Why does insurance cover Erectile Dysfunction but not Vaginoplasty if the latter is for functional problems?
Doctor Answers 3
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 Reconstruction vs VAginal Rejuvenation
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.