We've become a society obsessed with the quest for physical perfection. If you don't like the nose (or ears or lips or breasts) you were born with, there's a solution: find a doctor and get it fixed. Last year Americans underwent nearly 11 million cosmetic plastic surgery procedures, according to the American Society of Plastic Surgeons. That's an increase of 7 percent from the previous year and more than 400 percent from a decade ago. Clearly, the idea of altering nature's plan for your appearance is now widely accepted. But are there parts of your body that should be off limits?
Some doctors think so. Last week the American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice issued a statement to its members warning about the dangers of trying to create "designer vaginas" through procedures that purport to trim and slim the vaginal lips, tighten the vagina or add extra bounce to the G-spot with injectable materials like collagen. Over the past few years these procedures have been marketed in magazines and over the Internet largely as boosts to sexual satisfaction, turning labiaplasty (the technical name for surgery that snips the vaginal lips, or labia) into one of the fastest-growing procedures. Labiaplasty is sometimes necessary for medical reasons—if there's a problem with urination, for example. But doctors say those cases are not the reason for the surge. Although there are no firm numbers on how many procedures were performed last year, doctors around the country report more and more requests from patients for purely cosmetic changes. When there's no medical reason for these surgeries, they're not covered by insurance and can cost patients as much as $10,000.
Not so long ago, the main clientele for cosmetic vaginal procedures was sex workers and nude entertainers, but with the increasing popularity of bikini waxes, women have become more aware of the appearance of their vaginas, and a growing number seem to feel they don't measure up. Others worry that they don't enjoy sex as much after pushing a baby out the birth canal; they hope that tightening their vaginas will restore the thrill. In many cases women say that they began to question the look of their vaginal area after a comment from a male partner who had been influenced by images in sexually explicit magazines or movies. Doctors say they're seeing women of all ages—even in their 60s and 70s—who want vaginal makeovers.
But the peril may be much greater than prospective patients realize, ACOG warns. "What we're concerned about is that there is no safety or efficacy data for these procedures," says Dr. Cheryl Iglesia, a member of the committee that issued the statement and the director of Female Pelvic Medicine and Reconstructive Surgery at Washington Hospital Center in Washington, D.C. "There are no studies in peer-reviewed journals that show long-term outcomes." The vast majority of these procedures are not medically indicated, Iglesia says, and women could end up in worse shape than when they started because of complications like severe pain from scarring by lasers used on the vaginal wall, decreased lubrication or incontinence. In the statement, the ACOG committee warned that "patients who are anxious or insecure about their genital appearance or sexual function may be further traumatized by undergoing an unproven surgical procedure with obvious risks."
ACOG says that women who are contemplating this kind of questionable procedure need to understand that there's a great variety in the appearance of the vaginal area—just as there is in any other part of the body—and most of those differences are well within the normal range, which means they do not require medical intervention. "You can have [vaginal] lips that are a few millimeters to a few centimeters," Iglesia says. "It's all normal. You don't have to look like a Playboy bunny down there." And a tighter vagina is no guarantee of a better time in bed. "There is real potential that you could make your sex life worse," she says. "You can't just say we will tighten it up and it will work better." Female sexual satisfaction is dependent on a wide range of factors. "It's not just the size of the vagina," Iglesia says. "There's a lot more involved, including nerves, blood supply and lubrication" as well as the critical emotional components of sexual satisfaction.
Women considering cosmetic vaginal surgery might also want to read up on the international campaign against female genital mutilation, procedures among some African, Middle Eastern and Asian cultures that often involve cutting or stretching of the labia and inserting corrosive substances into the vagina to make it tighter or narrower. Sound familiar? The World Health Organization and UNICEF, among others, have been actively lobbying for the elimination of genital mutilation, which may be performed on infants, children and teenagers. While this campaign continues to make progress, women in this country are paying doctors for what many think is a high-tech version of the practice. It's something to think about.