Vaginal “Rejuvenation” Not Safe or Necessary
Posted by Rachel on August 31, 2007
The American College of Obstetricians and Gynecologists has issued a committee opinion [PDF] on vaginal “rejuvenation” and cosmetic vaginal procedures, stating:
Medically indicated surgical procedures may include reversal or repair of female genital cutting and treatment for labial hypertrophy or asymmetrical labial growth secondary to congenital conditions, chronic irritation, or excessive androgenic hormones. Other procedures, including vaginal rejuvenation, designer vaginoplasty, revirgination, and G-spot amplification, are not medically indicated, and the safety and effectiveness of these procedures have not been documented. No adequate studies have been published assessing the long-term satisfaction, safety, and complication rates for these procedures.
The ACOG statement also recommends not going to straight to surgery to address a patient’s perceived problems, suggesting discussion of normal genitalia and underlying issues:
A patient’s concern regarding the appearance of her genitalia may be alleviated by a frank discussion of the wide range of normal genitalia and reassurance that the appearance of the external genitalia varies significantly from woman to woman (1). Concerns regarding sexual gratification may be addressed by careful evaluation for any sexual dysfunction and an exploration of nonsurgical interventions, including counseling.
The Committee also makes a strong statement about the marketing of these procedures:
It is deceptive to give the impression that vaginal rejuvenation, designer vaginoplasty, revirgination, G-spot amplification, or any such procedures are accepted and routine surgical practices. Absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable… Women should be informed about the lack of data supporting the efficacy of these procedures and their potential complications, including infection, altered sensation, dyspareunia, adhesions, and scarring.
You know what dyspareunia is? It’s pain while having sex. There’s nothing pretty about that.
In the Washington Post article on the ACOG statement, a former president of the Society for Gynecologic Surgeons is quoted as saying, “To do this for cosmetic reasons, and to say it will improve sexual fulfillment is totally absurd.”
The piece is mentioned on the WSJ blog, where an anonymous commenter observes, “Perhaps the only rejunvenation going on is the doctor’s wallet.” Jezebel also has commentary. Long-time readers pretty much know what I think about this, which is essentially that spending $3,500-$20,000 cutting up your hoo-ha isn’t going to fix what’s wrong with you.
ema said
Ugh, this is one of those times where I’d love to join the discussion but my utter paranoia about inadvertently disclosing too much information and breeching confidentiality prevents me from doing so.
Let me just say that the issue isn’t as black and white as ACOG makes it out to be.
Rachel said
Ema, I don’t know if this is what you’re alluding to, but I thought they could have done a better job of addressing the cultural issues tied into this topic, in terms of women coming from places where the appearance of virginity is extraordinarily important for their own livelihood and safety (not that I think women’s worth should be tied to those things, but still…). If not, can you indicate in a general way what you think they missed?
ema said
Yes, that’s part of it.
We shouldn’t prejudge these pts. Just because the procedures are elective, and just because we might not always understand the reasons for undergoing the procedures we mustn’t assume the pts are misguided.
You know, trust that [informed] women are quite capable of deciding what’s best for them and all that.
Also, let me just say that for every Dr. Matlock the media so eagerly portrays there’s a doctor who does similar work (for free), one the public will never hear of but should.
Hilary said
I had a discussion about this position statement with a fellow medical student the other night. I agree with the statement, and hardly think it is black and white.
The student was talking about what a great lecture he heard from an Ob-Gyn doctor about how great these procedures are. How wonderful a self esteem boost it is for a woman whose labial folds may not be the same size to get cosmetic surgery. When I asked him if he would consider getting his foreskin restored for a girlfriend who found that more aesthetically pleasing, or if he would consider getting his testicles altered if they didn’t hang exactly the same distance, he blanched, and muttered something about changing his mind about going into Ob-Gyn.
I believe women should be active participants in their own health care, but I do not agree that women are informed or capable of making all medical decisions for planning surgeries. Cohort studies indicate that elective cesareans have higher morbidity and mortality for mothers and babies, but some women may still want them and think they are safer, and many doctors offer them and downplay the risks. It is up to the doctors, professional health organizations and governments to regulate medical procedures, not the public. I have a hard time supporting medical procedures and their risks for non medical reasons, especially when they involve women and reproductive areas.
I would love to discuss the gray areas of cosmetic vaginal surgery. I would have a hard time performing a hymenoplasty on a woman who would risk violence when she returned home, but I would probably refer her to someone who would. I would explain why I would not do the procedure, but wouldn’t tell her off.
Speaking of risky medical procedures and position statements, these ACOG statements tend to be used often in malpractice cases as blueprints for standard of care. I would hate to risk setting a woman up for sexual dysfunction for merely cosmetic surgery for many reasons, and liability would be one of them.
Rachel said
Ema, I see what you’re saying, and I think if women make an informed choice to have the surgery, that’s their business. However, when they’re being told that it’s safe and effective and will fix their problems, and there’s no evidence to support that, without frank discussion of the risks (which could affect their sexual health), that is not truly an informed choice. If there really is a medical reason and medical benefit, fine. However, I think in a lot of cases there is an underlying problem with body image, self esteem, or a relationship (I read about a woman getting this as a “gift” to her husband), and that underlying issue needs to be addressed more than parts need surgery. It’s not really treating the problem, you know? I think that’s part of my problem with it – offering “treatment” that is not likely to really help anything, while ignoring the risks and the actual problem (wrt purely cosmetic procedures).
Shorter version: What Hilary said. Hilary, I love how you made the analogy with that other student.
ema said
Hilary,
Being informed and being capable of making a medical decision are distinct issues. Without access to correct/complete information clearly the pt is unable to make an informed decision, but just being female doesn’t preclude a pt from being capable of making a decision that’s in her best interest.
C/Ss do have higher M&M and some women may still want them even *knowing* the risk. Why assume the only reason for the woman’s decision is because she’s misinformed?
I understand your position on performing a hymenoplasty (that’s my policy for pts who don’t consent to blood transfusions). However, let me caution that in real life, when it comes to hymenoplasty, it’s quite likely you’ll run into some cases where you’re marinated in gray.
Rachel,
We’re in agreement then, mostly. I agree that these elective procedures shouldn’t be actively “offered”, but, when requested by an informed pt, they should be given due consideration.
Hilary said
Ema, I am confused, I never meant to imply that just being female would make a woman not able to make an informed decision. I will also probably refuse to perform non medically indicated circumcisions on men or women, among other procedures that I think are more harmful than helpful.
I also never meant to imply that these women may want to have procedures done that may be more harmful than helpful only because they are misinformed. They also may know certain prescription drugs are addictive and may want to take them anyway, possibly to excess. In fact, they may find a doctor readily willing to write such prescriptions on a regular basis. They may want antibiotics for a viral infection even if their doctor tells them repeatedly that it won’t do them any good.
A female relative of mine wanted an amniocentesis even though she was young and no other screening tests or family histories indicated a risk for genetic defects. Her doctor informed her of the risks (1 – 2% loss of the fetus) and refused. If she was high risk, I am sure she would have been referred for the procedure. She could have shopped around for a doctor who would do it anyway, as much as her original doctor tried to inform her. I cannot begin to quantify the myriad of reasons women may want to have procedures done that are more harmful than helpful, but it is definitely within the right of a physician or health care professional to refuse or refer someone who wants such a procedure done, and it is in the interest of the community’s health to have such procedures discussed and possibly regulated, depending on the procedure.
Hildy said
Ema: I don’t think that they should be even considered except in the context of an adequately designed clinical trial. If you don’t have accurate safety figures, you can’t obtain informed consent; if you can’t get consent, you can’t do the procedure.
ema said
Hilary,
My mistake then; I misunderstood.
Asking for an antibiotic for a viral infection (no benefits) and asking for an elective hymenoplasty (clear benefits in certain instances) aren’t comparable.
As you alluded to (…reasons women may want to have procedures done that are more harmful than helpful…) it all comes down to a risk/benefit analysis.
Hildy,
I disagree. Telling the pt you don’t have accurate safety figures is informed consent.
Sheila said
Ah I appreciate the discourse here, I really do. But I can’t help but think this seems like a perfect time to revisit Cheryl Hines’ epic and hilarious performance in “Good Night, Vagina”- a 9 minute film on labiaplasty.
“I need a new vagina, Jo. Case closed.”
http://www.vmix.com/playlist/143495/
Another Look at Vaginal Cosmetic Surgery « Women’s Health News said
[...] full and frank commentary on the “vaginal rejuvenation”-type surgeries we talked about last week. You have to love a post that asserts, “vulvas are gorgeous and cool and amazing in their [...]
Links: women’s work, internet poisoning, vaginal surgery, and Maher trolldom at Hoyden About Town said
[...] of Obstetricians and Gynecologists reckons labiaplasty and G-spot “enhancement” are reprehensible violations of a woman’s body, on account of they’re not medically indicated. However, they are just [...]
Joan Nelson said
As part of pelvic floor surgery, I had my vagina tightened. I now have very little sensation inside my vagina. These surgery’s are done to please men, not women. I completely trusted my doctor to inform me of any risks. I think he was looking out for my husband’s pleasure not mine! I would certainly like to know what results other women have had, and if there is any research going on about vaginal sensation and how to restore it if possible.
Julia said
Many of our clients are grateful after the surgeries. They say it changed their lives. Check out our site [spammy link deleted] – you can find answers to many concerns or questions you may have.
Joan said
Maybe it changed their partners life! I had vaginal surgery in Atlanta, not rejuvenation,and have pain everyday especially after intercourse. I hate the way the inside of may vagina feels. Its lumpy and something inside is pulling on my husbands penis. My doctor continuously canceled my follow up appointments and wanted to have nothing to do with me after the surgery.