American Gynecologists Discourage Vaginal Cosmetic Surgeries

Rachel at Women's Health News shared the release of a committee opinion from The American College of Obstetricians and Gynecologists on vaginal "rejuvenation" and other genital cosmetic/plastic surgeries.

So many of the young women that read Scarleteen often report feeling great confusion over the pervasive messages they're sent from the media and the cosmetic surgery industry: they feel certain their genitals MUST be abormal or ugly or in need of repair. It's pretty hard to know if your genitals are normal when you so rarely see other real vulvas, when you're already feeling so awkward with sexual development, and when there's still so much popular opinion about women's genitals that is negative, unrealistic and outright hating.

We'll assure them, again and again, that it is beyond likely that they and their genitals are absolutely normal, and that these messages are about someone making the big bucks off of these insecurities (and the bucks keep getting bigger -- cosmetic surgeries are still done primarily to women, to the tune of $14 BILLION dollars spent by Americans alone on surgeries last year) but it never hurts to show more and more experts -- the kind that know about what's really normal, and aren't looking to capitalize on folks who don't -- weighing in.

Here is the public statement (bolding mine): So-called "vaginal rejuvenation," "designer vaginoplasty," "revirgination," and "G-spot amplification" procedures are not medically indicated, nor is there documentation of their safety and effectiveness, said The American College of Obstetricians and Gynecologists (ACOG) today in a new Committee Opinion published in the September issue of Obstetrics & Gynecology. Moreover, it is deceptive to give the impression that any of these procedures are accepted and routine surgical practices, according to ACOG.

ACOG recommends that women considering cosmetic vaginal procedures should be informed about the lack of data supporting the effectiveness of these procedures as well as their potential complications, including infection, altered sensation, dyspareunia (pain), adhesions, and scarring.

Over the past several years, an increasing number of physicians have been offering various types of vaginal surgeries that are marketed to women as ways to enhance genital appearance and sexual gratification. Some of these procedures, such as "vaginal rejuvenation," appear to be modifications of traditional vaginal surgical procedures for genuine medical conditions. These medical conditions may include pelvic prolapse, vaginal relaxation with symptoms, the reversal or repair of female genital cutting ("female circumcision") and treatment for labial hypertrophy or asymmetrical labial growth due to congenital conditions, chronic irritation, or excessive androgenic (male) hormones.

"Many women don't realize that the appearance of external genitals varies significantly from woman to woman. As ob-gyns, we know this to be the case from years of experience," said Abbey B. Berenson, MD, a member of ACOG's Committee on Gynecologic Practice. An honest discussion about the wide variation in the appearance of normal genitalia could reassure women who are insecure about the look of their own genitalia, said Dr. Berenson.

Ob-gyns whose patients ask about these procedures should discuss the reason for the request and perform a physical evaluation for any signs or symptoms that may indicate a need for surgical intervention. Women who want to improve their sexual response should be evaluated for sexual dysfunction, and nonsurgical interventions, including counseling, should be considered.

"There are always risks associated with a surgical procedure," said Dr. Berenson. "It's important that women understand the potential risks of these procedures and that there is no scientific evidence regarding their benefits."

Very few cosmetic vaginal procedures are medically indicated nor are there published studies that assess the safety, complication rates, and long-term satisfaction for any of these unproven surgical procedures. "It is imperative that studies on these procedures be conducted and published in peer-reviewed publications so that the evidence and clinical outcomes can be reviewed," said Dr. Berenson. "Until that time, the absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable."

ACOG also is concerned with the ethical issues associated with the marketing and national franchising of cosmetic vaginal procedures. A business model that controls the dissemination of scientific knowledge is troubling, according to the new committee opinion. "When a new surgical procedure or a variation of an established surgical procedure is developed, physicians typically do not attempt to keep it proprietary or restrict who can perform the procedure," said Dr. Berenson.

It has been made clear, over and over again, that stating these surgeries will improve satisfaction with sex or body image when the problem with those issues is deep and is NOT medical, or based on any actual, real deformity, is a SHAM.

We also have long had plenty of sound data to show that ANY elective cosmetic surgery rarely nets people -- especially young people -- the sort of improvements to esteem they often seek with it: beyond data like this showing a threefold increase in suicide and substance abuse amoung women with breast implants, we know that younger people and those with existing depression or anxiety, body image problems, with the idea that cosmetic procuedures will help relationships or who do not have any real deformity at all are MOST likely to have poor psychological or psychosocial results from these procudures. (Perhaps interestingly, more women report positive outcomes from breast reductions than those do from implants.) Most studies, when combined and examined, come out showing that ultimately, amoung all patients, those seeking cosmetic surgeries in the hope it will improve relationships or their strong negative feelings about themselves find out that it doesn't make any difference to those things at all. Since most young people who come to Scarleteen considering cosmetic surgery are more often coming to it from a place of serious body dysmorphia, it's safe to say given the data we have that those considering cosmetic surgery from a place of very poor body image -- which is what so many ads for cosmetic surgery play on -- that those potential patients are the LEAST likely to feel better from cosmetic surgeries, which is a pretty pickle when you think about it.

To put that in perspective, consider this statement from this study: There is a particular subgroup of people who appear to respond poorly to cosmetic procedures. These are people with the psychiatric disorder known as “body dysmorphic disorder” (BDD). BDD is characterised by a preoccupation with an objectively absent or minimal deformity that causes clinically significant distress or impairment in social, occupational, or other areas of functioning. People with this disorder obsess about the perceived defect, usually for hours each day. The belief of imagined ugliness is often held with delusional conviction. In an attempt to alleviate their distress, sufferers may seek reassurance from others, check their appearance repeatedly in the mirror or other reflecting surfaces, pick their skin and try to conceal the “defect” through use of concealing clothing, wigs, makeup, hats, and so on. These patients constitute 6%–15% of patients seen in cosmetic surgery settings and about 12% of patients seen in dermatology settings.

For several reasons, it is important to recognise BDD in cosmetic surgery settings. Firstly, it appears that cosmetic procedures are rarely beneficial for these people. Most patients with BDD who have had a cosmetic procedure report that it was unsatisfactory and did not diminish concerns about their appearance.

Just think on that one for a bit: let it percolate. When it does, you'll likely feel pretty disturbed by it.

Obviously, as with anything, it's up to any woman who wants to get these procedures to go get them, and it should, absolutely, be her choice, no matter what she chooses. But it's a buyer-beware issue: we always want to do our best to be sure than any medical, surgical or sexual choice we're making for ourselves -- especially things like this, which carry so much short and long-term risk, and cost so much money we could use in other ways -- is based on credible information, not merely skilled salesmanship and slippery marketing coming from those who benefit the most from the procudures (hint: the surgeons, not the patients). It's gotten to the point where this marketing has become so predtaory that plans are being offered for low-income persons to finance cosmetic surgery: people for whom the cost of a procudure is easily several months or more of their most basic expenses, like food and shelter.

I'll go ahead and weigh in again, and be frank about it: vulvas are gorgeous and cool and amazing in their diversity. We're supposed to be different, and what makes people so interesting isn't our sameness, but our differences and our variance. That can be tough to accept during a period of your life when fitting in and being like everyone else is such a big deal, but it's the truth, and this too, shall pass (especially when it comes to genitals, and especially if you DO start to see more in real-life and see that what's normal is difference, not sameness).

If you're looking for a place to invest big money for as guaranteed a long-term payoff as possible when it comes to your self-esteem and your overall happiness, we DO have plenty of data to show that investing thousands of dollars in your extended education, or in things that are your deep, personal passion -- world travel, starting a band, publishing a chapbook, starting an organization or your own business, giving to a great charity -- are much more likely to be uses for your money that benefit you long term than any sort of elective, cosmetic surgery to fix something that wasn't broken in the first place.


(FYI, we're aware that every Google ad coming up on this post is, of course, solicitations from cosmetic surgeons. I've tried to filter the ads once, but new ones just came up, so I'm afraid that as much as it grates our cheese, we'll have to accept that these will be the ads that come up here on this entry.

And take it as an illustration and a very clear object lesson of the kind of pressures and marketing we're critiquing.)

Editor & Founder, Scarleteen: Sex Ed for the Real World
Author, S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You Through High School and Col

Editor & Founder, Scarleteen: Sex Ed for the Real World
Author, S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You Through High School and Col

i was just about to comment on the nasty ads, especially since i wanted to compliment you on the website. it is very, very needed! i'm pretty certain that nearly all women living in the western world are somehow ashamed of their genitalia. i don't know if you have it somewhere and i haven't seen it yet, but i also think artistic depictions could be nice.

thank you so much!