I was talking to one of my young patients the other day during an annual exam, and she asked me what she could do to strengthen her vagina.  I reviewed Kegel exercises and she said that she had already done those and that her vagina still didn’t feel “as tight as it used to be before I had my daughter”.  So we had the conversation about how childbirth can cause permanent changes to the pelvic floor and how her exam was actually completely normal.  She did not seem too pleased with this information, and said “Well, I can always get one of those vaginal rejuvenation surgeries done, right?”

So arises the topic of vaginal rejuvenation, which is something that patients are asking me more and more about these days.  What exactly is this?  You know it is a hot topic when there is a Wikipedia entry about it.  According to Wikipedia: “Sometimes referred to as “vaginal rejuvenation”, “aesthetic vaginal surgery” or “cosmetic vaginal surgery”, various results aim to strengthen the function of the vulvo-vaginal area, firm up and reshape tissue for youthful appearances. In regular terms, the procedure is essentially a “face lift” for the vulva and vagina.”[1]

 A face lift for the vagina?!  Really???

 It’s true- sort of.  Its basis is a surgical procedure most commonly used for patients who have some degree of pelvic organ prolapse (ie, the uterus has descended to the lower levels of the vagina or is “falling out”) or other genital malformations (cancer, reversal of female circumcision, etc.).  For these patients, vaginal reconstruction is a medical necessity. 

 In our day and age, however, a variety of vaginal reconstructive surgeries have become popular cosmetic procedures.  These range from labiaplasty (which is alteration of the “lips” of the vulva) to “G-spot” amplification to “revirgination”.  These surgeries are marketed to women with promises to enhance sexual pleasure or improve appearance.  What most women do not realize are that these procedures come with significant risks, including loss of sensation, scarring, bleeding, infection and future painful intercourse. 

 According to the American College of Ob/Gyn:  “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. Absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable.”[2]

I had a young patient tell me recently that she is unhappy with her vulva.  Apparently, she thinks that the “lips are too long” and that they are ugly.  I reassured her that they are not too long and definitely not ugly.  “Trust me”, I said.  “I see a lot more vulva that you do.  Your anatomy is totally normal”.  She was unconvinced and went on to see a plastic surgeon about the problem.  I was baffled.  How could this young girl be so convinced that her anatomy was abnormal?

I am not sure what to make of this increased obsession with the appearance of the female genitalia.  Most of my patients who are concerned about this are in their 20’s.  Young women today face tremendous societal pressures regarding their body image, with the concept of “perfect beauty” (whatever that means) being blasted at them from every angle.  It saddens me that this image now includes such focus on the vulva and vagina.  It may be time that we as women realize that this is a growing problem in our ranks and begin to address this assault into our most private lives.

[1] http://en.wikipedia.org/wiki/Vaginoplasty

[2] ACOG Committee Opinion No. 378, September 2007.  Vaginal “Rejuvenation” and Cosmetic Vaginal Procedures