Vaginaplasty by any other name would still sound awful—a “trim job?” A “tidy, tighten and tuck?” Would you prefer a spiffy “vaginal rejuvenation?” Perhaps a beefier G-spot would augment your sex life? Bothered by having misplaced your hymen—no problem, you can have a surgical revirginisation! (Whoever said you can never return to innocence apparently didn’t have a good plastic surgeon). And, of course, there’s the increasingly popular partial excision of those pesky protruding inner lips. For more and more women, surgery seems to promise the cute and perfect genitalia of their dreams.

But why are women flocking to doctors to have their genitals redesigned? Didn’t Mother Nature do a good job?

Apparently not. At least, not by the standards of Internet porn, according to which Mama Au Natural was sloppy, unsymmetrical and sometimes excessive in her vulva variations. Luckily, we have modern medicine to come to the rescue and fix all those droopy labia and floppy vaginas.

Vulvar and vaginal plastic surgeries are quite the fashion now. The ads assure women that they no longer need to feel embarrassed by their ugly vulvas. A simple surgical procedure, a little snip to remove excess tissue (it’s doesn’t serve any function, after all) and voila – you can have a vulva to be proud of! Don’t worry about loss of sensation, nerve damage, scarring, sexual dysfunction or future birth problems. Trust me, the docs say, it’s safe! (Besides, who cares how it works, as long as it looks good.)

A new study by Liao and Creighton that’s about to be published in the British Journal of Obstetrics and Gynaecology, (BJOG) calls the medical bluff about the “low-risk” nature of cosmetic labial surgery. In an extensive review of the literature over the past 59 years, they reveal an unsurprising (to me, at any rate) lack of evidence on the safety and long-term consequences of such procedures.

Are these operations really safe? No one actually knows, but since the amount of genital tissue removed in cosmetic labial surgery is comparable with several types of female genital mutilation, we can guess that similar problems could arise, such as birth complications like perineal trauma, postpartum hemorrhage and increased neonatal death. And sexual health and pleasure issues? Well, no one’s actually checked.

While doctors have a multitude of anecdotal claims about sexual satisfaction, they have no actual data to back up their assertions. Co-author of the study, Sarah Creighton, consultant gynecologist at University College Hospital, said, "This paper offers a critical review of available scientific knowledge on labial surgery and identifies a shocking lack of solid evidence. Some studies have laid claims to 'successes' despite suspect methodology, and some have not bothered to define how the conclusions had been derived. Anecdotes proliferate in the literature. Risks and complications are rarely documented.”

As to why women are seeking these procedures in escalating numbers, co-author Lih-Mei Liao, consultant psychologist at University College London, said, "Healthy women are commercially targeted for invasive and irrevocable surgery to the labia minora. Advertisements promote labial surgery as easy answers to women's insecurities about their genital appearances—insecurities that are fuelled by the very advertisements that prescribe a homogenized prepubescent genital appearance standard for all women."

I couldn’t have said it better myself! The wide and glorious range of normal, healthy genitalia is a deep dark secret. It’s like imagining that fashion models and TV actresses represent the normal range of women’s body types and beauty. At least you can walk down a street and know that beautiful women come in all shapes and sizes, but how would you know about the parts that are kept private?

Prof. Philip Steer, BJOG editor-in-chief, said, "Commercial images and social pressures often serve to distort public perceptions about what is physically normal. Healthy messaging about the normal variation in female genitalia, as well as body shape and size more generally is needed and important.” You tell ‘em, professor!

Women, the vagina Mother Nature designed for you over all those millions of years of evolution is perfect. It’s as beautiful as any other flower be it a frilly rose or an elegant tulip.

Women are unwittingly falling prey to limited cultural ideas of genital acceptability—they should be svelte and symmetrical, carefully manicured or hairless, and definitely discreet.

And in order to get the genitals of their dreams and of porn fantasy, they’re willing to take risks—including the possibilities of decreased sexual pleasure, birth complications and ongoing medical issues. Of course, they don’t know they’re taking those risks. So, let the designer vagina buyer beware!

Reference
Liao L, Michala L, Creighton S. Labial surgery for well women: a review of the literature. BJOG; DOI: 10.1111/j.1471-0528.2009.02426.x