Illustration by Dennis Nishi

Health

Photo by Illustration by Dennis Nishi

Vaginal Surgery: If It Ain’t Broke, Fix It Anyway


The rise of cosmetic vaginal surgery and how it’s all porn’s fault.



In 1984, a three-page article in the journal Plastic and Reconstructive Surgery suggested for the first time that labia reductions should be done for purely aesthetic reasons. The authors – plastic surgeons Dr. Darryl Hodgkinson of Sydney, Australia, and Dr. Glen Hait of Scottsdale, Arizona – cited “sociological pressures applied to today’s females” and recommended cutting off excess tissue in a woman’s inner labia to improve how it looked and improve sexual performance.

Today, women are getting their hymens reattached as anniversary presents.

It seems our obsession with the vagina is greater than ever. Everyone’s talking about pussy these days. Naomi Wolf wrote a biography for hers, Missouri senators attribute it magic powers and Michigan Republicans are so rattled by it that they’ve banned the word on the House floor, even if the bill concerns, you know, vaginas.

As for the rest of us, we’re obsessed with improving it. The vaginal modification industry is exploding. In February 2012, the Annals of Plastic Surgery reported an “exponential growth in popularity” for labiaplasty (reduction of the inner or outer labia tissue). Hard numbers are hard to come by, but the estimates are staggering.

In 2005, the American Society of Aesthetic Plastic Surgeons (ASAPS) counted 793 “vaginal rejuvenations.” In 2011, it was 2,142. But ASAPS only counts surgeries that member physicians report. A 2009 survey by another body, the American Society of Plastic Surgeons, estimated that its members perform 5,000 labiaplasties per year. And that doesn’t include the gynecologists who are in on the action, too. The International Society of Cosmetogynecology was formed in 2004, claiming 700 members in 30 countries. But gynecologists don’t officially track cosmetic vaginal surgeries.

So the best number we have is from the American Academy of Cosmetic Surgery, which estimated that over 50,000 vaginal rejuvenations were done in 2009 in the U.S. That’s 136 beavers per day. Or one every ten minutes. And at about $5,000 a pop, that’s $250 million a year business. Pandora’s box is definitely open.
 

Porn, TV and Technology

Dr. Gary Alter, who invented the primary labia reduction technique and performs up to 500 vaginal surgeries a year, lists his services from his plush Beverly Hills office: “I do labia reductions, labia plumping, labia reconstruction, clitoris reduction, clitoral hood reduction, pubic liposuctions, pubic lifts, reconstructions, hymen restoration, correction of external deformities, vaginal rejuvenation, and labia majora remodeling.”

And we haven’t even started on the nonsurgical options like vaginal brightening, vajacials, vajazzling, vaginal makeup or simply a plastic insert for your underpants to prevent camel toe.

The reasons for our current obsession with vaginal improvement are many. Alter blames waxing, in part. “In the 70s when everybody had a forest down there, nobody could see anything anyhow, right?” he says. “When girls start waxing, you start seeing other girls’ whatevers and you start comparing.”

And if seeing pussies by the truckload is the culprit, then the biggest factor of all will come as no surprise. “Porn,” he says. “That’s probably the driving force.”  

He’s not the only one with this view. Dr. Belisa Vranich, a clinical psychologist and relationships expert who has appeared on CNN, the Today Show and Good Morning America also credits the “pretty” vagina trend to porn. “When women started seeing more ‘perfect’ vaginas, they felt theirs were ugly,” she says. And even women who don’t watch porn are affected. “Surgery is generally more mainstream and there is much more marketing going to vaginas now—you are expected to do all kinds of grooming and even decorating.”

The mainstream media has played its part. Plastic surgery television became a staple TV genre from ABC’s Extreme Makeover in 2002, to The Swan (Fox), Dr. 90201 (E!), Miami Slice (Bravo) and I Want a Famous Face (MTV) in 2004. FX’s scripted drama Nip/Tuck ran for six seasons.

It also helps that surgery has advanced. Whatever sparked the interest, as Alter says, “you have to have effective procedures available for demand to increase.” He should know. Alter pioneered the “central wedge” labiaplasty in 1994. “At the time, no one was doing it this way. They were just trimming the sides of the labia with a knife or laser, which I felt produced an unnatural result.” Since then, he has developed all kinds of techniques like the clitoropexy (reduction of the clitoral hood), the clitoral reduction, and the pubic lift, among others. 

The Dark Side of the Vagina

There are risks to all this, though—both physical and psychological. While getting a good blow-out or a mani/pedi can certainly get you out of a funk, cosmetic surgery for your lady parts teeters on the line between empowerment and the exploitation of securities.

For one thing, serious gynecologists do not approve. Back in 2007, the American Congress of Obstetricians and Gynecologists (ACOG) released a formal Committee Opinion that strongly opposed cosmetic vaginal procedures, saying that “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.” The main concern was the lack of data. The fact that no group or body tracks the number of surgeries means that little is known about success rates or complications.

One reason there is so little data, Alter says, is because “any licensed doctor can legally do these procedures. A cardiologist can do brain surgery. That’s the way the law works. So if a plastic surgeon has read one of my articles and a girl walks into his office, he says, ‘Yeah, I can do it.’” And it’s virtually impossible to know how many doctors are performing these procedures. What we do know is that the incentives are large. The Atlantic reported last year that many doctors, facing lower insurance reimbursements and decreasing income, are seizing the chance to make fast money in a medical area that is poorly monitored and regulated.

On October 26, those doctors will be at the American Society of Plastic Surgeons Annual Meeting in New Orleans. One of the seminars is entitled “Cosmetic Vaginal Surgery: Labiaplasty and Beyond.” Citing the growing interest, the authors promise that after a one-hour instructional course, “participants should be able to … perform labioplasty, clitoral hood reduction and labia majora reduction.” One hour.

“Women have to be careful who they go to,” Alter says. “Some doctors will say they have experience with clitoral hood reductions when they really don’t.” In fact, Alter spends up to a fifth of his time fixing the mistakes of other physicians, such as asymmetrical labia, scarring and near-complete removal of the labia.

The psychological risks are more nebulous. Vranich worries about our focus on a quick-fix solution, and the problem of “putting a woman’s worth and self-esteem” on something like her labia. One by-product is that young women increasingly feel like something is wrong with them. A 2008 article in Time highlighted teens going online to compare and complain about their labia.

Whatever we feel about it, however, vaginal modification is here to stay. And the trend’s biggest evangelist may be Dr. David Matlock, a gynecologist who founded the Laser Vaginal Rejuvenation Institute in Beverly Hills. A regular on Dr. 90210, Matlock has discussed tightening up vaginas and stimulating G-spots on shows like The View. In 2010 he told the Huffington Post that cosmetic vaginal surgery today is “where breast implants were 20 years ago.” If that’s true, and pussies lag breasts by 20 years, then going by the number of boob jobs performed last year (over 300,000, says ASAPS) combined with population projections, roughly 1 in every 500 American women will be getting their vajayjays tweaked by 2030.

It’s something to think about, all right. But why not ponder its significance while getting a Brazilian wax followed by a soothing Vajacial? Katherine Goldman invented and trademarked the Vajacial at the Stript Wax Bar in San Francisco in 2009. She says clients come in every six weeks for a four-step treatment that includes an antibacterial cleanser, a papaya enzyme application, extractions and a mask.

Now what could be wrong with that?

 

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