The Unspoken Question

“Doctor, I think that things have changed down there. Do you think that surgery could be an option? “

I have been asked this question by a number of patients, and know that many women would like to ask it but do not because of embarrassment.

Overtime, the vulva and the vagina undergo physical changes due to many reasons: childbirth, loss of elasticity due to aging and lack of estrogen.

Vaginoplasty, the procedure to “tighten up” the vagina, has been promoted as a procedure to improve female sensitivity. In addition, some doctors have advocated labioplasty to improve the appearance of female genitalia, a procedure to change the size and shape of the labia.

Both procedures are purely cosmetic and ACOG (the American College of Obstetrics and Gynecology) remains cautious of both due to their potential risks and current lack of data on safety and effectiveness. In fact, ACOG says, women’s genitalia present a wide range of appearances that are all anatomically correct.

The surgical tightening of the vaginal tissue cannot guarantee an enhanced sexual response, since female orgasm is complex and conditioned as much by emotion and personal factors as by esthetic ones. In addition, higher sexual “sensitivity” does not necessarily lead to more pleasure.

In recent years, there has been increasing promotion of various vaginal surgeries marketed as “vaginal rejuvenation” where laser technology has replaced the traditional scalpel. Overall, long-term satisfaction and complication rates for these procedures have not been clearly evaluated.

If you are considering cosmetic vaginal surgery, make sure to talk to your doctor about your concerns, and your expectations for surgical and non-surgical options. Make sure that among your options you consider counseling to address sexual self-esteem and confidence. A woman’s sexuality is complex and rarely are there quick fixes.