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Nip/Tuck/Vagina

By Mia Abrahams

Cosmetic gynecology (aka vaginal rejuvenation) is one of those “buzz” topics that everyone seems to have a *very* strong opinion about, whether or not they seem to know much about it. “It’s because of porn!” “It’s because of unrealistic expectations society places on the way women’s bodies should look!” “It’s your body, do what you want!” “It’s an incredible way for women to address health issues like pain from endometriosis or increase enjoyment and feeling during sex! Yay science!” “Does this have anything to do with vajazzling??” (OK, that last one might be me).

Of course, like any topic that specifically addresses a woman’s vagina, the issue is a lot more complicated than it first appears, so it’s worth breaking it down. Google trends tells me that vaginal rejuvenation as a search term has been growing exponentially in the last 10 years, so clearly y’all are out here Googling too! (PS. S/O to Mississippi for being 2017’s #1 Googling state for the word “period” so far! I wonder if that has anything to do with the state of sex ed….)

The first time I remember being shocked about the rise of this vaginal-cosmetic trend was when I heard that a friend-of-a-friend had gotten a labiaplasty because she was so embarrassed by the size of her labia that she didn’t even want boys to touch her. She was sixteen.

Turns out, she wasn’t alone. So many young girls (in 2016, an 80% increase from 2014) are seeking cosmetic surgery to trim or shape their external genitalia that the American College of Ob-Gyns had to issue guidelines urging doctors to reassure patients, suggest alternatives to surgery, and screen them for psychiatric disorders that might be causing obsessions about perceived physical defects.

Let’s just clear up a couple of things here. Just like there are many more parts to your vagina than just your “vagina”, there are a bunch of different procedures under the cosmetic gynecology umbrella (ella ella ey ey ey).

Labiaplasty is a surgical procedure that reduces the length of the labia minora (the inside labia), and probably what you think of when you hear “designer vagina.” Between 2010 and 2016, the US saw a more than a 100% increase in the surgery. Why would you do this? Well, many women who get the surgery do so because of pain or irritation from too long or twisting labia, and some women get the surgery for cosmetic reasons, because, as this Dallas surgeon’s website explains (I recommend taking a deep breath before reading this next line): “Childbirth, the aging process and the effects of gravity may all erode the beauty of the female genitalia”.

Vaginoplasty (or maybe what you are thinking of when you hear “vaginal rejuvenation”) is a procedure that involves the reconstruction of the vaginal canal – to tighten muscles that might have loosened (common with age or after childbirth). What are the functional reasons you would have the procedure? To make sex feel better or to stop urinary incontinence. A third of women who give birth vaginally have some damage to the muscles responsible for vaginal tightness. And, some women might choose to have the procedure for cosmetic reasons, or to please their partner.

As with all surgeries, there are risks. Labiaplasty could cause damaged nerve endings or scar tissue, resulting in numbness, pain, or loss of sexual sensation, and vaginoplasty could cause infection, scarring, and bleeding. These procedures are also rarely covered by insurance, and can cost thousands. Basically, not something to take lightly.

Non-surgical options for vaginal rejuvenation (price tag: $1,200-$4000), which often have wonderful names like MonaLisa Touch and FemiLift, promise to tighten vaginal muscles, improve vaginal dryness, and address issues such as urinary incontinence and painful intercourse through laser therapy (by burning lots of tiny holes in the lining of the vagina, promoting blood flow and collagen growth, making the skin more taut). While treatments like these are FDA-approved, studies showing long-term effects and efficacy of these treatments just aren’t there yet. Why not? If successful, these treatments could greatly assist women suffering from issues related to sexuality and their ability to enjoy sex, particularly later in life or after childbirth.

Even though, like plastic surgery, cosmetic gynecology is a mix of reconstructive (implants after breast cancer) and elective surgeries (bigger boobs because you want them). As Amelia Harnish writes in her great piece for Refinery29, “thanks to a toxic combination of entrenched sexism and continued dismissal of women’s sexual concerns, even the reconstructive procedures are still deemed frivolous, unscientific, and, ironically, misogynistic.”

It’s clear to me that even after dipping my pinky toe into the world of vaginal surgery, that once you get past the headlines and Real Housewives-style drama of Los Angeles plastic surgeons offices, there is a real need here: women who are suffering – from urinary incontinence, prolapsed bladders, pain, discomfort, or just dissatisfaction during sex… and there are now options out there for them. Of course, as always, there clearly needs to be more research, more studies, more options. We need to open the conversation around this topic (did someone say break taboos???) so that we can give women the tools they need to make whatever decision they want about what’s best for their vagina and health.

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