Female Genital Interventions/Surgery

Female Genital Interventions/Surgery

Throughout history, artists have been quite free to render their idealized versions of the female genitalia in drawings, paintings, and sculpture. However, the public has tended to discourage an open dialogue on this sensitive matter which has generally been considered taboo leaving many women to wonder if they are “normal.” This stigma has prevented affected women from speaking freely about their concerns; many of these whom have expressed an awareness which may date back to childhood. In recent years, the growing interest in plastic surgery has made women realize that there are many options available for addressing their treatment goals.

A variety of popularized techniques are grouped under the procedure “labiaplasty”. These are also known as labia(l) rejuvenation, beautification, remodeling, reduction, contouring, augmentation as well as pubic lift, liposuction, lipoinjection, vulvectomy, labioplasty, etc. I have described some of these below. It is unlikely that you will need all of these. Therefore a clinical exam is necessary in order to assess your particular anatomy and to determine the most appropriate procedure to achieve your goals.

Labia Minora Reduction

This procedure is requested by women who state that their labia minora (inner lips) are excessively large. This may affect one or both sides. Women report that they are uncomfortable or sore while exercising or competing in sports such as bicycle riding. Others are embarrassed and refrain or are hesitant to undress in front of a potential intimate partner. Another frequent complaint is discomfort in tight garments. Many individuals report being embarrassed by the appearance of their labia in well-fitting clothing such as bathing suits or lingerie. Large labia minora may interfere with sexual activities preventing stimulation of the clitoris during sex. Excessively large labia which are repeatedly subject to trauma may become irritated, painful, and ulcerated. Some women report an increased incidence of urinary infections due to difficult hygiene considerations. Enlarged labia may be congenital (present at birth) or made worse by repeated pregnancies or prolonged or particularly traumatic labor and delivery. A labia reduction (labiaplasty) procedure can be performed to reduce the labia minora.

Various techniques are available for treating prominent labia minora. The standard approach utilized by many gynecologists and plastic surgeons is a simple removal of leading edge of the labia, thereby shortening and reducing it. The edge is then repaired. This is the least complicated technique and is easily completed in the office. Another method recently popularized by Dr. Alter called the “Alter labia contouring” procedure “the new labiaplasty”. In this surgery, the excess labia are reduced by removing a wedge (pie shaped piece) of labia and closing the remaining tissue resulting in smaller labia. This produces a scar across the labia rather than running the length of the leading edge. This is indicated for women in whom the central one third of the labia minora is largest.

This surgery is commonly completed under local anesthesia using oral sedation and can be performed in our fully accredited surgical center. General anesthesia is available if requested but is not necessary. In individuals concerned about postoperative discomfort, a pain pump can be inserted but is not typically requested. The incidence of complications is low and manageable. You can resume light duty work in 5 days. Sexual intercourse is restricted for about 4-6 weeks.

Labia Majora Remodeling

The outer hair bearing lips (labia majora) of the genitalia can be affected by redundant skin or bulky tissue. Women describe being embarrassed by a visible bulge in snug clothing such as active wear or bathing suits. Labia majora hypertrophy (overgrowth) may be due to a congenital condition, aggravated by pregnancy, or generalized aging. Early or less severe degrees of labia majora hypertrophy without skin laxity can be managed with liposuction if the primary problem is fatty or “puffy” labia. More advanced hypertrophy can be treated with labia majora reduction which is accomplished by excising an elliptically (football) shaped section from the inner or hidden surface of each labia majora. The incision is concealed in the valley between the labia minora and majora.

These procedures tend to require to more surgery than a labia minora reduction and are therefore frequently performed under general anesthesia in our fully accredited surgical center. In individuals concerned about postoperative discomfort, a pain pump can be inserted but is not typically requested. The incidence of complications is low and manageable. You can resume light duty work in 5 days. Sexual intercourse is restricted for about 4-6 weeks.

Labia Majora Augmentation

Atrophic (sunken, empty, deflated) appearing labia majora may be a consequence of genetic factors, weight loss, or aging. This results in a loss of the youthful fullness of the labia majora. Augmentation of the labia majora can be achieved by lipoinjection (fat grafting from the abdomen or thighs). This is collected using liposuction techniques.

This surgery is typically is scheduled for 1 hour and performed under monitored or general anesthesia. It is commonly combined with other female genitalia cosmetic surgery procedures. If performed as an isolated procedure, you should be able to resume sexual activities in about two weeks.

Mons Pubis Liposuction and/or Lift

Following massive weight gain and subsequent loss or a prolonged pregnancy, it is not uncommon for a woman to report dissatisfaction with her loose, sagging, or prominent mons pubis. Rarely patients may be born with an excessive fatty deposit in this region. Patients describe a visible pubic fullness or mass which is clearly evident when wearing pants. Many women complain that the bulge makes them look like a man. Liposuction is a convenient method of extracting and diminishing the volume of the pubis. Occasionally there is an associated skin laxity which creates the illusion of an aged or collapsed appearance due to loss of support. A lift or suspension of these tissues is accomplished by excising an elliptical (football) shaped piece of skin immediately above the pubic hairline. This elevates and rejuvenates the genitalia in combination with liposuction. It is frequently completed in massive weight loss procedures such as tummy tuck but can be done as an isolated surgery subsequent to an abdominoplasty. These areas can be rejuvenated and lifted by excising excess skin above the pubic hair and removing excess fat in the pubic region. The pubic liposuction and pubic lift procedure may be combined with a tummy tuck or requested after having a tummy tuck.

These procedures are most commonly performed under general anesthesia in our fully accredited surgical center. In individuals concerned about postoperative discomfort, a pain pump can be inserted but is not typically requested. The incidence of complications is low and manageable. A drain may be required. You can resume light duty work in 7-10 days. Sexual intercourse is restricted for about 4-6 weeks.

G-Spot Amplification

The G-spot is an erogenous zone located on the upper wall of the vagina approximately 1/3 of the distance from the vaginal entrance to the cervix. When stimulated, it is considered responsible for triggering vaginal orgasms. Injection of a filler material (either collagen or hyaluronic acid i.e., restylane) has been credited with making the area more accessible. This has been shown to result in enhanced sexual arousal and gratification.

This procedure is performed using topical anesthesia and involves injection of filler materials which are identical to those placed into the face.

OVERVIEW

As you can see, an important part of this examination is the evaluation of the underlying anatomy. The procedure of choice is a complex decision process determined based on your desires, anatomy, practicality, and wound healing. During the consultation we may determine that other procedures are better suited for your optimal outcome. It is also possible that although an appropriate plan has been determined at the time of the initial consultation, it may need to be adjusted intra-operatively.

Insurance may cover the labiaplasty surgery if you have any physical discomfort or functional conditions. It is best to come with a letter documenting and supporting your complaints after evaluation by your gynecologist. Should you seek insurance predetermination of benefits, we are happy to assist you in obtaining preauthorization. However, we do request a consultation fee which can be credited towards your surgical fees.

The length of the surgery depends upon the type of procedures selected. The procedures are most commonly performed on an outpatient basis.

The procedure can be done in several different places (hospital, office surgical suite, or surgicenter) and the prices vary accordingly.

There are risks to crossing the street or flying in an airplane and, of course, there are risks to any surgical procedure. These risks can occur regardless of surgeon or technique. These include but are not limited to: infection, hematoma, discomfort at rest with or without clothing or sexual activity, wound separation, excessive scarring, asymmetry, unfavorable healing, numbness, pain, adverse reaction to medications/injectables/implants, palpability, need for secondary surgical revisions, and inability to guarantee a specific functional and or cosmetic result.