Designer vagina surgery has become so commonplace in the past few years, greatly due to the demystifying of plastic surgery and the increasing pressure for Hollywood perfection, but Dr John Miklos, an international expert on vaginal surgery who was in South Africa recently, warns that these procedures should not be gone into lightly.
Recognised for his work in "reconstructive vaginal therapy", Miklos is Director of Urogynecology and Reconstructive Pelvic Surgery at the Atlanta Centre for Laparoscopic, Reconstructive and Aesthetic Vaginal Surgery.
He currently runs a clinical and academic practice, performing surgery on about 500 patients a year, and has some of the largest published surgical series in the world on minimally invasive and cosmetic vaginal surgical technique.
"I spend hours in consultation with a patient before surgery is agreed on," he says. "Mostly I listen, because women know better than anyone about their own bodies, but I also spend a lot of time informing them of the benefits and risks.
"Ultimately, surgery is surgery and it involves cutting, and I won't perform a surgery unless the patient is fully informed and I'm satisfied there is no unhealthy outside influence."
By this, Miklos means the influence of a lover, boyfriend or husband whose sexual desires are being selfishly prioritised. "I establish whether this is the case in questions, and have found that contrary to what people think, few women who come to me are being unduly influenced. Many of them have not even told their partners. It is unfair to women to assume they are seeking this kind of surgery for any other reason than they themselves desire it," he says.
Of the most common vaginal surgeries at his practice, and also at those of vaginal rejuvenation specialists like Dr Samuel Perpinyal and Dr Julian Bassin, gynaecologists at Linksfield hospital, is vaginoplasty, which entails the tightening of the vagina, which is indicated in the case of vaginal prolapse (the vagina has become "relaxed", sometimes presenting as a "bulge"). It mostly affects women who have given normal or instrumentally assisted birth, once or many times.
The looseness of the vagina, Miklos explains, reduces friction during sex, which in turn can make it difficult for both the woman and her lover to orgasm. "I will ask the patient, 'Has a vaginal orgasm become harder to achieve than a clitoral orgasm?' A 'yes' is very telling. I then ask how long that has been the case. The answer is usually 'ever since my pregnancy'," he says.
Most of these women fall into the 40 to 70 age bracket, but Miklos says he performs tightening surgeries on younger women too. "There are women who've had 10 babies and have no problem, but there are also those who weigh 40kg and had no children and their uterus is falling down.
"Gynaecologists tend to miss it because they are pushing the vagina up with a speculum (instrument that opens on insertion) during examination," he says.
Miklos says each vaginoplasty is different. "Each area of the vagina is addressed differently, depending on what part is defective, be it the floor or ceiling. In most cases the opening of the vagina is tightened too. Also, the tightening is only up to 60 or 70 percent of the length of the vagina, as to tighten it all the way would cause pain during intercourse."
In some cases, the vagina has been overtightened, which can make intercourse painful. "At my surgery two to three percent of patients complain afterwards they are too tight, but a good surgeon who hasn't cut away too much skin can loosen it up," he says.
The results depend on the skill of the surgeon - "surgeons are not all created equal," warns Miklos - adding that it's imperative that he or she has not only an excellent reputation but has many before and after pictures to show of work done. "Also ask how many vaginal surgeries he/she has performed in the last month, as practice is key. At my surgery we do 35 to 50, or eight to 12 surgeries a month," he says.
Labioplasty, which entails reducing the size or changing the shape of labia (outside lips of the vagina), is another increasingly popular surgery worldwide including South Africa, and one that invites controversy, with some in the medical fraternity voicing concern over pornography feeding some women's aspirations, not appreciating that vaginas are as unique as noses.
Miklos says, however, that about 33 percent of his patients suffer real discomfort if they have labia that are large or protrude, sometimes due to weight gain or a "robust pregnancy".
"Labia can rub and swell, and can be a problem for sporty women in particular. In these cases, I'm taking away pain," he says.
Other women simply don't like the way their labia looks, which he says is just as valid a reason to have labioplasty, unless they again are being unduly influenced, he says. "In about 8 percent of cases at my surgery there has been outside influence, and I have also had cause to talk patients out of this surgery."
While labioplasty can be cosmetic, vaginoplasty is regarded as a functional operation. Either way it involves cutting, whether by laser or another method, with attendant risks, however minimal.
Dr Perpinyal says however that these operations have been "around for 40 years", and countless women have benefited from them.
"Surgeons in the US have just done a very good job of marketing this type of surgery, so thus the increasing interest," he says. "But there's nothing wrong with more women wanting to improve their lifestyles."
Dr Bassin adds that many women still needlessly live with discomfort, unaware that their problems can be addressed. "Those who do discover there's a remedy usually have the surgery of their own volition," he says.
CONTACTS
- Dr Julian Bassin: Tel: 011 647 3547 or visit www.drbassin.co.za
- Dr Samuel Perpinyal: Tel: 011 640 7746 or visit http://drperpinyal.co.za
- Laser Vaginal Rejuvenation Institute of SA: Visit www.lvri.co.za
Vaginal rejuvenation surgeries
- Vaginoplasty: Mainly done for looseness of the vagina resulting from vaginal (normal or instrumentally assisted) deliveries. The sagging anterior vaginal wall (cystocelle) or posterior wall (rectocelle) is surgically tightened. In most cases the entrance to the vagina (introitus) is also tightened.
- Stress incontinence: The muscles keeping the vagina in place also hold up the bladder and rectum, so losing elasticity can also cause embarrassing leakage. This can be rectified with various types of "sling" operations, where specially designed mesh is used to lift the lower part of the bladder, performed alone or in combination with a vaginal procedure.
- Labioplasty: Reducing the size or changing the shape of the labia. It is the clitoris and not the labia that is most sensitive, so surgery makes little difference to sensation in this area during intercourse.
- Hymenoplasty: In some cultures virginity is very important, and some bleeding is expected on the first night of marriage. The hymen can be restored to the original anatomy in these cases.
- High perineum or narrow introitus: In younger women where penetration is difficult or painful due to their unique anatomy, or if muscles in the area are very strong, surgery can enlarge the vaginal entrance.