born. She couldn’t feel her husband as much. “I thought, ‘Why not do it?’” Gibson says. Her husband agreed.

She flew to San Antonio last July, where she met Dr. Troy Robbin Hailparn at the Laser Vaginal Rejuvenation Institute. Hailparn is one of two doctors in Texas performing the surgeries—the other’s in Pharr—and the only woman using the laser for these procedures anywhere in the country. Gibson had her vaginal walls tightened and, for appearance’s sake, her labia trimmed. The procedure took a little over an hour. She flew home the next day.

The healing process took two months, but it was worth it. Gibson won’t soon forget the first night back with her husband.

He screamed, “This was so worth the $10,000!”

CALL IT, AS ONE PLASTIC SURGEON DOES, THE SEARCH FOR “designer vaginas.” Call it, as many people do, vanity run amok. The truth is, there’s a growing number of women who want to look like a porn star or feel like a virgin, or who want their sex lives restored or childbirth-induced incontinence cured. There are about a dozen doctors across the nation who perform these laser vaginal rejuvenations. And, no surprise, some of their clients come from Dallas. The laser vaginal rejuvenation, some doctors say, is the new Botox. Heck, the new boob job.

But there are no nationwide statistics kept on the number of such surgeries. The LVRs are too new for that. Dr. V. Leroy Young, head of the American Society of Plastic Surgeons Emerging Trends Task Force, first heard about the surgeries three years ago. He thought then they were a fad. He doesn’t now. He’s noticed the proliferation of ads in magazines and on billboards, and the web sites that have popped up, even the discussion of laser vaginal rejuvenation on Dr. 90210, a reality show on E!. Young says that he hopes to have relevant stats by the end of the year.

It’s about time, Hailparn says. The labia surgeries she performs at her clinic have tripled from two years ago, and the vaginal tightenings have doubled. “I’ve done hundreds of these in the past two and a half years,” she says.

Naturally, not everyone’s pleased business is booming. Some feminist bloggers and authors say LVR is female objectification; at worst, they liken it to genital mutilation. More locally, Charles Curran, a professor of human values at SMU’s Perkins School of Theology, calls the surgeries “just as rank” as anything else society faces today. And the American College of Obstetricians and Gynecologists, while withholding a formal opinion of the surgeries, aired several “concerns” about them in a 2004 letter, namely how the surgeries are marketed to the public, labeled within the medical community, and taught to other surgeons.

Indeed, business booms for people like Hailparn because so few doctors are willing to perform the surgeries. The controversy surrounding them is too great. “I think it’s seen as kind of a vain thing,” Young says. Too vain for plastic surgeons? “The sexual aspect of it is what makes it a little more taboo.”

And we still have yet to talk about what’s most taboo, the hymen repair. Yes, you, too, can have your hymen reattached (well, if you’re a woman). Shay Gibson opted out of that procedure. But Jeannette Yarborough didn’t. She’s a medical assistant from San Antonio and she went to Hailparn to have her vaginal walls tightened and her “virginity restored” as a gift to her husband on their 17th anniversary. “It was the ultimate gift that I could give him,” Yarborough says.

Though Hailparn doesn’t do too many hymen repairs, Dr. Marco Pelosi does. He’s a gynecologist in New Jersey who’s performed hymenoplasties for 30 years. Until recently, the women requesting them came from Middle Eastern cultures in which punishment for an impure bride was, in some cases, stoning. Today, though, most women requesting the surgery are upper-middle class, largely white, coming from all over the world (and, yes, Dallas, too, Pelosi says, though D could not reach any former clients), and they are having the procedure for reasons similar to Yarborough’s. Pelosi now does 10 hymen repairs a month, up from two a decade ago.

“I say it will be a one-night deal,” Pelosi says. “But the women say, ‘I don’t mind.’”

Thomas G. Stovall thinks it’s all bunk. A past president of the Society of Gynecologic Surgeons, he told the Wall Street Journal surgeries to improve one’s sex life rarely work and “hymen repair is a totally bogus procedure.” Jeannette Yarborough disagrees. She says Stovall should ask her husband if he thought the hymen repair was bogus. And as far as the sex goes, both she and Gibson say it is “incredible” now.

In any case, none of this comes cheaply. A hymen repair costs about $5,000, roughly the same price as a vaginal tightening and a labia trim. To have two surgeries performed, as both Gibson and Yarborough did, can cost as much as $12,000. Financing in some cases is provided through the clinic. But, still, $5,000 for a surgery that will be undone by morning? Twelve thousand dollars for surgeries that insurance won’t cover?

“This can be a relationship saver,” Hailparn says. She says the surgeries are borne, more times than not, out of marital unrest. After childbirth, “no one is talking to women about the sexual intercourse,” she says. “Ninety-nine percent of my patients say their OB-GYN isn’t asking about it.” Women have been taught to accept a frustrated sex life, Hailparn says. Or a mid-life filled with pain (because some pants chafe too much) or embarrassment (because some pants reveal too much). “It doesn’t have to be that way,” Hailparn says.

Shay Gibson agrees. “I think every woman should have it,” she says.

Dr. David Matlock, the pioneer of vaginal rejuvenations, who now does 500 a year in Los Angeles and teaches other surgeons how to perform them, offered the procedures 10 years ago “as a result of listening to women,” he says. And he’s kept listening. If a woman is pressured into a surgery, he won’t do it. (Hailparn and Pelosi say they won’t, either.) But now women want more than the perfect vagina, Matlock says. So he’s had to work harder. He’s already patented one idea, even tested it on eager women who enjoyed the results in their yoga and spin classes, or driving over cobblestone streets. Matlock says the product will hit the market this summer.

It is a collagen-based g-spot enhancement.