Ever considered getting a designer vagina? Once a taboo subject, the cosmetic procedure is increasingly popular. Gynaecologist Dr Gabrielle Downey explains exactly what is involved
We have our hair done. We use make-up. We enhance our breasts. We hone and tone our bodies– so why not consider touching up the area of our body that truly is what makes us a woman physically? Now, children as young as nine are seeking surgery on their genitals because they’re distressed by its appearance. In 2015-16, more than 200 girls under 18 had labiaplasty on the NHS and more than 150 of those girls were under 15. These procedures can be life changing. But they’re not trivial procedures and it’s important to be armed with the facts before you make any drastic changes, especially if surgery is involved. Not all of these surgeries are available on the NHS and can be extremely costly, so even more reason to get armed with the facts.
Indeed, there is no doubt that both nature and life alters our bodies. For some women sex is not as good after they have had their babies. They can’t feel their partners any more. These operations are cosmetic in nature and not medically necessary. They are performed to either improve function or appearance or both. So what can be done to help things?
The most commonly requested procedure at present is excision of excess labial tissue (the inner lips of the vulva that hang outside the outer lips). This is termed labioplasty. Women ask for the surgery either because they do not like the look of the labia, it rubs on their clothes, swells and ulcerates or gets caught during sex. These issues can cause embarrassment and low self-esteem. Labioplasty is a cosmetic procedure to sculpt and remove excess and usually even out the labia minora (inner lips). Some doctors do remove excess tissue around the clitoris (called prepuce reduction) but most will avoid this due to the potential of nerve damage and thus reduced or absent sensation.
Some refer to it as a form of female genital mutilation (FGM)
Surgery in this area is controversial. The NHS cites it as a ‘procedure of limited clinical value’. Some refer to it as a form of female genital mutilation (FGM). The fundamental difference between labioplasty and FGM is choice. The enlarged tissue only is removed. The clitoral nerves are left intact and the vaginal entrance remains the same size. It is illegal to perform FGM in the UK so no doctor will undertake the procedure.
We advise against sexual activity for 4-6 weeks following surgery and tampons for the first six
Labial reduction takes between one and two hours and can be performed under local anaesthetic or general. Some prefer local to avoid an anaesthetic but the chances of symmetry are reduced. Any cuts that are made are carefully placed to prevent scarring along the rim of the labia and are closed with dissolve-able sutures.
You can expect mild discomfort and swelling for a few days after the operation which usually disappears completely after 1-2 weeks. This can be managed by taking painkillers, using local anaesthetic gels, medihoney and teatree oil. A week after surgery you should be able to return to work, and be able to resume normal daily activity after 2-3 weeks. However we advise against sexual activity for 4-6 weeks following surgery, and tampons should not be used during the first six weeks. The labial incisions usually heal quickly and are rarely noticeable.
Costs: ranging from £1750 – 3000
Vaginoplasty or Vaginal Rejuvenation
In some women the vaginal muscles have poor tone, strength, and control. The internal and external diameters increase. The muscles of the perineum are weak and poorly supported. Under these circumstances, the vagina is no longer at its optimum physiological state. As a result, the sensual side of sexual gratification is diminished.
Pelvic floor exercises can improve tone in up to 70 per cent of women
Vaginal Rejuvenation was designed to enhance sexual gratification for women who for whatever reason lack an overall optimum architectural integrity of the vagina. Pelvic floor exercises can improve tone in up to 70 per cent of women and should always be tried first before contemplating any surgery. Women with involuntary loss of urine with coughing, sneezing, laughing, exercising, or sex can have their stress urinary incontinence corrected along with enhancement of sexual gratification can be improved with pelvic floor exercises.
Vaginal Rejuvenation stimulates the production of collagen
For some that is not enough. So what can be done for them? Relatively new to the UK is Laser Vaginal Rejuvenation®. It is about a one-hour outpatient surgical procedure designed to enhance sexual gratification by increasing the amount of frictional forces generated. The healing is quick and you can resume normal activity in a few days to weeks. A wand type instrument is inserted in to the vagina and is attached to a laser. It is performed awake in an outpatient setting and is relatively painless. It stimulates the production of collagen (the tissue that gives your tissue tone and elasticity) as well as increasing fluid production by increasing blood flow. Repeat treatments are required usually annually.
More conventional techniques are to perform a traditional gynaecological operation called an anterior and posterior repair. The excess vaginal tissue is removed and the muscles brought back to the normal position. The recovery is 4 – 6 weeks. It is more precise but equally more complicated with a risk of infection, scarring and damage to bowel and bladder all of which are rare. The need for another operation is 2-3/10 over your lifetime.
Cost: About £4000 (vaginoplasty), £1500-3000 for laser vaginal rejuvenation
The perineum is the area between the front and back passage. It is often stretched at delivery of the baby’s head and the muscles can be torn or cut. This results in a gaping appearance and reduced muscle tone. The fact that the vaginal entrance is more open can result in air getting trapped or difficultly emptying/controlling your bowel movements.
The muscles can spasm when returned to their natural position
Perineoplasty repairs and restores the relaxed, ageing, or injured perineum. It is usually done in combination with vaginal surgery but can be a stand alone procedure as well, as some women have had scarring or poor healing after a vaginal delivery. It can be painful as the muscles can spasm when returned to their natural position and are tightened. The net effect is increased sensation at penetration. Your surgeon has to be quite skilled to prevent it from being too tight and thus painful.
Mons pubis reduction
A lot less common a procedure is reduction of the mons pubis – the area above the pubic bone. Generally it is a cosmetic surgeon and not a gynaecologist who undertakes these procedures. It reduces the bulge in your swimsuit by removing fat (usually by liposuction).
Cost: Around £1500
So ladies, you can see that there is a lot that can be done for your damaged and ageing vagina as well as correcting what nature has given you. My advice is to be sure that:
- You have a real problem
- Your motivation is to restore normality/function
- Your surgeon is competent and gives you informed choice i.e. they tell you all the risks and benefits
- The clinic that you choose is accredited i.e. has a safety record and is safe.
Ultimately it is your choice. Get as much information as your can and be clear what you want to achieve.
Dr. Gabrielle Downey is a Birmingham-based consultant gynaecologist. She has been a consultant gynaecologist at the Birmingham City Hospital for over 15 years. Dr. Downey publishes regularly in renowned journals and writes for medical textbooks, was a co-author to the current NHS cervical smear program and has specialist expertise in problems such as abnormal smears among many other conditions.
Click here to read more about Dr Downey.