Genital cosmetic surgery

The number of women seeking genital cosmetic surgery (GCS) is increasing. We look at the different procedures available and what women should know before choosing GCS. By Kirsten Braun

pdfAlso available in Health Journey Issue 3 2013 (1.6MB)

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What is genital cosmetic surgery (GCS)?

There are several procedures that come under the term GCS. They include:

Labiaplasty – This involves surgery to the labia minora (inner lips) and less frequently, the labia majora(outer lips).  Labiaplasty of the labia minora is the most commonly performed GCS procedure. It generally involves reducing the size of the inner lips so they do not protrude below the outer lips. It is also used to correct asymmetry of the lips, where one lip is significantly different in size/length to the other. Some women have labiaplasty because their labia cause them chafing, irritation and also limit their participation in activities such as bike riding. However, many women also undergo labiaplasty because they are embarrassed about the appearance of their labia.

Vaginoplasty – This involves tightening the inside of the vagina and the vaginal opening by removing excess tissue from the vaginal lining. It effectively results in a vagina with a smaller diameter. Vaginoplasty is often promoted as a solution for women who have experienced a loss of vaginal tone due to childbirth. It is also referred to as 'vaginal rejuvenation'.

Hymenoplasty – This procedure reconstructs the hymen (the thin membrane of skin that partially covers the vaginal entrance in a virgin). The edges of the torn hymen are reconnected so that when sexual intercourse takes place the membrane will tear and bleed. While hymenoplasty is predominantly performed for religious or cultural reasons, it is also being promoted as 're-virgination', for women who want to give their partner the 'gift' of their virginity.

Labia majora augmentation – This procedure seeks to plump up the outer lips by injecting them with fatty tissue taken from another part of the woman's body.

Vulval lipoplasty – This procedure involves the use of liposuction to remove fat deposits from the mons pubis (the pad of fatty tissue covered by pubic hair). This results in the mons pubis being less prominent.

G-spot augmentation – This procedure involves injecting a substance such as collagen into the G-spot in order to enhance its size and, therefore, theoretically also a woman's sexual pleasure. The effects will last 3-4 months on average after which the procedure needs to be repeated.

Clitoral hood reduction – This procedure involves reducing the hood of skin which surrounds the clitoris, exposing the glans (or head) of the clitoris that lies underneath. A clitoral hood reduction is aimed at providing more stimulation, therefore, heightening a woman's sexual pleasure. The procedure is also known as hoodectomy.

Who is having GCS?

There has been an increase in the number of women having GCS in the last decade. Medicare claims for vulvoplasty and labiaplasty jumped from 707 in the 2002/03 financial year to 1,588 in the 2012/13 financial year. Medicare statistics do not include women having their surgical procedures in the private health system so the true number of GCS procedures is likely to be higher. In November 2012, a cap was placed on the Extended Medicare Safety Net(EMSN) for vulvoplasty and labiaplasty. Essentially this means that the Medicare benefit amount that women can claim for these items is now capped, regardless of the fee charged by the doctor. It will be interesting to see what effect this change has on the number of procedures being carried out.

Why are more women seeking GCS?

The rise in numbers of women having GCS is in some part due to a greater awareness of the available procedures. There is a wealth of information about GCS on the internet and major women's magazines have also featured articles on the topic. Similarly, many surgeons advertise GCS services on the internet and in other publications. While more women know about GCS, this doesn't explain why more women feel the need to have it. What is causing women to modify their genitals?

The rise in popularity of Brazilian waxing appears to be one reason why GCS is on the rise. Removing the vast majority of pubic hair means that the genitals are less camouflaged and women are more aware of their appearance. Increased exposure has led women to feel more self-conscious about their genitals and worried about whether they are 'normal'.

How the female genitals appear in pornography has also been given as a reason why women are pursing GCS. Professor Ajay Rane, an urogynaecologist recently remarked to Australian Doctor that GCS was "promulgated by internet pornography – it's promoting a false idea of what genital anatomy should look like."

In order for an adult magazine to be classified as 'unrestricted' and, therefore, sold on the shelf in a newsagent, a woman's genitals must be 'discreet'. Women's genitals are, therefore, typically airbrushed so that the labia minora are not visible, often resembling those of a pre-pubescent girl. The internet has meant that women are more likely to encounter pornographic images and inevitably they may find themselves comparing their own genitals to those of the women featured.

What are the risks and complications of GCS?

GCS carries with it the associated risks of surgery, including the risks of anaesthetic, bleeding, infection and scarring. Other risks of GCS include:

  • Nerve damage and loss of sensation
  • Labia asymmetry
  • Permanent colour change
  • Scalloping of the labia edge
  • Tissue death along the wound
  • Blood clots
  • Pain during sex
  • Change in sexual arousal
  • Dissatisfaction with results
  • Damage to other genital areas

Some of these complications may require further surgery.

In addition, there are very few studies that examine the long term effects of GCS, particularly regarding sexual function, pregnancy and childbirth and ageing. Most existing studies only measure women's satisfaction a short time after the surgery. Similarly, the studies are often conducted by those performing the surgery and, therefore, do not provide an independent view. It is important that there is more reliable and unbiased evidence on GCS.

We know, for example, that the labia play a role in sexual arousal (see What is
normal?). What effect does labiaplasty, therefore, have on sexual function?Similarly, at menopause women often experience less lubrication due to the drop in oestrogen levels. Will women who have had labiaplasty (and hence already have a reduced source of lubrication) suffer more from a lack of lubrication?

Choosing a surgeon

Surgeons who conduct GCS have different qualifications, training and experience. Women should look for a surgeon that belongs to a professional body. For example, a member of the Australian Society of Plastic Surgeons (ASPS) has completed a minimum of 12 years medical and surgical education plus at least five years of specialist postgraduate training. The ASPS provide a searchable database of surgeons on their website (www.plasticsurgery.org.au).

There are a number of questions that women can ask their surgeon:

  • Their experience at performing a particular procedure
  • What particular technique they use (eg., in labiaplasty there are several different surgical variations)
  • The risks/complications and side effects of the procedure and how common (or rare) they are
  • How side effects/complications are treated/managed
  • The level of post-operative pain and how long it will last for
  • Length of recovery (including how much time needed off from work/household duties/sex)
  • If surgery/treatments are required for post-operative complications, who is responsible for the extra costs.

What is normal?

Many women who consider having GCS actually have genitals that are in a normal range. A study published in the International Journal of Obstetrics and Gynaecology in 2011, for example, found of the 33 women requesting a labiaplasty, all actually had normal sized labia minora. Knowing what is normal, therefore, is important in any woman's decision to explore GCS. Patients who request a labiaplasty in Professor Ajay Rane's clinic are firstly shown some 300 images of women's genitals as a way of demonstrating the natural variation.

The female genitals vary greatly in their colour, size and shape. In a 2005 study of 50 pre-menopausal women, published in the British Journal of Gynaecology, the labia minora ranged from 20-100mm longways and 7-50mm in width. As this was only the variation in 50 women, the variation in the general population is likely to be much wider. Labia minora can be short, thick and ruffled or long, thin and smooth and anything in between. They range in colour from deep pink, brownish pink, reddish pink, purplish, grey or black. They are often not the same colour all over but a combination of different colours (ie., edges darker). It is also not uncommon for the labia to be asymmetrical, with one being larger/longer than the other.

The function of the labia minora is to provide a protective covering for the urethra and vagina. They also play a role in sexual arousal. When sexual arousal occurs blood flows to the area and the labia minora swell, heightening sexual pleasure. The labia minora also provide lubrication so that the skin doesn't rub.

The labia majora are also designed to protect the genitals underneath. In addition they act as cushions during sexual intercourse. The labia minor and labia majora are derived from the same tissue as that of the shaft of the penis and scrotum, respectively, in a male embryo. This helps to explain why the labia have the appearance that they do.

The mons pubis is also designed to reduce discomfort during sex by providing padding over the pubic bone. This is why it remains, even after a significant weight loss.

As well as a wide variation amongst women, an individual's genitals will change over their life span. During puberty girls may notice a darkening of the skin in the genital area and/or an enlarging of the labia in response to the hormonal changes. Pregnancy is also a time when the labia undergo changes, including enlargement and/or a change in colour. When women reach menopause the connective tissue and fat deposits in the labia majora (outer lips) are reduced and they appear thinner. Similarly, the labia minora may shrink and change colour, becoming paler.

Last updated: October 2013

© Women's Health Queensland Wide Inc. This article was written by Kirsten Braun and reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey Issue 3 2013.

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