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 woman 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 have 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, although Bassin’s fee was R10 500.
The surgery, under general anaesthetic, took about two and a half hours, and after Bassin had cut away the excess labia with a laser, the young 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 had 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.
Bassin says vaginal rejuvenation involves two types of surgery, “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 American reality series about plastic surgery, Dr 90210, which began its run in 2004.
It featured Dr David Matlock, a gynaecologist and obstetrician who founded the world-renowned Laser Vaginal Rejuvenation Institute of Los Angeles. He had discovered that the fashion for less pubic hair, commonly achieved with the Brazilian wax, meant that the vulva was under closer scrutiny, and that pornographic films were fuelling this trend.
In 2005 Bassin decided to learn from Matlock and flew over 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,” Bassin recalls. “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 textbook for this particular surgery.”
Under Matlock, Bassin learnt several techniques in tailoring a woman’s labia to her desire, using a laser that looks like a pen and which 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 (fold of skin that protects the clitoris),” he says.
Unlike Americans, South African women who opt for a labiaplasty are less concerned with aesthetics than with 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 may be obstructive in sex, with the labia minora tending to be pushed into the vagina, or making the wearing of underwear uncomfortable. Sporty women, especially cyclists and horse riders, may 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 because of the expense. Bassin’s fees are about R10 000, but with 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, although in exceptional circumstances, as in the case of Portia’s daughter, a medical aid may find it medically necessary and agree to cover the costs.
Vaginal rejuvenation involves tightening vaginal muscle tone, and enhancing strength and control.
“If you inflate then deflate a balloon, that’s what childbirth and natural ageing do to the muscles and ligaments surrounding the vagina. This weakening gradually worsens and, in later years, may cause the pelvic organs (urethra, bladder, rectum, and uterus) to drop from their normal positions, known as prolapse,” explains Bassin.
Diminished sexual gratification due to lack of vaginal muscle tone, the leaking of urine and difficulty in passing stools are common symptoms. “These aren’t life-threatening problems, but they do affect one’s quality of life.”
In vaginal rejuvenation surgery, again using a laser, the walls of the vagina are tightened and sutured, decreasing the diameter. The muscles of the perineum (area between the vagina and anus) can also be tightened. The surgery takes about two hours, but you spend 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 because she was showing the 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, 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,” she laughs.
Vaginal rejuvenation is a low-risk surgery, but as with any surgery, there is a risk – 1 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, he adds.
Bassin can also repair the hymen, a procedure known as hymenoplasty, where 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, his surgeries 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.”