“All You Ever Wanted to Know about Female Genital Plastic/Cosmetic Surgery” Information from Michael P Goodman, MD- Davis, CA


“All You Ever Wanted to Know about Female Genital Plastic/Cosmetic Surgery”

(No-Hype, Honest Information on the procedures of Labiaplasty, Clitoral Hood Reduction and Vaginoplasty/”Vaginal Rejuvenation” Surgery)

All of the mixed information in the media, plus the glossy hype and promises involving labiaplasty and vaginal tightening on advertising websites in my home state of California and elsewhere have got to make the prospective genital reconstructive patient feeling a little like a Christian Scientist with appendicitis… What to Do?!?

It makes sense, and no-one gets upset, when a woman decides to enhance her appearance, function, and self-confidence by selecting a cosmetic or plastic surgery procedure on her nose, abdomen, breasts, butt, etc. However, a decision to “remodel” more intimate areas of her anatomy seems to elicit parental and puritanical responses from more straight-laced medical professionals and “retro-feminists”: who pontificate “…WHY would you want to do that…” or, “…Glory in your uniqueness (sic)…”

Women tend to consider genital remodeling of the vulva (labia; clitoral hood) or vagina for reasons of enhancement of self-confidence and sexual openness, aesthetic, and “functional” reasons such as discomfort from overly generous labia, difficulty in fitting in tight-fitting clothing, or for sexual enhancement after the “loosening” that frequently follows childbearing, by improving coital friction via vaginal tightening and improving vaginal muscular strength.

A “well-endowed” woman with large labia; a woman who has had a couple of large children and now finds herself “loose”, with declining pleasure with sexual intimacy secondary to lack of friction from vaginal laxity—this is not abnormal. BUT—just because something is “normal” (like small breast size) does not mean that it cannot be revised to provide increased comfort and pleasure for its “wearer…”

What is available, and what are the pitfalls?

Labiaplasty/Clitoral Hood Reduction

Labial size and appearance, like breast size and appearance, is extremely variable, as are women’s responses to these anatomic differences. There are no exercises, creams or potions to make labia smaller; this requires a surgical approach, and surgeons certainly vary in their expertise, their approach, their esthetic, their training and experience. A ”score sheet” is an excellent way to evaluate your labiaplasty or vaginoplasty surgeon. (see below)

Several surgical techniques have been utilized for labiaplasty with or without reduction of hood size. Two seem to be the most widely utilized:
1)The “modified V-wedge” procedure removes a wedge of redundant, darkened, thickened, “floppy” labia from the mid-portion, re-approximating the remaining top and bottom labial edges with fine absorbable suture, producing an outcome that includes a smaller curtain of labia around the “opening” for a more “natural” and individualized appearance. If the hood is hypertrophied, the incision line is carried upward laterally on either side to include superficial removal of the thickened hood.
2)The “sculpted linear resection” procedure (sometimes nick-named “Barbie Doll” or “rim look”) involves resecting the enlarged labia linearly, taking off more or less dependant on individual desires, repairing the cut edges with fine absorbable suture. This can remove the majority of the labia minora, leaving a flatter, “cleaner” appearance of the opening, beveling the labia at the upper portions where they connect with the hood.

Both of these methods have their advantages and pitfalls. The “V_wedge gives a more “natural,” individualized appearance, but has a slightly greater risk of separation, and may slightly diminish the size of the vaginal opening. Labiaplasty surgeons performing a linear resection must take great care to not remove too much, which can produce scarring, chafing, and pain with or without intercourse.

The most important thing is to work with a surgeon who both has considerable experience (I’d suggest a minimum of 25 cosmetic/reconstructive cases), and who is competent in both procedures (“…If all you have is a hammer, everything looks like a nail…”). Inexperienced surgeons get into trouble with both unappealing appearance, scarring, and post-operative sexual pain.

Vaginoplasty/Perineoplasty/”Vaginal Rejuvenation”

Vaginoplasty is a surgical procedure whereby the mid/lower half of the vagina, particularly the posterior vaginal wall of “floor” of the vagina is tightened by a “3-layer closure” approximating first the levator, or “tightening” muscles, second by re-approximating and tightening the recto-vaginal fascia over the muscles but under the skin, and third by carefully re-constructing the vaginal wall. (Make certain that your surgeon utilizes a “3-layer closure.) If your surgeon is skilled enough to be able to perform this under a local anesthetic, so much the better, as he or she can ask you to contract the muscles (you’re awake…), thereby being more accurate in locating the best spot in which to locate the sutures. It’s also much easier to recover when you’ve not been put to sleep… In selected situations the surgeon may also work on the uppermost vagina if there is a concomitant loss of support of the base of the bladder with mild incontinence, and/or women with a very wide uppermost vagina. This modification requires a general or spinal anesthetic however. Vaginoplasty is always combined with a “posterior colporrhaphy and perineoplasty, or reconstruction/tightening of the vaginal opening, bringing the perineal muscles together, building up the opening to change the angle of “vaginal thrust” for more pressure on both the G-Spot and the clitoral body.. “Vaginal rejuvenation” is a proprietary term meaning vaginoplasty and/or periineoplasty). Again, the important thing is to work with a surgeon well-experienced in these procedures. There definitely are potential risks from vaginoplasty (not tight enough; too tight; injury to rectum or bladder, infection, post-operative pain, etc.) so it is important to find the right surgeon!

Additionally, a vaginal tightening procedure is only as good as your perineal/vaginal muscle strength. Make sure your surgeon carefully checks this, and if it is weak, that (s)he refers you to a “pelvic floor physical therapist” to help you work on your muscular strength, and/or fits and instructs you in pelvic floor exercises with an “APEX, “In-Tone.,” or other pelvic floor exercising device for at least 6 months use, as well as vaginal cones or vaginal spheres for ongoing use. Don’t accept “…just do some Kegel’s exercises…” You will need help to get it just right, and your surgeon is the one who should know this and get things going!.

One last thing: These are procedures with sexual ramifications and overtones. You should expect your surgeon to ask you questions about sexual issues, and to be quite comfortable with the subject. If she or he is not: go elsewhere!

Article by
Davis OB/GYN