Cosmetic Vaginal Surgeons Clueless

At a “first-ever” conference on what they hope is a growing field, surgeons showed an appalling indifference to how women experience sexual pleasure.

Some 150 gynecologists, urogynecologists and plastic surgeons met last month to observe, in bloody still shots and loops of video, the signature ways that the fathers of vaginal cosmetic surgery—and they’re all men—carve, burn, cauterize, and stitch the female labia, clitoral environs, vaginal canal, and other points south. They cut in order to create supposedly longed for “designer” vaginas and thereby “enhance sexual gratification.”

Those physicians were gathered for the “first-ever Global Symposium on Cosmetic Vaginal Surgery.” It was the opening salvo in a worldwide effort by the symposium’s sponsor, the nascent International Society of Cosmetogynecology, to set standards for and promote this “new subspecialty.”

Actually, cosmetogynecology is not a real subspecialty (yet) nor is vaginal cosmetic surgery all that new. Fourteen years ago, the star of the symposium—gynecologist David 90210 Matlock—began aiming his lasers at women’s genitals, performing and promoting his “Laser Vaginal Rejuvenation” techniques, which he trademarked and refuses to publish.

Since then, we’ve seen a blizzard of popular press; an explosion of websites for cosmetic vaginal surgery, complete with explicit “before” and “after” vulva shots; and well earned criticism, most notably, from the American Congress of Obstetricians and Gynecologists (ACOG). I decided to head for the Rosen Shingle Creek Resort in Orlando after perusing the symposium’s agenda online and discovering a presentation entitled: “The Great Controversy: Does Vaginal Rejuvenation Enhance Sexual Gratification?” Following more than a decade of female genital slicing and dicing, I was stunned that they might not know the answer to that question. After 11 hours of presentations by 20 male physicians from five countries (Chile, Greece, the Dominican Republic, Brazil and the U.S.), I can tell you with confidence: They don’t have a clue.

“Will it be a Rim or a Barbie?”

In a world where internet porn, Brazilian waxes, and celebrity flashers are ubiquitous, it’s not surprising that one of the most spotlighted procedures of the day was labiaplasty. That’s surgery to reduce the inner (minora) or outer (majora) vaginal lips because they are, to quote the doctors, “too large, loose, floppy, bulky, excessive, uneven, redundant, or overpigmented.” California urogynecologist Red Alinsod—who believes he is the busiest aesthetic vaginal surgeon on the West Coast—proudly presented his signature labiaplasties. They include the “Rim,” wherein he leaves just the edge of the inner labia, and the “Barbie,” wherein he cuts the entire inner labia off.

A few of the presenters acknowledged that no data exist on whether a labiaplasty will burst during childbirth—a major issue since many of the women having labiaplasties are younger, including patients under 18. But not a single speaker raised the issue of the potential impact of labiaplasties on female sensation or sexual stimulation.

Asked for a comment by email on this missing question, Leonore Tiefer, clinical associate professor of psychiatry at NYU and Albert Einstein College of Medicine and a sex therapist, wrote me: “In the opinion of most sexologists, the labia are part of the arousal structures of the genitals and their loss impairs sexual experience.”

Matlock and his disciples (most of the presenters) insisted that for a labiaplasty to provide “a complete aesthetic look,” some of the skin around the clitoris has to be excised. Yet, this can be the cruelest cut, leaving the woman to experience pain, not pleasure, when the clitoris swells and she is sexually aroused.

So inconsequential is this issue that the physicians, including several presenters, who conducted a soon-to-be published, first ever, U.S. multi-center study on outcomes of cosmetic vaginal surgery did not separate out the women who had a “clitoral hood reduction,” much less attempt to assess the impact of that procedure on pain during sexual arousal.

“Vaginoplasties Save Relationships”

The other spotlighted procedure of the day’s proceedings was vaginoplasty—surgery to tighten the vagina and supporting structures, often done in combination with related procedures.

The message from New York City gynecologist Robert Jason was that surgery for a vagina that is “all stretched out… helps and saves relationships.” He heartily agreed with his mentor, Matlock, who in his morning remarks told of a husband delighted with the result of his spouse’s vaginal rejuvenation procedure because it was “like having the same wife, but a new woman.” Jason added his own arguments for the surgery, to wit, “It’s cheaper to keep her,” and “breasts catch a man, but a tight vagina keeps him.” He wondered when a man goes “after a younger woman, is it that she’s more beautiful or is it because of this?” And of course, if it is because of “this,” then (a) it’s understandable, and (b) surgery is the answer. The case he made had little or nothing to do with the woman’s sexual pleasure.

Throughout the presentations, I found myself holding my legs together as tight as I could and having to restrain myself from gasping at the bloody messes being created between women’s legs. Yet, there was nary a sound of dismay in the room. The audience just sat, watched and listened.

But when Alexander Krakovsky, MD, gave the one presentation on male genitals, “Penile Triple Augmentation: State of the Art in Phalloplasty,” and the screen filled with bloody cut and mangled penises to increase length or girth, everything changed. Male voices on my side of the room erupted into audible “aaahhhhs,” moans, and groans, accompanied by much seat shifting and this plaintive question from a row behind me: “How painful is that?”

Show Me the Numbers

The speakers maintained that women were banging down their doors for these procedures—and even more worrisome, increasingly, for corrections of botched procedures. While I found an unattributed stat “in the tens of thousands” for America and a handful of other countries (in an article on Matlock’s website), in fact, no dependable U.S. statistics exist.

The American College of Plastic Surgery collected statistics on “vaginal rejuvenation” for two years and found there were so few procedures (800 in 2004 and just over 1,000 in 2005) that they were not worth tracking; the American Society of Aesthetic Plastic Surgery reported not quite 3,500 vaginal rejuvenations in 2008; and even though gynecologists are major practitioners of these procedures, ACOG collects no statistics.

Whether the number of these aesthetic cosmetic surgeries will truly skyrocket, or whether the vast majority of women will continue to say, WTF? remains to be seen. But as a very self-satisfied Matlock told me at the cocktail party at the end of the day, this branch of medicine, which he believes is where breast implants were 20 years ago, “ain’t goin’ away.”

The next meeting of the International Society of Cosmetogynecologists will be in Las Vegas, in September.