Vulvo-Vaginal Aesthetics

by Michael Goodman, M.D.

The time was, when you heard the term “plastic surgery” you thought of Carol Doda’s prodigious décolletage or cousin Suzi’s nose job.

No more!  From breast augmentations, reductions and lifts to Botox, Restylane and collagen; from liposuction to transplants, lifts, nips and tucks, Aesthetics (a more encompassing name than the old “plastic surgery”) have become as much a part of men’s and women’s cosmetic options as the comb, brush and makeup kit (although certainly a more expensive one). 

With all of the “work” performed on both our neighbors and ourselves, if we raised our eyebrows at everyone who was “enhanced” we’d be in need of a Botox injection. 

There is really no reason not to look your best.  If you are oriented in that direction, there are a multitude of options.

Perhaps the newest entry in the field of “snip, lift, tighten and liberate” is the field of vulvo-vaginal aesthetics.  Previously limited to perineorrhaphy (repair of the vaginal opening) which, especially as previously performed was by itself not particularly successful, outpatient options now available to women include labioplasty (labial reduction) “vaginal rejuvenation” (vaginal tightening) with or without perineorrhaphy and hymenoplasty (repair of the hymen).  Frequently, women requesting a vulvo-vaginal aesthetic procedure have incontinence as well which, like vaginal rejuvenation, can be corrected by radiofrequency wave tightening and strengthening of the base of the bladder.

LABIOPLASTY:  “Labial Reduction/Beautification” for Enlarged Labia 

Women’s labia, like breasts, noses and other bodily projections, come in all shapes and sizes from small strands to “elephant ears”.  There is a very wide range of normality.  Because it is within this range, it does not mean that an individual is comfortable with her appearance, or that excessive size doesn’t cause problems.

Women see me in consultation for possible revision in the size of their labia for two reasons:  medical and aesthetic (or a combination of the two). 

Medical reasons for labiaplasty/labial reduction (surgery to reduce/modify labial size) include discomfort or irritation with tight pants, sports, cycling or other physical activities.  In many instances, women are born with large labia; others may develop the condition with childbirth or age. 

Aesthetic (beautification) reasons include self consciousness and self-esteem issues and a desire for sculpting to achieve a better look for ones self. 

The surgical procedure to reduce labial size involves removing a wedge from the midportion of the enlarged labia and meticulously re-shaping the resulting smaller “lips”. 

VAGINOPLASTY (Tightening and Rejouvination of the Vagina for Vaginal Laxity)

An enlarged vagina is frequently a problem after childbirth, especially after multiple children, vaginal delivery of a large baby or a difficult delivery.

The specialized surgical tightening and rejuvenation of the vagina, perineum (vaginal opening) and supporting muscles is called vaginoplasty.  Many women with grown children are now seeking renewal of vaginal tissues, both to increase their “feeling”, sexual satisfaction, and to enhance the sexual experience they have with their loving mate. 

Vaginoplasty is frequently performed with the SURx bladder support procedure: a perineoplasty sometimes is done as well to bring the pelvic floor muscles in closer approximation. 

There are two methods of vaginoplasty:  laser, or radiofrequency wave tightening.

Laser vaginoplasty treats the surface vaginal skin, tightening that layer, while the radiofrequency approach treats the fascial layer surrounding the vaginal barrel, tightening vaginal support tissues.

PERINEOPLASTY

A sequel of difficult childbirth or a vaginal/perineal tear from childbirth can create an unusually “open” vaginal orifice, which can lead to irritation from tight clothing as well as self consciousness and diminished sexual enjoyment.

A plastic procedure to remove the scarred or lax opening, repair and elevate the perineum and bring the stretched levator muscles closer together is called perineoplasty. 

Perineoplasty may be performed alone for hymenal reconstruction or for an open, uncomfortable vagina and is frequently combined with a vaginoplasty.

Female genital surgery, of which vaginal cosmetic surgery is a part, is a demanding surgical field and should be approached with the same respect and caution as any other elective surgical procedure.

Michael P. Goodman, M.D. is a gynecologist, perimenopausal medicine specialist and vulvovaginal surgeon with offices in Davis, California.  Web sites are www.caringforwomyn.com and www.pelvicsupport-aesthetics.com.