It becoming popularized under many names: "vaginal rejuvenation," "designer vaginoplasty," "revirgination" and "G-spot amplification" to name a few. In other words: surgery down there. Elective cosmetic genitoplasty being aggressively marketed to women on late-night TV and in magazines; even the NYTimes has written about it. Eponymous websites like labiadoctor.com actively target the young and nulliparous, as well as aging vaginas.How do women talk themselves into it? The proffered promise is that genital surgery can enhance one's sexual pleasure, aesthetic beauty, and self-esteem.
Just who would offer up the most exquisitely sensitive part of her body to a surgeon with a scalpel? Apparently, growing numbers of enthusiastic women. It's estimated that an intrepid few of the 6,000 members of the American Society of Plastic Surgery (ASPS) have performed over 1,000 "vaginal rejuvenations" in 2005, 30% more than the previous year. That doesn't count in the pioneering gynecologists who do the bulk of these operations but haven't fessed up statistically.
What these surgical volunteers have in common is a shared misconception about normal genital anatomy and low self-esteem– coupled with the notion that a surgical fix is the answer.
The American College of Obstetricians and Gynecologists (ACOG), with 51,000 members, issued a two-page statement in the September 2007 issue of Obstetrics & Gynecology that declares "it is deceptive to give the impression that any of these procedures are accepted and routine surgical practices." Moreover, the doctors concluded that "the absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable."The British Medical Journal (BMJ) also weighed in on the topic with a May 2007 article calling cosmetic genital surgeries an "extreme and unproved intervention" that "could undermine the development of other ways to help women and girls to deal with concerns about their appearance."
Among the treatments doctors are offering only labiaplasty, which involves trimming and reshaping that part of the female external genitalia (the four folds of tissue of the vulva), is well documented in the scientific literature. Vaginal "rejuvenation" employs techniques similar to vaginal reconstruction after trauma (birth or tumor): the wall, muscle and connective tissue is supported and the introitus (opening) is tightened. (The non-surgical approach is to tone by strengthening the muscles with Kegel exercises. Yes! you could do it right now and no one would know.) Less commonly, the fat of the mons pubis is be reduced or enhanced, the clitoral hood removed, the hymen restored, or the G-spot plumped.
But the big seller is labiaplasty.
Who of the rich and famous are having it done? Well, what exactly would one be doing that might reveal the appearance of one's labia? Beyond Britney Spears and Lindsay Lohan (nothing obvious there), the only rich and famous patients we can rightly suspect are the action porn stars. Larry Flint made a career for himself in the 1960s revealing the labia minora; doing so at one time changed the classification of a girlie mag from pin-up pulp to porn. In Australia, it’s still illegal for an adult publication to show the inner labia. Pamela Anderson's labia first famously disappeared when one of her 1990 rear-view poses was selected for reprint in a Playboy's Sexy 100. That area was airbrushed out, effectively 'defeminizing' her.Nowadays, photoshop is used to create the illusion of uniformity. The carefully composed vulvas found in men’s magazines promote a smooth, sleek clam-shape as normalcy. Reality? Most adult women have inner labial lips that are at least partially exposed.
Historically, you have to go pretty far back to find that realism in the Western hemisphere: perhaps the Vénus impudique c. 24,000-22,000 BCE. Classical European sculpture and art right through Victorian times most often showcased the feminine ideal as a smooth, hairless surface with a hand firmly shielding it from view. The rule-buster was the mid-nineteenth century masterpiece by Gustave Courbet entitled L’Origine du Monde. (In contrast, less familiar erotic art has been produced in Japan, China, India and most Asian cultures for centuries.)
We modern women are equally mystified by and estranged from our own genitals. We don’t know how it’s supposed to look, do we? Whose aesthetics do we want anyway? The sad truth is, prospective patients come toting porn particulars. But is this a realistic consumer guide for the women, let alone the girls, to whom this surgery is being marketed?No two vulvas are ever identical.
These trendy surgeons' websites offer for-profit before-and-after shots which are extremely misleading. Nearly all the surgeons are men.
The aesthetics are entirely made-up and money is the driving force. There are some hilarious discussions on female-authored sites like Jezebel.com– check out this posting. That blog did some undercover comparison shopping interviews and found the pornographer more trustworthy than the surgeons; he alone seemed to hold a sincere appreciation for natural feminine variation. Much like Carl Linnaeus, the porn guy offered a taxonomy: "the bat," "the clam," the meat," and "the out-and-about." (In the 16th century, Sheik Umar ibn Muhammad al-Nafzawi wrote The Perfumed Garden, an Arabian erotic manual cateloging 34 different types of vulvas!) Or one can explore down-there diversity by ordering the video Viva la Vulva. And for the artistically inclined, there is this lovely, best-seller coloring book for purchase.What about the other claim? Does it really improve sex? The inner labia (minora) are richly endowed with nerve endings while the vagina itself has few. Tightening the vaginal vault shouldn’t help much and resecting a muscle compromises its strength. If the pelvic muscles are strong, orgasm is likely to be more intense and pleasurable– puts the ooh-la-la in lady-land. Cutting the labia could actually hurt (yee-ouch!) the chances of gaining better orgasms by interrupting the pertinent nerve fibers. And the post-surgical scarring alone, to say nothing of possible infection, could also seriously alter sensation for the worse. It's called dyspareunia, ladies, and that kind of pain isn't sexy fun. Most experts agree, great sex is in your head.
Does it turn men on? One article quoted them extensively:
"Unless there's some surgery that can change the taste of the vagina from salty and pungent to sugary — like a Twinkie, maybe? — then I probably don't care. Men are more concerned with 'rug burn' from infrequent shaving than the appearance of the vagina."So why do women do it? Another great undercover article by Lisa Carver, Surrender the Pink (borrowing from Carrie Fisher's book, you can guess at what it means), offers one conclusion:
"Women constantly do things to their bodies I wouldn't do on a dare, so this latest craze in body alteration doesn't shock me or anything."
"I never thought about someone having unattractive labia. I'm usually so happy to get to see them in the first place that it never occurred to me they might be too big or too small."
"He shines a bright, hot light between your legs and offers you power over a part of yourself you don't understand. We could, by harnessing his "laseroscopy" machine, control our vagina. That's the snake oil he's offering. In the hour and a half I spent with him, he never mentioned men. It was power he was selling me. And for just a minute, I forgot I was a spy — I was ready to buy."
Want this look?
A labiaplasty operation performed in the Midwest runs around $4,900 in surgeon's fees. A vaginorrhaphy is in the neighborhood of $5,500-7,000. Labiaplasty is an outpatient procedure usually performed under local anesthesia. Very, very few women have clinical significant labia hypertrophy (labia stretched so long that it pulls into vagina with intercourse) which insurance would cover. Check with a gynecologist.
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