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Nip and Tuck

by Dr. Barb DePree

In my line of work, I’ve looked at a lot of lady-bottoms, and I can tell you that “normal” female anatomy is extremely diverse. We are each as unique “down there” as we are in every other body part, and, mostly, it’s all normal. (See for yourself. Check out images of this art installation titled “The Great Wall of Vagina.”)

So the recent buzz about “vaginal rejuvenation” has me befuddled. Why have women suddenly become so self-conscious and discontented with the way their genitals look? So much so that a new subspecialty of cosmetic surgery promises to nip and tuck, neaten and tighten all for the sake of a “comfortable, athletic, petite look,” according to a well-known cosmetic surgeon.

The procedure, called a labiaplasty, reduces or tidies up the labia minora (the inner lips surrounding the vagina), creating a smooth “clamshell” appearance. Sometimes the labia minora is removed altogether. This is called a “Barbie.”

But that’s not all. Cosmetic surgeons can tighten the vaginal opening, tweak the outer labia, reduce or remove the clitoral hood, or perform a little G-spot enhancement.

For the most part, these procedures are done for the sake of appearance. Some practitioners say their patients sometimes enjoy greater genital sensitivity, but no science supports these claims. In fact, surgery always carries a risk of infection or nerve damage, which could actually reduce sensitivity.

Plus, botched labiaplasties are not uncommon. “The problem with this surgery, frankly, is that it looks easy, but there’s a lot of finesse involved,” said a plastic surgeon who specializes in the procedure in this article. “If you don’t know those nuances, you’re going to have dog-ears, or complete removal of the labia when that’s not what’s requested.”

Another specialist estimates that 20 percent of his business involves fixing work that other practitioners messed up.

None of the surgical procedures to achieve a designer vagina are endorsed by the American College of Obstetricians and Gynecologists, or even by the American Society of Plastic Surgery. Both professional groups are cautious about supporting an untested and unnecessary procedure.

Now, the distinction between reconstructive surgery and cosmetic surgery is important. Some women need surgery to fix functional problems like incontinence or to mend genetic defects like vaginas that are short, malformed, or missing altogether. And some women need labial surgery for physiological reasons.

But most women who seek “vaginal rejuvenation” do it to feel better about how their genitals look.

While cosmetic genital surgery is far less common than breast augementation, it has recently hit the radar as the next body part in need of perfecting. Some social commentators (and some women) say that the porn industry is setting the standard for how a woman “ought” to look.

And that look has become increasingly pubescent—hairless, small, and “neat.” Just like the photos of genitalia in girlie magazines. Which, just so you know, aren’t what normal women look like.

“It’s a concerning situation,” says Cheryl Iglesia, a specialist in reconstructive pelvic surgery in this article for Guernica. “A lot of women are being duped by the media and by unethical doctors who are preying on their insecurities.”

And why, I wonder, does it take a surgical procedure (or several) for a woman to like the most intimate part of her body? Does looking like a porn star—or like your girlfriend—create confidence?

I suspect that many of us have made our peace with the way we look and with the inevitable changes wrought by time. But cultural messages are powerful. They can catch us off-balance at times of transition. Certainly, they affect our daughters and granddaughters.

And that’s worth thinking about.


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