Aesthetic surgery of the female genitalia, or ‘designer vaginas’, includes a number of surgical procedures designed to improve their appearance. It is claimed that, occasionally, sexual function may be enhanced. The availability of such surgery in the U.S. is still limited, and it controversial.
With a growing acceptance of surgery designed to alter appearance, and the increasing availability of explicit images of naked women, a number of women are requesting surgery to alter their intimate appearance feeling that they compare unfavorably. There are other women who claim that the size or shape of their vagina or external genitalia prevent them or their partner from achieving full sexual satisfaction.
The most commonly requested procedures are labial reduction (‘labiaplasty’) and vaginal tightening (‘vaginaplasty’) operations. Other procedures include liposuction to the mons pubis; fat injections to the labia majora or mons in order to give a more youthful appearance to these areas; removal or reduction of skin around the clitoris (‘hoodectomy’), to improve clitoral sensitivity; and reconstruction of the hymen for cultural reasons. Laser therapy has been described for the removal of labial wrinkles; and hair transplantation for hypotrichosis of the mons pubis.
Labial reduction includes a number of operations designed to decrease the size and degree of protruberance of the labia minora, or ‘inner lips’ of the vagina. The most common reason for women to request this operation is because the labia are perceived to be too large and aesthetically unpleasing. A small number of women state that the large size of their labia make them noticeable in tight clothing, or make sports such as cycling uncomfortable. Others have problems with penetration.
The procedure is relatively simple, excising an area of the labia minora using a variety of incisions; and can be performed under local anesthetic. Careful placement of the scar is important, however, in order to prevent painful scar contracture along the rim of the labia.
Vaginal tightening operations are requested by some women who feel that their vagina has become lax following childbirth, or with age. As a consequence, they claim that sex is less satisfying for them or their partner. The procedure may be as simple as placing sutures at the introitus (vaginal opening), or may involve excising excess vaginal mucosa together with tightening the muscles of the posterior vaginal wall.
The former procedure is not widely offered. The second procedure is usually performed under general anesthetic, more commonly by gynecologists. Perforation of the bowel is one of the more serious complications which may occur.
Liposuction or ‘liposculpture’ of the mons pubis may be an isolated procedure or performed in conjunction with liposuction of the abdomen or thighs. The appearance of the mons is enhanced by improving its definition.
In contrast, fat injections to the mons or labia majora plump out these structures, giving them a more youthful appearance.
Hoodectomy, or removal of the fold of skin around the clitoris, is performed to expose the clitoris and make it more sensitive. However, there is little information on outcome, other than anecdotal.
As with many aspects of human anatomy, there are a wide variety of shapes, sizes and appearances of the female genitalia, all of which are within the limits of normal. Before undergoing any surgery, it is important to determine whether there really is a problem with the genitalia or whether another solution would be more rewarding.