How surgery can make it neat ‘down there’

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Johannesburg - When Portia’s* daughter turned 12, she began menstruating – a perfectly normal occurrence, except that wearing sanitary pads was uncomfortable because her inner labia (labia minora) were large and protruding.

 “The labia minora had grown about two inches long, and aside from the discomfort of wearing panties and pads during menstruation, she was becoming very self-conscious about it,” says Portia.

 Portia decided to help her daughter and made an appointment with a female gynaecologist, who then referred her to Dr Julian Bassin, a specialist gynaecologist and founder of the Laser Vaginal Rejuvenation Institute of South Africa, based at Joburg’s Linksfield Clinic. He recommended an operation known as labiaplasty that reduces the size of the labia majora (outer labia) or labia minora.

 In the case of many adult women who undergo labiaplasty, it’s because they want what’s known as a “designer vagina”, a neat, apparently more aesthetically pleasing vulva (external genital organs). But in Portia’s daughter’s case, it was less about cosmetic appearance than about removing discomfort and addressing her pubescent self-consciousness, so she made the decision with her daughter to book the op, even though Bassin’s fee was R10 500.

 The surgery took about two-and-a-half hours, under a general anaesthetic, and after Bassin had finished cutting away the excess labia with a laser, the girl received 18 stitches and was discharged from hospital the same day.

 “It was extremely sore for my daughter, and the pain and discomfort lasted about two weeks,” says Portia. “Going to the toilet, wiping or bathing was particularly uncomfortable. There’s a lot going on down there that makes healing painful.”

 But Portia’s daughter is happy she went through the surgery. “She’s 100 percent comfortable with herself now. It made a big change in her life, and I want her to grow into a young woman with no body issues. I’m glad I took action when I did,” says Portia.

 “Vaginal rejuvenation involves two types of surgery,” explains Bassin, “either cosmetic surgery (labiaplasty), or rejuvenation of the vagina, where we decrease the vagina’s diameter. Or a combination of both can be done.”

 The cosmetically enhanced vagina was popularised with the advent of the US reality series about plastic surgery, Dr 90210, which began its run in 2004.

 In it was Dr David Matlock, a gynaecologist and obstetrician who founded the world-renowned Laser Vaginal Rejuvenation Institute of Los Angeles. He’d discovered that the fashion for less pubic hair, commonly achieved with the Brazilian wax, meant that the female vulva was under much closer scrutiny, and that pornographic films were fuelling this trend.

 In 2005 Bassin decided to learn from Matlock and flew to the US to do a course in laser vaginal rejuvenation, which Matlock pioneered and developed. “Early in my career, I assisted a gynae with labiaplasty procedures, but they were crude. He would just pull the excess labia, clamp it, knife it off and stitch it. The patient would recover, but would bruise and bleed for some time afterwards. At the time there was no medical text book for this particular surgery,” Bassin recalls.

 Under Matlock, Bassin learnt several techniques in tailoring a woman’s labia to her desire, using a laser which looks like a pen and enables the doctor to make a more precise, bloodless cut as it seals at the same time.

 “We can change anything you don’t like, the inner or outer lips, or the clitoral hood (the fold of skin that protects the clitoris),” he says.

 Unlike Americans, South African women who opt for a labiaplasty are less concerned about aesthetics than comfort or freeing themselves of complexes. Like Portia’s daughter, most of Bassin’s patients are seeking relief from the discomfort of long, protruding labia, which might be obstructive in sex, with the labia minora tending to get pushed into the vagina, or which makes wearing underwear uncomfortable. Sporty women, especially cyclists and horse riders, might desire a cleaner-cut vulva. “I had one patient who would tape her labia in place before setting off on a cycle race,” says Bassin.

 Still, it’s not uncommon for a patient, after an initial consultation, to forgo the surgery due to the expense. Bassin’s fees are around R10 000 but with the hospital fees added, the procedure amounts to between R40 000 and R50 000.

 Medical aids don’t cover this as they regard labiaplasty as cosmetic, though in exceptional circumstances, as in Portia’s daughter’s case, a medical aid may find it medically necessary and agree to cover the costs.

 Vaginal rejuvenation, meanwhile, involves tightening vaginal muscle tone, enhancing strength and control. “If you inflate, then deflate a balloon, that’s what childbirth and natural ageing does to the muscles and ligaments surrounding the vagina. This weakening gradually worsens and in later years, may cause the pelvic organs (urethra, bladder, rectum, uterus) to drop from their normal positions, known as prolapse,” explains Bassin.

 Diminished sexual gratification due to lack of vaginal muscle tone, leakage of urine and difficulty in passing stool after a bowel movement are common symptoms of this.

 “These aren’t life-threatening problems but they do affect one’s quality of life,” says Bassin.

 Vaginal rejuvenation surgery, again using a laser, effectively decreases the internal and external vaginal diameters by tightening and suturing the vaginal walls. The muscles of the perineum (the area between the vagina and anus) can also be tightened. The surgery takes about two hours, but then you stay two or three nights in hospital.

 Phindi*, 51, had a vaginal rejuvenation procedure at the same time as she had a hysterectomy, recommended by her gynaecologist due to her having early stages of prolapse.

 “The doctor tightened up the weakened vaginal tissue. It went well, but I didn’t realise how sore I would feel afterwards. It was painful to stand up and sit down, and I was told I could only shower, not bath, for 10 days. And I was told, no intercourse for six weeks.”

 It was worth it, though, says Phindi. “I enjoy a healthy sex life, which I believe has improved, and I can trust my bladder to hold out if I’m far from a loo.”

 Vaginal rejuvenation is a low-risk operation, but as with any surgery, there’s a risk – one percent – of infection. “Surgery on the upper and lower portions of the vagina carries the risk of injury to the bladder and the rectum, but this is extremely rare. Also possible, but rare, is over-correction which can potentially result in painful sex,” says Bassin.

 The procedure costs about R40 000 but is covered by medical aid in the event of prolapse, and most patients return to work in five to seven days.

Bassin can also repair the hymen, a procedure known as hymenoplasty in which the tissue remnants of the hymen are sutured together.

 “I’ve only ever been asked to do that twice. It’s a rare request,” he says.

 Ultimately, Bassin’s operations are about enhancing a woman’s quality of life. Interestingly, most of his patients are in their 40s, 50s and even 60s.

 “It’s just unfortunate that due to the cost and medical aid not covering labiaplasty, the most deserving of women often don’t get the benefit of this simple procedure,” he says.

 * Real names not used

 * Contact: Laser Vaginal Rejuvenation Institute of South Africa. Visit www.lvri.co.za or call 011 647 3547/3500.

 * Dr Julian Bassin will be a speaker at this weekend’s Bodysculpture Show in Sandton, where people can consult with top cosmetic surgeons, dermatologists, doctors, dentists and anti-ageing specialists about the latest cosmetic procedures available in SA.

 “Techniques and procedures, both temporary and permanent, will be shown and exhibited,” says show organiser Michelle Taylor. “Consultations with surgeons and consultants are available under one roof.”

 Among the speakers will be labiaplasty specialist Dr Bassin, cosmetic surgeons Dr Gabriel Doucas, Dr Vernon Ching and Dr Mark Steinmann, botox and dermal filler specialists Dr Alek Nikolic and Dr Reza Mia as well as Dr Ridwan Mia, the lead surgeon in the case of three-year-old burn victim, Isabella “Pippie” Kruger. Mia grafted sheets of skin grown from skin taken from Pippie’s groin.

 Author Patrick Holford will be at the show, which will also have exhibits from spas, salons, gyms and the like.

 The show runs from 10am to 6pm from Friday November 23 until Sunday. The daily workshops, lectures and presentations are free. Visit www.bodysculptureshow.co.za to see when the various doctors and celebrities will be at the show and for more information on exhibitors.

 Tickets are R140 and will be sold via Computicket and at the Sandton Convention Centre door, with a percentage going to The Smile Foundation. - The Star

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