Vaginal Rejuvenation

In an culture which promotes clinging to youthful appearance it is not surprising that focus has now shifted to our genitals. If you Google “vaginal rejuvation” you will retrieve dozens of pages of surgeons who are self-proclaimed “masters” of vaginal & labial plastic surgery. You will also see heart warming & wrenching testimonials of proponents & victims of the procedures, & some fairly disturbing graphic images.

Some of these surgeons are probably skilled & experienced with a genuine desire to help women with distressing problems. Others have little formal training or skills & may have attended a weekend training course to become an “expert.” Some prey on their patients’ insecurities & fears of inadequacy motivated only by financial gain. Increasingly poor payments from Medicare & insurance have driven some surgeons to offer these cash-only procedures in an attempt to pay their staff & stay in business. Most elective plastic vaginal or labial surgery is not covered by insurance, & costs can range from $5000 – $20,000. Since hospitals & anesthesiologists would not be paid by insurance companies for these procedures, they are usually performed in a private office facility, often in a spa-like environment.

“Vaginal rejuvenation” surgical procedures often consist of what would be considered a standard, medically-indicated repair of posterior vaginal prolapse with thinning of the tissue between the vagina & rectum. Other procedures remove or “shape” the lower part of the labia to make them smaller (“labiaplasty”). “Re-virgination” procedures sew the opening of the vagina partially closed or reconstruct the hymen (“hymenoplasty” or “hymeonorrhaphy”). Outside of trying to fool an arranged marriage virginity inspector, who in their right mind would want to re-experience the pain of their first intercourse?


Anatomic landmarks

From a Urogynecology perspective, the problem is terminology- in a sense, any standard surgery for vaginal prolapse “rejuvenates” the vagina by restoring normal anatomy & allowing normal sexual function. Delivering a baby through the vagina enlarges the vaginal opening & reduces the amount of tissue between the vagina & rectum (the “perineal body”). This is very common & usually does not cause problems with sex. In some women, the damage can be more severe, progressing over time, & results in reduced sensation during intercourse & dissatisfaction for both partners. The surgical repair of this problem is a standard, medically-indicated procedure called a “rectocele” or posterior”  repair (or “colporrhaphy”) usually with repair of the stretched & separated perineal muscles (perineorrhaphy or perineoplasty). All gynecologic surgeons are trained to perform this procedure; but the insurance companies & Medicare pay about 1/10 what the so-called vaginal plastic surgeons get their patients to pay. Surgeons who promote this standard procedure as a “vaginoplasty” to “tighten” or “rejuvenate” the vagina as elective plastic surgery are obvious canny business people.

Follow this link to see an ABC news report about vaginal plastic surgery:

A recent addition to the treatments advertised to make a vagina smaller for better sex is to use a “laser speculum” to burn the vagina. Cash only of course. There is no scientific data that these treatments (it takes at least 2) to reduce vaginal volume, & it is reminiscent of a medieval treatment of prolapse in which a red hot poker was used to burn the vaginal opening so that it would scar down& keep things inside. Ouch.

Less accepted procedures involve surgery to improve the appearance of the labia or the “lips” of the vulva. Like our noses, everyone’s vulva is different with varying labial shapes & sizes. These variations generally have nothing to do with sexual function. It is normal for the labia to enlarge to some degree or become more visible with time. As images of women’s external genitalia have become more prevalent & easily accessible on the internet, the pornographic standard of the hairless vulva with the tiny labia of a teen-aged girl has proliferated & been promoted as the ideal. As if women do not have enough parts of their body to feel insecure about if they vary from unrealistic cultural norms, now they have to wonder about what’s between their legs. These procedures generally do nothing to improve sexual satisfaction from a physical standpoint.

Some women do have excessively long labia which can be uncomfortable wearing clothing or exercise, or they may have sustained damage to their labia during childbirth. We repair those problems in a standard urogynecologic procedure (“labioplasty”). Reshaping or trimming the labia as an elective surgical procedure is any woman’s choice to achieve their desired body image, but we do not do that.

Most vaginal plastic procedures are relatively simple with rare complications. If the “vaginal rejuvenation” or “revirgination” procedures are performed too aggressively, severe & irreparable damage can result in permanent pain with intercourse or even the inability to be sexually active. One of the most dangerous procedures involves removing part of the hood which partially covers of the clitoris (“prepuce”) to purportedly increase sensation during sex & orgasm. These “hoodectomy” or  “female circumcision” procedures are nothing short of female genital mutilation performed in the 3rd world, & can lead to excruciating pain with sex & the inability to wear any clothing which places pressure on the clitoris, such as jeans.

Sex is an important part of our lives. A satisfying sexual relationship is complex & depends on many intertwined factors regarding our emotions, self-esteem, health, & spirituality of ourself & our partner. It is rarely a simple issue that a pill, the appearance of our genitals, or increased friction from a smaller vagina will help.

In summary, we would never criticize women who desire cosmetic vaginal surgery, but we do not perform it. We have taken care of thousands of women with sexual problems due to childbirth injury & aging, & we perform those reconstructive procedures on a weekly basis. If you are considering a labial plastic procedure, be skeptical of the claims you read on the internet. Investigate your surgeon’s experience & make sure your desired outcomes are achievable & worth the expense.



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