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Female sexual enhancement is becoming an increasingly popular as elective surgery. Once limited to repairs of injuries, breast enhancement, and breast enlargement, plastic surgery with the goal of enhancing women's sexual self-esteem and pleasure.

How safe is the procedure?

Variously known as vaginal beautification, labiaplasty, or female genital cosmetic surgery (FGCS), of which vaginal beautification is a part, this surgically demanding procedure is performed by a relatively small number of plastic surgeons who have the skills to get good results. It's extremely important for women considering any kind of female genital cosmetic surgery to make sure their surgeons have the skills and get the results that truly enhance their patients' beauty. Common procedures include:
  • Labiaplasty, surgical reduction of the size of the labia minora, the two lengthwise folds of skin on either side of the vulva. Many women are embarrassed by labia that protrude outward. At one time this procedure was limited to models, gymnasts, and swimmers, but in recent years it has become as frequent as pectoral implants in men.
  • Vaginoplasty, surgical tightening of the vagina. Loosening and tears in the connective tissues around the vagina is common after difficult childbirth and in women who have given birth to multiple children. This procedure involves tightening of not just the vagina but also of the muscles in the pelvic floor around it. This procedure is more likely to be covered by medical insurance.
  • Combination labiaplasty and vaginoplasty, usually offered to women who want to achieve a "pre-pregnancy" state as quickly as possible, or offered by doctors who are concerned about subjecting the woman to anesthesia on multiple occasions.
  • Hymen restoration is usually offered to women who have been victims of child abuse, child molestation, or rape, especially women of cultures and religions that require an intact hymen for marriage.
  • Clitoral hood reduction, also known as clitoropexy, is offered to women who experience chafing or discomfort from this fold over the clitoris, or who have a bulge in the front of their clothing from the oversized hood. In some cases, the clitoral hood resembles a small penis, and interferes with sexual self-esteem. The sides of the clitoral hood can be reduced during labiaplasty, but the length of the clitoral hood has to be reduced during a separate procedure, such as extended central wedge resection. The objective is to remove excess skin over the clitoris without disturbing nerves. Sometimes both procedures are performed at the same time.

Beautification alone or medical reasons?

These procedures are not for beautification alone. There are often sound medical reasons for the reconstruction. Labiaplasty can keep women from experiencing chafing and repeated infections. It's especially helpful when women have an outward protrusion of the labia minora and they are physically active or choose to wear tight pants. Most women who have the procedure, however, simply want to recapture an aspect of their younger sexual beauty that will enhance their more mature sexual experience.

Vaginaplasty can stop urinary incontinence in women that began when they had a difficult delivery, or they had fibroids, or they had uterine surgery that left adhesions, tiny bands of tight scar tissue that can tug and pull on the bladder. But it can also enhance the sexual pleasure of women's partners and rekindle romance. In much of the Western world, either goal is considered healthy and legitimate.

Hymen restoration is not just about meeting the demands of a male-dominated world to have proof of sexual purity before the rite, and rights, or marriage. It is also about putting horrible events to closure and restoring mental health after horrific abuse. Clitoral hood reduction can protect the clitoris from injury and preserve its delicate nerve endings.

About two-thirds of women who have any of these procedures have some medical reason for the surgery in addition to any desired benefits for their sex lives. While there is a concentration of specialists in this procedure in Beverly Hills, there are also doctors all over the world learning and mastering the techniques of these surgeries to give women who don't lead glamorous lifestyles access to fundamental medical care.

The safety record of these procedures is not well-established in the medical literature

Although these surgeries simply have not been around long enough to collect good data, all of these procedures are, by and large, uncomplicated and safe when they are performed by a doctor who has experience, expertise, and proven results with the particular kind of operation the woman wants. There is no more important factor in the safety of female genital cosmetic surgery than choosing a doctor who is not "practicing," but who knows what he or she is doing.

Where the safety record is much better understood is for non-surgical approaches to vaginal beautification, do-it-yourself methods that women try before plastic surgery. Here are some common vaginal beautification methods and their risks.

  • Vajazzling is the application of rhinestone jewelry to freshly waxed skin with glues and adhesives. For women who discover they are allergic to the adhesive after they have applied it to their vagina, this can be a most unpleasant experience. A good idea is to test a drop of the adhesive on the back of your arm, allowing it to stay in contact with the skin without washing for at least 24 hours. If there is no reddening, itching, or inflammation, then it may be safe to use the adhesive product on the vagina.
  • Pubic hair dyeing uses the same hair dyes that would be used on the scalp. The scalp, however, is much less sensitive to drying and inflammatory chemicals than the vagina. Test a drop (just a drop!) of the dye on the arm pit for 24 hours before using on the vagina.
  • Laundry bleach is often used to lighten pubic hair. Amazingly, most women don't encounter problems with it, but it can cause severe irritation of the cervix in some.
  • Brazilian bikini waxes remove the hair that buffers the vagina against physical injury. Also, it's very important to go to a salon that is very careful with sanitation. You don't want to pick up lice or bacteria from a previous customer!
  • Piercing the lips of the vagina or the clitoral hood carries the same risks of infection as piercing other parts of the body, only more so. The piercing site should be inspected once or twice a day for infection until it heals.

  • Goodman MP. Female cosmetic genital surgery. Obstet Gynecol. 2009 Jan,113(1):154-9
  • Miklos JR, Moore RD. Labiaplasty of the labia minora: patients' indications for pursuing surgery. J Sex Med. 2008 Jun,5(6):1492-5. Epub 2008 Mar 19.