Why does insurance cover Erectile Dysfunction but not Vaginoplasty if the latter is for functional problems?

the woman has little to no feeling during sex (even if the man is at 100% capacity - thx to his medically necessary insurance covered Viagra!!) so she either dreads sex or avoids it altogether causing a slew of problems possibly ending her relationship & has bad self esteem, depression, feels "broken". (After having children) This happened to me I had my 2nd son 19 mo ago and 8 mo. Ago had an A&P (for prolapse) still am lax and need revision for popped stitch after 2nd dg tear can insur. Cover?

Doctor Answers 4

Vaginoplasty and vaginal rejuvenation not covered by insurance

I totally hear you!!  Every woman comes in complaining of how their partners are now equip with viagra but hey don't have a reciprocating vagina!  As woman age the narrowing of the vagina and loss of elastin and collagen makes sex very uncomfortable and sometimes even unbarable.  But not all treatment options are covered for woman besides hormone therapy. In the younger woman such as yourself, the looseness is a factor.  But insurance doesn't cover that as well.  This is a battle that will be fought for many years. And maybe we will never win...

Vaginoplasty is for enhancement, vaginal reconstruction is for functional problems and is covered by insurance

Vaginoplasty is done to tighten the vaginal wall muscles in a relatively normal and well supported vagina. This is considered to be a tune-up of essentially normal functioning anatomy. Not much different than a tummy tuck to tighten up loose abdominal muscles in the eyes of the insurance company. However, if you don't have a well supported vagina and suffer from symptoms of prolapse or incontinence, your insurance will cover medical and surgical treatments for these conditions. Keep in mind that reconstructive surgery for vaginal support does not involve tightening of the vaginal muscles. You need an expert in both procedures.

Vaginal rejuvenation, prolapse repair and insurance coverage

Prolapse repairs are performed in the hospital and are billed through medical insurance. Often, when there is vaginal relaxation and looseness with intercourse, there is also some degree of prolapse or rectocele. It sounds like you had a simple prolapse repair that either failed, resulting in recurrent prolapse or that did not include a perineorrhaphy or vaginal tightening. Go in for a consult with a urogyencologist for further treatment options which may include a formal repair with perineorrhaphy. We have patients who travel from out of state for these procedures and the surgery is billed through insurance. 

Vaginal Reconstruction vs VAginal Rejuvenation

Thanks for sharing.....but you should probably address this not with the surgeons but your Prime Minister and ask him the same question.  Your PM nor his wife or children have the same insurance you have - send your concern to your government and take that question up with them. Also reconstruction and getting a rectocele and a cystocele fixed is not the same as rejuvenation. Rejuvenation is really a cosmetic/function type problem and reconstruction is not.  What is vaginal rejuvenation?  Vaginal rejuvenation really means the internal tightening of the vagina and tightening of the vaginal opening usually to enhance friction for intercourse.   In experienced hands this surgery is approximately 85-90% successful as defined by the patient ( i.e. she is satisfied with the enhancement of friction during the act of intercourse 12 months after surgery).   There are only 4 papers written on this topic and my partner, Dr Moore and I are co-authors of two of these papers.    This surgery is usually accomplished by performing posterior vaginal wall surgery ( known as a posterior repair and coupling this with a levator muscle plication) + a vaginal opening repair known as a perineoplasty.   This requires experience, expertise, and good knowledge of  the pelvic floor.   But you don t know if you want of need this--- one surgeon was suggesting it to really just narrow the opening of the vagina so you don't see the internal skin coming out.   You see for many patients who have had multiple childbirths many need more than just tightening procedure they actually need vaginal reconstruction. Interestingly YOU did not mention anything about being tightened......only YOU can tell the surgeon if you want or need to be tightened.
What is vaginal reconstruction?  Vaginal reconstruction is what most urogynecologist have been trained to do...to reconstruct the vagina to give the support back and this does NOT focus on tightening the vagina. The urogyencologist has extensive training and is the most experienced of all surgeons in operating on the relaxed vagina.  The urogyn  is trained by first spending  4 years in a residency in obstetrics and gynecologic surgery and instead of going out to practice they then tspend 3 more years of subspecialty training in vaginal reconstruction or the rebuilding of the vagina (when it falls down aka vaginal prolapse - see the next few paragraph for an explanation).  Plastic surgeons, dermatologists, an family practice doctors who have perform cosmetic vaginal surgery do little concept of vaginal reconstruction.  They are not trained in residency to do vaginal surgery nor have they spent 7 years learning vaginal reconstructive surgery like a urogynecologist.  In fact I do not know of any plastic surgical residency in the nation who dedicates more than a few months to training their resident on vaginal surgery.    Vaginal Prolapse is basically the same as the vagina falling down and each area of the vagina which falls has its own descriptive name" Uterine prolapse - the uterus is falling down into the hollow of the vagina and towards the opening of the vagina in severe conditions the uterus can actually fall  out of the vaginal opening and it hangs between a womans legs.  Cystocele - the deeper portion of the ceiling of the vagina gives way and the bladder which is being supported fall downward into the hollow of the vaginal canal. Often these patients will suffer from frequency and urgency of urination as well as vagina pressure.  If the condition is very severe the patient will have difficulty emptying her bladder. Urethrocele - the ceiling of the vagina near the opening of the vagina gives way and the urethra sags.  Often these patients will suffer from cough urine leakage ( aka stress urinary incontinence) Rectocele - the floor of the vagina gives way and the rectum pushes upward into the vaginal canal producing a bulge pushing towards or out of the the opening of the vagina.  Often patients will complain of difficulty emptying their rectum of stool.  Urogynecologist have been trained to treat the anatomy of the vagina to support each of these structure as well as consider the function of urination and defecation as they perform surgery. Often this surgery needs to be accomplished laparoscopically i.e. small incisions through the abdominal wall.   However most urogynecologist have not been trained in the concept of cosmetic vaginal surgery or  vaginal rejuvenation .When I reviewed your photos above ( difficult to see the details at the opening of the vagina) it appears the ceiling of the vagina is falling downward suggesting either a cystocele, urethrocele or both.   You certainly would benefit from a thorough evaluation by a urogynecologist or a pelvic floor surgeon.  A cosmetic surgeon for a labiaplasty and a quick fix to tighten the inside of the vagina will not suffice.  So I caution you to choose a surgeon wisely............choose a surgeon who can accomplish both of your needs: 1) cosmetic labia surgery  2)  decreasing the exposure of the inside of the vagina ( which maybe best accomplished by restoring the supportive anatomy of the vagina and NOT JUST TIGHTENING the vaginal opening.  Choose a surgeon who is specialized in urogynecology or vaginal floor reconstruction and cosmetic vaginal surgery.  Please see both sections of my website to get a full understanding and the different between cosmetic vaginal surgery and vaginal reconstruction.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.