Cosmetic vaginal procedures are on the rise, and a growing number of (mostly male) gynos and plastic surgeons are promoting elaborate below-the-belt makeovers. Cosmo went behind the scenes to find out more.
At Cosmo, We get notices about countless health-related events, but recently, an odd one caught our eye: the International Society of Cosmetogynecology's Global Symposium on Cosmetic Vaginal Surgery. We knew cosmetic vaginal surgery existed but didn't realise it was wide spread enough to warrant a worldwide conference. The program lineup made it clear that the target audience was physicians, not patients, with lectures like 'How the Addition of Cosmetic Services to an Ob-Gyn Practice Results in a More Rewarding and Profitable Practice.' And we couldn't help but pick up on the fact that all the presenters listed were male, which is strange since almost half of Ob-Gyns are women. We decided to go to Orlando to see what was going on. As we stepped through the door of the nondescript hotel conference room, we were surprised to find that the crowd, too, was almost exclusively male. Clean-cut, suit-clad gynos who looked like they could be our very own MDs milled around, shaking hands and introducing themselves. We took a seat and tuned in to some of the most jaw-dropping-and disturbing-info we've ever heard.
The New Nip/Tuck
Of the 21 doctors speaking that day, one man took credit for jump-starting the cosmetic vaginal surgery trend: "no one even considered performing these procedures until I popularised them 14 years ago," said David Matlock, a slim, 50-something gynaecological surgeon, whose name you may recognise-he's a former cast member of Dr 90210.
As his story goes, a woman called his Los Angeles office and requested vaginal tightening to make sex more pleasurable (up until then, he says, it was done only out of medical necessity-as a cure for incontinence, for example). Dr. Matlock agreed...and soon realised he had stumbled upon an untapped market. He put an ad in the local paper publicising the service and was immediately inundated with calls from women seeking not just vaginal tightening but aesthetic surgeries too.
Armed with photos from porn magazines, his clients pointed out models whose vaginas they wanted him to copy and asked for shorter labia, thinner labia, fuller labia, less skin surrounding their clitoris, and on and on. Dr Matlock's new business was taking off.
Since there is a lack of published studies on cosmetic vaginal surgery, it's hard to know exactly how much the practice has grown since then. According to the conference speakers, a rising number of doctors are offering the services and reporting an influx of patients seeking a wider variety of genital aesthetic treatments. They also say patients are getting younger. "I see girls as young as 15 coming in now," Dr Matlock announced. And this statement sent a shiver up our spines.
Racy Role Models
It may seem surprising at first that most of the women who seek cosmetic vaginal surgery look to porn as a standard of belowthe-belt beauty. but it makes sense: where else are they going to see naked female genitals in detail?
The problem is that, like breasts, vaginas shown in nude magazines are relatively uniform. Just open up Playboy and you'll notice that they're all perfectly neat and symmetrical, with no visible labia minora. "Some art directors will airbrush models' genitalia to clean them up," reveals brian Gross, president of bSG Public Relations, who has worked as a publicist in the porn industry for 11 years. New trends in X-rated entertainment have added to the focus on vaginal features. For one, since Internet videos last only a few minutes, directors have scrapped any resemblance of a plot in order to get to the money shot: an explicit close-up of female parts. "Porn today is extreme. because it's so prevalent, directors have to churn out increasingly graphic content to capture people's attention," explains Gram Po nante, writer for the website Porn Valley Observed, which covers all aspects of the US porn industry. Plus, the brazilian bikini-wax trend leaves everything visible, so women can easily compare their labia and clitoris to what they see onscreen. Add the fact that more women are viewing flesh flicks (according to Nielsen, 37 percent of US visitors to adult sites are female) and it's easy to understand why we've begun to question how our va-jayjay stacks up.
So what is normal? According to a study published in the International Journal Of Obstetrics And Gynaecology, female genitalia vary enormously, from colour to size to the positioning of various parts. The full length of average-size labia can range from about a quarter of an inch to 2 inches, says Cheryl Iglesia, M.D., chair of the Committee on Gynecologic Practice for the American Congress of Obstetricians and Gynecologists (ACOG). "The vast majority of labia minora extend past the labia majora. Invisible labia minora are very rare in developed females; it's usually prepubescent." Maybe that's why doctors at the conference called having the labia minora removed completely the Barbie-doll look-it's not something you'll frequently see on real women.
Selling designer vaginas
The gynos and plastic surgeons who took the stage claimed that by providing procedures like lip tucks and removal of skin around the clitoris, they're addressing women's needs for increased self-confidence. Whether these surgeries actually satisfy those needs seemed beside the point. Many of them just seemed eager to sign up another patient. "If a woman thinks she looks abnormal and wants the surgery, you should do surgery on her," said Adam Ostrzenski, an older ob-gyn with an Eastern European accent who practices in St. Petersburg, Florida.
The real motivation for attending the event was obvious, and no one was trying to hide it. "Money is often the bottom line for people who are here today," said Robert Jason, an OB-Gyn with shaggy hair who works in New york City. According to national statistics, patients are charged about twice as much, on average, for cosmetic vaginal surgeries as they are for having a baby delivered. And by showcasing so many options for sculpting the labia, clitoris, perineum, and more, patients may request multiple procedures, explained Kevin Jovanovic, a bespectacled OB-GyN with a goatee who's based in NyC. "Offering diverse procedures allows patients to return for services." And more services means more profits. "Two incisions, 15 minutes, and I cash the cheque" was how one of the speakers put it. One M.D. pointed to a slide of himself performing a labiaplasty. "Those are my dirty, golden fingers," he said. Not all speakers were so self-incriminating. While we wouldn't disagree with John Miklos, a sandy-haired, deep-voiced OBGyN from Georgia, who said, "A woman should have the right to say she wants her labia to be a certain length and colour," we'd argue that by offering these services, doctors are sending the message that there's a right way for a vagina to look. While clicking through images of patients' genitals on Power Point slides, the speakers made comments like "This is not so pleasant looking" and "Notice the aesthetic improvement." One even defined cosmetic gynaecology as "transforming female external genitalia to an aesthetically pleasing look"- implying it's unpleasant to begin with. Appearance isn't the only thing these M.D.s claim their procedures can improve; they also suggest they'll boost male attraction.
Red Alinsod, a middle-aged ob-gyn with a friendly face who practices in orange County, California, pointed out, "Husbands love the peek-a-boo look"-where their partner's labia minora is just slightly visible. "I trim off the dark, irregular wedge to make it a little prettier."
Dr. Jason wrapped up his presentation with a slide showing a couple embracing at sunset on the beach. "These surgeries save relationships," he concluded triumphantly.
Bodies at Risk
As legitimate as these doctors try to make cosmetic vaginal surgery sound, ACog doesn't support it and has spoken out against these procedures for several reasons, including that they're not medically necessary and their safety hasn't been documented. Labiaplasty is medically called for, Dr Iglesia says, only "if a woman's labia grow from a rare hormonal imbalance or are so long that sex feels painful or physical activity is uncomfortable." And some women may need surgery to reshape their vagina if childbirth has caused a weakening of the pelvic organs or they suffer from incontinence. But for the rest of us, these procedures put us needlessly at risk: Snipping, sewing, and lasering one of the most complex, nerve-packed areas of our body can have devastating results. "We've seen a boom in doctors selling cosmetic vaginal surgery over the past decade, and there's concern about the adequacy of their training," notes Virginia braun, Ph.D., a senior lecturer at the University of Auckland who studies the social and psychological ramifications of female genital cosmetic surgery. Tall and slender, with short dark hair, she was one of the few women attending the conference. Since some of the M.D.s performing these procedures are plastic surgeons and some are ob-gyns, many of them are likely to have a blind spot: "Plastic surgeons may not fully understand vaginal anatomy and physiology," braun explains. "And ob-gyns may not have as thorough a knowledge of working with tissue as plastic surgeons do."
These surgeries can potentially cause nerve damage, pain, necrosis (death of tissue), loss of sexual arousal, and an inability to experience pleasure. "It's also difficult for that part of your body to heal because it's usually covered with tight-fitting clothing," adds Erin Tracy, an ob-gyn in Massachusetts. "The friction increases the chance of infection and tissue damage."
Aesthetically, the results can be deforming: "you can end up with labia that are tattered at the ends or shaped like hockey sticks," Dr. Iglesia says. "Loss of pigmentation, scar tissue, and thinning of the tissue are other possible outcomes." And because zero empirical studies analysing the safety and effectiveness of the procedures have been published, there's no way to know how they may impact a woman during childbirth or as she ages. From a patient's perspective, the dangers simply aren't worth it.
on the upside, for profit-hungry doctors who flock to conferences like this one, cosmetic vaginal surgery mishaps have launched a new medical specialty: there's already a doctor in California who advertises repairs for labiaplasties gone wrong.