COMMENTARY

Aesthetic Vaginal Surgery Today: A Collegial Rebuttal to Drs. Iglesia and Walden

Red M. Alinsod, MD

Disclosures

August 07, 2013

In This Article

Aesthetic vaginal surgery (AVS) (the term I prefer), also called "female genital cosmetic surgery," "cosmetic vaginal surgery", or "cosmetic gynecologic surgery," is an umbrella term for various surgical procedures performed to improve the appearance or function of the vulva region.[1,2,3] AVS consists of elective minimally invasive surgeries, such as vaginoplasty (vaginal tightening techniques, such as vaginal rejuvenation), perineoplasty for vaginal tightening, labia minora plasty for hypertrophic or irregularly shaped labia minora, clitoral hood reduction for an excessively large clitoral hood, labia majora plasty for enlarged or lax labia majora, or labia majora augmentation for hypotrophic labia majora.[1,2,3,4] Although the first documented AVS procedure was reported in 1984,[5]misperceptions that this subspecialization of gynecology and plastic surgery is a merely a new fad persist.

In a 2007 opinion paper, the Committee of the American College of Obstetricians and Gynecologists (ACOG) advised caution regarding AVS procedures owing to a lack of data on safety and efficacy. The Committee concluded that medical indications and safety have not been documented for AVS procedures, such as vaginal rejuvenation, "designer vaginoplasty," "revirgination," and "G-spot amplification."[6] Their opinion stressed correctly that these aesthetic gynecologic surgeries were not routine or generally accepted in surgical practices. ACOG recommended that women considering cosmetic vaginal procedures be informed about the lack of clinical data on the effectiveness of these procedures and on their potential complications, including infection, altered sensation, dyspareunia, adhesions, and scarring. The take-away message for readers of the article was that there is no scientific evidence for the benefits of a wide array of AVS procedures.

Some doctors in the parent field of gynecology correctly called for rigorous research published in peer-reviewed publications in order to evaluate the safety, complication rates, and long-term patient satisfaction of AVS procedures. Unbeknown to many critics was the fact that expertly trained, highly competent gynecologic and plastic/cosmetic surgeons were conducting ongoing clinical research in this field. These experts are continually raising the bar for standards of quality in AVS.

Instead of expanding options for women, the ACOG Committee appeared to want to limit their choices. Many of the ACOG Committee's complaints about AVS procedures were directed at franchised surgical procedures, such as "designer vaginas," "vaginal rejuvenation," and "revirgination," as well as "G-spot amplification" (an injection of a dermal filler used to increase sexual stimulation during intercourse).[6] "Vaginal rejuvenation" and "revirgination" are trade names for pelvic floor surgeries usually involving one or more conventional vaginal reconstructive operations, such as vaginoplasty, perineoplasty, and colporrhaphy. These procedures are traditionally used to anatomically change the vaginal opening,[2,7,8,9] or surgically reconstruct the vaginal introitus and vault,[3,8,9,10] or are integrated into prolapse surgeries, such as a cystocele and rectocele repair.[9]

Despite the criticisms levied by ACOG, the field of AVS has expanded over the past decade. In 2010, an estimated 5200 women in the United States underwent AVS procedures performed by plastic surgeons. This figure is much higher if the operations done by gynecologists are included.[4] Unlike the ACOG Committee, aesthetic vaginal surgeons have observed great benefits with very low risks for complications in patients undergoing properly done surgeries. There is but scant mention of the satisfaction and potentially life-changing benefits women receive from AVS procedures.

As a gynecologic surgeon who has specialized in pelvic reconstruction and AVS for more than 2 decades, I am shocked and dismayed at the amount of misinformation being passed off as scientific fact within the medical community, particularly in obstetrics and gynecology (ob/gyn) and in plastic surgery. While I prefer to refrain from commenting on professional debates about AVS, I am compelled to speak out on this topic.

During my career over the past 23 years as a urogynecologic surgeon, I have performed an average of 200 separate AVSs per year, for a total of more than 4600 AVS procedures. The insights that I have gleaned from my active clinical practice in AVS may prove instructive to doctors on both sides of this controversy.

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