Consistently inconsistent: interest in sexual function

TO THE EDITORS: I read with both interest and dismay the article, “Consistently inconsistent, the posterior vaginal wall,” in which Drs Hale and Fenner describe symptoms of posterior vaginal wall prolapse, describing dyssynergic defecation, constipation, splinting, tenesmus, etc and rightfully bemoan that “…patient expectations are not met by standardized surgical procedures.” Although I laud the authors for memorializing the lack of global success of these site specific repairs, I posit that one of the reasons for failure is a disconnect between patient and provider in history taking and focus of repair when no attention is paid to sexual complaints and when no effort is made during the surgical repair to address sexual concerns. {Read More}

 

Commentary on: A Retrospective Study of the Psychological Outcomes of Labiaplasty

The article “A Retrospective Study of the Psychological Outcomes of Labiaplasty” by Sharp, Taggemann, and Matteske adds to our expanding knowledge base regarding the outcomes of elective women’s genital plastic and cosmetic reconstructions, aka “female genital plastic and cosmetic surgery” (FGPS). This is a retrospective study examining the effect of labiaplasty (LP) on women’s sexual satisfaction and psychological wellbeing. As such, it is a welcome addition to the accumulating literature, both prospective and retrospective regarding the outcome of the “intimate surgical procedures” engaged in by women to adjudicate a functional discomfort (LP) or diminishment of sexual pleasure (functional vaginoplasty) or to address aesthetic dissatisfaction(s) related to external genital appearance (LP or perineoplasty).

It is both evidence-based and intuitive that a woman’s comfort with her body appearance (especially genital appearance) and function significantly impacts sexual satisfaction. Women who feel embarrassed, uncomfortable, distressed, displeased, or sexually dissatisfied over the size, appearance, hygienic challenges, chafing, re-arranging, and sartorial “bulges” engendered by robust labia/clitoral hood, or by a “wide and smooth” vagina or gaping and ptotic introitus are certainly expected to be sexually distressed, and it is not unexpected that this conundrum would negatively affect their sexual universe. In this study, women’s satisfaction with their surgical results additionally appeared to translate into improvements in their sexual satisfaction and psychological well-being, compared to recalled levels prior to their surgery. {Read More}

 

Evaluation of Body Image and Sexual Satisfaction in Women Undergoing Female Genital Plastic/Cosmetic Surgery

Physicians who work with women interested in altering appearance or function of their genitalia soon come to understand how much extremes of size, symmetry, “laxity,” or visually self-perceived unattractiveness affects them. Feelings of emotional and psychosexual distress, in addition to functional distress, significantly impact these women. Protrusion of labia minora well beyond the confines of the labia majora, as well as marked redundancy of labia majora, have cosmetic, self-esteem, hygienic, sexual, and functional ramifications. Those ramifications are commonly cited by women requesting surgery. Physical discomfort and cosmetic concerns are frequently combined, and many women relate feelings of vaginal and perineal laxity detrimental to coital enjoyment and orgasmic facility.

Female genital plastic/cosmetic surgery (FGPS) has been developed in response to women’s desires to modify the appearance and function of their vulvas and vaginas. A growing literature is accumulating regarding the rationale for choosing FGPS. Although much of this has been retrospective, recent studies have been prospective. A small pilot study published in 2011 found significant short term (6-month) resolution of apparent body dysmorphic complaints noted at study entry. Veale et al noted similar findings at 3 months postoperative, using a different testing instrument. The relative paucity of research paired with the increasing demand for FGPS provides the impetus for the current study. {Read More}

 

Female Genital Plastic/Cosmetic Surgery

Female genital plastic surgery (FGPS is surgery that gives women the option of altering the apperance of their external genitals, repairing hymenal tears, and/or tightening their vaginal canal. Women may do this for personal, cosmetic, functional, or sexual reasons.

There are many reasons why women may be interested in FGPS. Some women may experience pain with intercourse from tugging on the vaginal lips (labia). Others may want to reverse changes in the genitals that have occurred after childbirth or with aging. Still others may simply desire a change in the appearance of their genitals. There is no one reason to seek it that applies to everyone; however, it is important that a woman who is interested in FGPS be seeking it for her own benefit and peace of mind. {Read More}

 

Are All Estrogens Created Equal? A review of oral vs transdermal therapy.

Estrogen has been considered by some to be an antiaging modality capable of reducing health consequences of aging in many different tissues. It may be hypothesized that ongoing hormonal exposure could cumulatively change aging tissue, thus allowing for greater responsiveness at older ages. Tissue differences, characteristics of the hormone therapy (HT) regimen, and variations among patients may influence estrogen’s effects. Characteristics that have an impact on estrogen function and risk include specific estrogen type, dose, and route of administration and certain patient risk factors. One striking illustration of these differences is oral vs.transdermal (TD) and transmucosal routes of administration. For the sake of simplicity, transmucosal products will hereafter be included under the umbrella of TD preparations.

Estrogen type and route of administration appear to matter. The skin metabolizes estradiol (E2) only to a small extent. Therefore, TD administration produces therapeutic plasma levels of E2 with lower circulating levels of estrone and estrone conjugates and requires smaller total doses than does oral therapy. {Read More}

 

The Sexual, Psychological, and Body Image Health of Women Undergoing Elective Vulvovaginal Plastic/Cosmetic Procedures: A Pilot Study

This study followed a small group of women requesting female genital plastic/cosmetic surgery (labiaplasty, clitoral hood reduction, “vaginal rejuvenation”) in California and Georgia, comparing them with a “control group” of patients from the same doctors’ offices undergoing surgery for non-cosmetic reasons.
The 2 groups were essentially normal at entry to the study, with the major exception that 61% of the genital plastic group met psychological criteria, as determined by a standardized testing “instrument” (questionnaire) to be diagnosed as having Body Dysmorphic Disorder (“BDD”).
Re-testing was carried out at 1 and 6 months post-op. Psychologically and sexually, the women requesting genital plastic/cosmetic surgery tested no different to controls. Scores for sexual arousal and satisfaction rose very slightly (not statistically significant) at 6 months but, very interestingly, scores for BDD in the genital surgery group fell from >60% to just >8% by 6 months after surgery, to even lower than the control group.
The finding of rapid disappearance of body dysmorphia symptoms (pathological dissatisfaction with the appearance/function of one’s body) occurring with only a surgical procedure is extremely controversial in the psychological community, where it is heresy to believe that women’s symptoms of “body dysmorphia” when evaluated by a validated standard questionnaire utilized by psychologists and psychiatrists, would “disappear with
only a relatively simple, single surgical procedure.{Read More}

 

Is Elective Vulvar Plastic Surgery Ever Warranted, and What Screening Should Be Conducted Preoperatively?

An interesting flurry of e-mails among participants in the ISSWSHNET chat occurred recently [1]. The issue at hand was the propriety (translation: “political correctness”) of performing vulvovaginal plastic surgery on women who are desirous of effecting a change in the appearance and functioning of their external and internal genitalia. Many of the responses were quite parental, puritanical, and retro-feminist (“. . . glory in your uniqueness . . .”).
I am a gynecologist, gynecologic surgeon, and perimenopausal practitioner with 35-year practice experience. I have been performing vulvovaginal aesthetic surgery for many years, initially reconstructions of sometimes pretty horrific lacerations of both vagina, introitus, and vulva secondary to stellate lacerations during the many years that I practiced obstetrics and backed-up nurse midwives.
Secondary to requests from my gynecologic patients with redundant labia at or above the large range of normality and/or with widened, relaxed, or gaping perineum or vaginal vaults, I began performing labial reduction (“labioplasty”), perineoplasty, and vaginoplasty several years ago, and presently do 1–3 per month. My experience, working with many women requesting vulvovaginal alterations, is this.  {Read More}

 

“Female Genital Cosmetic and Plastic Surgery: A Review”

Reconstructive reparative procedures designed for cosmetic and functional improvement have been available for thousands of years. As women become more comfortable with the idea of procedures on other parts of their bodies designed to enhance their appearance and self-confidence, it is not surprising that they may wish to alter, change, “rejuvenate,” or reconstruct even more intimate areas of their bodies.  Although gynecologic surgeons have for years performed surgical procedures resulting in alterations in genital size, appearance, and function (repairs after obstetrical delivery, perineorrhaphy, anterior/posterior colporrhaphy, and of course intersex and transsexual surgical procedures), Honore and O’Hara in 1978, Hodgekinson and Hait in 1984, and Chavis, LaFeria, and Niccolini in 1989 were the first to discuss genital surgical alterations performed for aesthetic and/or sexual reasons.
This review will give an overview of the most commonly performed procedures: labiaplasty of the labia minora and/or labia majora (LP), clitoral hood size reduction (RCH), perineoplasty (PP), vaginoplasty (VP) (the latter two sometimes referred to by patients as “vaginal rejuvenation” (VRJ), and hymenoplasty (HP), and will review the literature on the rationale of surgery, ethical issues, patient expectations, training issues, psychosexual issues, demographics, the procedures themselves, and presently available outcome data.  {Read More}

 

“Female Cosmetic Genital Surgery”

Genital plastic surgery for women has come under scrutiny and has been the topic of discussion in the news media, online, and in medical editorials. In the absence of measurable standards of care, lack of evidence-based outcome norms, and little standardization either in nomenclature or training requirements, concern has been raised by both ethicists and specialty organizations…

Esthetic surgery of the vulva and vagina has not been described as such nor sanctioned by specialty organizations. Some would go so far as to describe it as experimental. I disagree… {Read More}

 

“A Large Multicenter Outcome Study of Female Genital Plastic Surgery”

The relatively recent addition of genital plastic procedures to the plastic surgery armamentarium has not been without controversy. The procedures and their credibility have touched a nerve in both the medical and lay communities.  In September 2007, the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice issued a Committee Opinion in which they made it clear that in the absence of credible long-term safety and efficacy data, recommending procedures such as “vaginal rejuvenation” (VRJ) and others and touting their potential for enhancing sexual performance and gratification was “untenable.” However, as women become more comfortable with elective procedures on other parts of their bodies to enhance function, appearance and self-confidence, it is not surprising that they may wish to alter, “rejuvenate,” or reconstruct even more intimate areas. {Read More}