Trained as a gynaecologist and reconstructive surgeon, Dr John Miklos
calls himself a "medical tailor," specialising in surgery to reshape a
woman's genitalia. The Atlanta surgeon, who has performed gynaecological
surgery for nearly 20 years, cites cases of patients who say their
sexual response improved after vaginoplasty, a procedure to surgically
tighten a vagina stretched by childbirth or ageing.
"Women come to me and say they don't have the urge to have sex anymore
because they don't feel anything," Miklos said. "I guarantee that if a
man didn't feel anything, he wouldn't have sex either."
Concern over safety
Female genital cosmetic surgery is a small segment of the US plastic surgery
market, but it is growing, with thousands of women estimated to undergo
such procedures every year. That growth comes despite a warning from
the American College of Obstetricians and Gynaecologists (ACOG) in a
2007 notice to member physicians that strongly questioned the medical
validity and safety of female genital cosmetic surgery. Earlier this
year the group debated the trend at its annual meeting in San Diego.
"None of these procedures have proven effectiveness, and there is
potential for harm," Dr Cheryl Iglesia, a Washington, D.C.,
gynaecologist and former ACOG committee member, wrote in an editorial
published in the Obstetrics and Gynaecology. "Women are being misled or
are confused about what is normal," she wrote - and about what
constitutes a condition that can actually be helped through treatment.
Critics say the trend is the latest service aimed at women pursuing an
impossible ideal of physical perfection, hyped by Internet pornography
and advertising by surgeons who may not explain all the risks, such as
infections, scarring, pain and the loss of the very sensations some
patients seek to enhance.
"Even when women are told of potential complications, like
insensitivity of the clitoris they still may be unstoppable if they have
the notion that they need a younger-looking or more perfect or more
desirable vulva," said Harriet Lerner, a psychologist specialising in
women's issues.
Vaginal rejuvenation procedures growing
More than 2 140 US women underwent "vaginal rejuvenation" last year,
according to the American Society for Aesthetic Plastic Surgery. The
International Society of Aesthetic Plastic Surgeons put the US total at
nearly 5 200 in 2010. Experts note such figures do not include the many
procedures done by gynaecologists.
ACOG not only points to the risks of genital surgery but also
emphasises that female sexual response is driven by psychological
factors rather than genital appearance. The group has asked its members
to be aware of how they might unwittingly influence a patient to
consider surgery.
In practices across the country, doctors say more women, from teenagers
to those in their late 70s, want to discuss the procedures, which can
cost between $2,500 (R21 000) and $12,000 (R100 000) and are usually not
covered by insurance.
"I tell every patient you are normal the way you are," said Dr Miklos,
who each year performs as many as 180 labiaplasties to cut back the skin
flaps surrounding the vaginal opening. "I would never suggest that they
get one. What is the right size of a nose, or a chin? That's up to the
individual. It's her right to decide."
From repair to aesthetics
Corrective gynaecological surgery has been available for decades,
including procedures to alleviate incontinence or sagging of the vaginal
canal after childbirth. In the 1990s surgeons began offering procedures
that promised the improved aesthetics, self-esteem and confidence
associated with nose jobs or other plastic surgeries.
"One side was longer than the other side. It was something that
bothered me," said Kari, a 36-year-old labiaplasty patient of Beverly
Hills, California, plastic surgeon Dr Fardad Forouzanpour. (She did not
want to give her last name.) "It makes me more comfortable. I like the
way that it looks."
She said her boyfriend was not involved in her decision, but she did "look at a few Playboys here and there."
One patient, who did not want to use her name, said she had surgery
because she hated the look of her labia, even though her husband had no
problem with her appearance.
Other procedures include creating a new hymen for "revirgination" and
"G-spot amplification," which involves injecting the area in the front
wall of the vagina with collagen or another filler to enhance sexual
gratification. In some cases, patients may not leave satisfied. One way
Dr Miklos seeks clients is by running a website called botchedlabia.com,
where women who have already experienced complications can get advice
on revisions.
Porn starts have undue influence
Surgeons say many patients have been influenced by images of the waxed,
buffed or surgically altered genitals of porn actresses.
"They see these porn stars who have things done, and they look so nice
and clean-cut," said Dr Forouzanpour, who does 15 to 25 labiaplasties a
month. "It is normal to have some extra skin, or some discoloration."
While studies have shown some social advantages to plastic surgery that
improves a person's overall appearance in public, like a nose job or
face-lift, there is no data showing the benefits of altering one's
genitals.
"The ethical question is: How much are you playing on women's
insecurities?" Dr Iglesia said. "Women are getting very much duped into
thinking there is a standard look for the vulva."
By all measures, Dr Miklos has thrived on his expertise. Along with
partner Dr Robert Moore, he now has practices in Atlanta, Georgia and
Beverly Hills. He says he tries to stay away from procedures with more
dubious outcomes.
For example, surgery claiming to enhance the "G-spot," which may play a
role in sexual arousal, raises red flags as no controlled studies have
been done, or are likely to be done, to show whether it has any effect.
"I don't routinely do them. People ask for them, but I don't want
someone to pay $1,000 and have high hopes," Dr Miklos said. "People get
upset when there is no response."
- Reuters Health, August 2012