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A Private Perfection
In the first of a two-part series on women's health issues related to sex and reproduction, we look at the controversy around vaginal cosmetic surgery.
| Robin Summerfield | |
| Calgary Herald |
Jennifer has discovered her sexpot self and for the first time in her life, sex is fabulous.
"It's awesome. I can't describe what he's done for me," she says.
The "he," in this case, is not Jennifer's husband.
The hero in her bedroom is Dr. Bruce Allan, a gynecological surgeon who made some nips and tucks in the Calgary woman's most private of places.
Vaginal cosmetic surgery, dubbed the "designer vagina," has become the answer for a growing number of women.
The cosmetic surgeries aren't medically necessary, come with risks, have stirred controversy, and are costly. Yet, women are accepting the risks for the promise of a life without pain and humiliation.
"It's me and it's lovely," says Jennifer, a 49-year-old professional and mother of two teens. "He made me look like the girls in the magazine."
Think of vaginal cosmetic surgery as the extreme end of the boom in plastic surgery. There are no comparable figures for Canada but, according to the American Society for Aesthetic Plastic Surgery, nearly 8.3 million surgical and non-surgical cosmetic procedures were performed last year in the U.S.
Since 1997, surgical procedures in the U.S. have jumped 87 per cent, while non-surgical ones, such as collagen injections, have soared 471 per cent.
Custom-made nether regions are billed as the surgical solution to unhappiness with the look, shape, texture and tightness of floppy, uneven, asymmetrical and/or stretched genitals.
A reduction labioplasty trims and shapes overly large labia minora (inner lips), which, at the extreme, can stretch halfway down the thigh. (Although in some countries -- such as Japan, where it is called "winged butterfly" -- the condition is considered sexually desirable, many women consider it unsightly and embarrassing.)
Muscles down below can be firmed and toned, perineums and vaginal walls can be tightened. Hymens can be restored and clitoral hoods reduced with the pass of a laser, the slice of a scalpel and a few stitches.
These surgeries cost $4,500 to $10,000, depending on the physician and the work required, and is not covered by Alberta Health Care.
The decision to have such surgery is not made lightly. Among some of the reasons women have cited for tinkering with their private parts:
- With extra skin down below, sex causes pinching and is painful and embarrassing;
- Post-children women may want to tighten up the hatches for better sex;
- With a reattached hymen, women on second marriages can become born-again virgins for that honeymoon fresh feeling; and
- African and Middle Eastern women look for hymen reattachment to become surgically enhanced virgins.
The quest for a tighter crotch is nothing new.
The so-called "husband stitch," a post-birth, surgical stitch of the vagina has been widely performed and is still used today to sew up torn tissue after birth. While the stitch has repair value, it is widely recognized as a tool to make after-baby intercourse more enjoyable.
These surgery, like any operation, is serious business and is largely done in private surgical centres.
In the operating room, a local or general anesthetic can be used and surgery can be done on an outpatient basis. Patients can expect to be on the table one to three hours, depending on the work needed.
Recovery is described as uncomfortable to excruciating. Swelling is a given and icing is prescribed. Sitting, standing and walking can be painful the first few days after surgery. Patients are prohibited from having sex for six weeks to ensure proper healing. Infection and excessive bleeding are risks.
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For 25-year-old Samantha, her enlarged labia minora consumed her thoughts.
"I can't say I felt less feminine, but when I was nude and looked at my body, I hated it, I hated it," says the Toronto woman, who works in a feminist arts organization.
Being a feminist getting cosmetic surgery was the "biggest hurdle" Samantha says she had to leap in deciding to get the surgery she underwent last September.
Crotch thoughts are no longer in the forefront, yet her feminist self still wrestles with the bigger cosmetic surgery picture.
Society should examine the systemic reasons why cosmetic vagina work is even on the menu, she says, rather than the should or should nots of getting the surgery.
"I hope it never becomes a hugely popular treatment."
Getting a custom-made "designer vagina" is a controversial procedure.
Some critics say nether-region cosmetic surgery sets another unrealistic, model-perfect, out-of-reach ideal for women. Others say hymen and clitoral work is akin to genital mutilation, especially when women are encouraged to undergo surgery for cultural reasons.
This type of "vaginal reconstructive surgery" is being culturally driven largely by African and Middle Eastern culture which "values tightness in the vaginal canal," says University of Calgary communications and culture professor Chloe Atkins.
"Some of these procedures may well (be) being done to mask the practice of female circumsion," adds Atkins.
The debate is global: In January, Sweden's National Board of Health said it is considering declaring some of the vaginal cosmetic procedures illegal and a form of genital mutilation. It has yet to figure out where these procedures fit into law.
In Canada, the surgeries are beyond Health Canada's scope, as the federal agency doesn't regulate medical procedures. The Women's Health Network, a national advocacy and lobby group, has neither an official stance nor an expert on its roster to talk about the surgeries.
A handful of Canadian physicians, both gynecological surgeons and plastic surgeons, do the work. Looking for a physician generally requires a doctor-by-doctor search of the telephone book. Internet or referral by family physicians.
None of the physicians' associations in Canada -- neither gynecologists nor plastic surgeons -- have a handle on how many of their colleagues are offering these services.
"It hasn't become something that our physicians have been asked about a lot," says a spokesman for the Society of Obstetricians and Gynecologists of Canada.
But the society's U.S. equivalent -- the American College of Obstetricians and Gynecologists -- does have something to say. Officially, ACOG has said the procedures are not considered mainstream medicine. At a 2001 ACOG conference, a committee noted there is no "medically appropriate procedure" for the reestablishment of virginity. The college also noted concern regarding the safety of laser use in the vagina.
Ethics and safety aside, there are the issues of how beauty is perceived in society.
"We are caught up on normal. We are caught up on beauty. We are caught up on height," says Dr. Ian Mitchell, director of University of Calgary's office of medical bioethics.
Female genitalia, like noses, chins, ears and eyes, come in all shapes and sizes and all have unique characteristics that should be appreciated rather than abhorred, adds Calgary-based sexpert and Herald sex columnist Trina Read.
"If women could see other women's crotches, they wouldn't feel so bad," Read says.
"What's wrong with being both bright and beautiful?" counters Toronto plastic surgeon Dr. Robert Stubbs, who has been performing the surgeries for about 20 years and has a busy practice in genital cosmetic work.
So does genital plastic surgery go too far?
"We go too far with everything. We cross the line, get bitten and then jump back," says Stubbs. "There is no straight path for (plastic) surgery. Surgery is definitely a jagged course."
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Miranda lived in quiet shame, never confiding in a soul about her down below differences.
"I felt doomed," she says.
Like Jennifer from Calgary, the 40-year-old Toronto social worker had enlarged labia minora. Over the years, physicians offered no help. Her own naked body repulsed her and at one point Miranda considered cutting her genitals with a razor blade to "make myself normal," she says.
Then last year, she read an article about designer vaginas.
Today, seven months after labioplasty surgery, her new body is "a masterpiece," and a "work of art," Miranda says.
While many may criticize a woman's decision to have painful cosmetic surgery on her genitals, the decision must remain with the patient, she says.
"People are very uncomfortable with anything to do with penises and vaginas," she says. "It's very hard for people to have empathy when you look fine and normal."
The women willing to talk about going under the knife say their new vaginas have transformed their lives, improved their sense of self and allowed them to live without shame.
"As fringe as one thinks this is -- the demand is there," says Dr. Wayne Perron, a Calgary plastic surgeon and immediate past-president of the Canadian Society of Plastic Surgeons.
While he hesitates to use the word "underground," Perron admits many physician and surgeons aren't openly advertising these services. He estimates six doctors or less in Canada are performing the work so women looking for help have to rely on a network among physicians to find out who's doing what.
"It's a word-of-mouth thing," Perron says, who doesn't cosmetic vaginal surgeries himself.
In the U.S., Los Angeles plastic surgeon Dr. David Matlock is considered one of the pioneers in the field. He uses billboard ads depicting women throwing their bodies back in sexual pleasure. His website also offers financing.
Up until January when insurance rules changed, Canadian physicians were nipping and tucking women from around the world.
Now doctors must rely on in-country patients for business or set up shop elsewhere.
"We want to respond to a demand, not create a demand," says gynecological surgeon Bruce Allan, who opened his southeast Calgary clinic two years ago.
At an average of six procedures per month, business is steady but not busy. His website documents the cosmetic vagina work he offers.
At Stubbs' Toronto clinic, business is brisk.
The plastic surgeon performs about 100 cosmetic genital surgeries on women per year. (He performs an equal number on men looking for penis work.) Genital surgeries on both sexes represent half his workload every year. Stubbs calls it "psycho-surgery" for its effects on both body and soul.
The surgeons say the procedures typically result in better fun between the bedsheets -- Stubbs boasts a 97 per cent satisfaction rate, while Allan says he tops out at 100 per cent-- but there are no guarantees.
Surgery, says Allan, is not a quick fix for the orgasm-challenged. The major sex organ in the body is the brain, he says, and not the naughty bits.
"You're going to be the same person. You're going to have the same job. You're going to have the same relationships," says Allan. "Nothing else is going to be magical about this."
The brain is where better sex is at, agrees sex columnist Read.
In the bedroom, men are more turned off by women who are "wound up" and "uptight" about their genitals than size, shape or an unusual-looking vagina, she says.
"If women have been able to achieve orgasmic pleasure, why mess with the physical appearance? I say, 'Leave well enough alone,'" adds Mary Valentich, a Calgary sex therapist and University of Calgary social work professor.
But, she emphasizes, each woman must make her own health and sexuality decisions.
For years, Jennifer hid a secret -- two inches of excess skin hanging between her legs. Her enlarged labia minora made wearing jeans painful, skirts with pantyhose out of the question.
"There were 1,000 things that I couldn't, or wouldn't do," she says. "It was part of my body. It was an abnormality and I knew it.
"It was gross and it kept growing as I got older."
On May 28, the Calgary mother of two celebrates one year of freedom from discomfort, thanks to Dr. Allan's handiwork.
It gave Jennifer and her husband a new lease on their sex life. She remembers their first coital meeting six weeks after surgery.
"I was scared. It was tight. It was like being a virgin again," she says. "It's more sensitive, more tight -- everything about it is wonderful."