Claudia Nuñez-Eddy, MS, and Claire Viscione, National Center for Health Research
Variations in the natural female form used to be accepted, even celebrated. In recent years, though, it seems that these variations are not seen as assets, but as problems to be taken care of by plastic surgeons. As a result, Americans spent over $6 billion on cosmetic surgery in 2018. Breast augmentation, liposuction and eyelid surgery were the most popular surgical cosmetic procedures, but there has recently been heightened demand for new surgical trends.
One of the fastest growing procedures is cosmetic vaginal surgery, increasing 262% in 6 years, from 3,521 procedures in 2012 to 12,756 in 2018. In 2012, all female genital reconstruction procedures were categorized under “vaginal rejuvenation.” However, the high demand for this type of plastic surgery grew the specialty to include more specific options for women to purchase the vagina of their dreams. Now, “vaginal rejuvenation” not only refers to surgical procedures, but also to laser treatments. Once the domain of sex workers, nude entertainers, swimsuit models, and a relatively small number of women with medical abnormalities, vaginal plastic surgery and procedures have gone mainstream.
If you are considering any of these procedures there are two important things to keep in mind:
- Lasers used for these procedures are not approved by the Food and Drug Administration (FDA) because their use is not proven to be safe or effective.
- There is insufficient scientific evidence that these procedures provide any sexual or psychological benefit.
Why Do Women Want Genital “Reconstruction”?
Advocates and critics agree that the new popularity of these procedures is caused by the desire for heightened sexual pleasure and more youthful looking genitals that are in line with main-stream beauty ideals. Most people getting these procedures, particularly labiaplasty, are women ages 18-34. Some doctors claim that the demand for genital plastic surgery is being driven by pornography, now more readily available than ever on the Internet and television. Dr. David Matlock explains on his website that “… many people have asked us for an example of the aesthetically pleasing vulva [so] we went to our patients for the answer and they said the playmates of Playboy.” Another important factor in many women’s decisions to have genital reconstruction surgeries is pressure from their partners. Surgeons attract patients with discounts and claims that the procedures are “rejuvenating” or “designer.”
The Surgical Procedures
There are five types of surgical genital reconstruction: vaginoplasty, labiaplasty, labia majoraplasty, clitoral hood reduction, and monsplasty. Vaginoplasty is surgery on the inside of the vagina. It brings separated muscles together to increase tightness. This type of surgery has been performed in the United States for over 22 years, but until now was typically performed to treat a loose vaginal canal, usually as a result of childbirth. The other surgeries for “vaginal rejuvenation” reconstruct the external genitalia. Labiaplasty is a procedure that shortens the length of the labia minora, the inner lips. Labia majoraplasty is a procedure to reduce the size and length of the labia majora, the outer, hair-bearing lips. Clitoral hood reduction removes excess folds in the clitoral hood, and monoplasty reduces the size of the mons, the upper hair-bearing part of the vulva, by removing excess skin and fat. Among these surgeries, labiaplasty is the most common. The American Society for Aesthetic Plastic Surgery (ASAPS) reported 12,756 labiaplasty surgeries in 2018, costing more than $53 million. There has been a 53% increase in this procedure in the last 5 years, according to ASAPS statistics.
There is limited scientific evidence that these surgeries provide any sexual or psychological benefit. However, like any surgery, genital surgery has risks. Serious risks include painful scarring or nerve damage that could result in loss of sensation or hypersensitivity. Another risk is over-tightening of the vaginal walls, which can result in painful intercourse.
Nonsurgical, Laser-Based Treatments: Hype or Help?
Most procedures now advertised as “vaginal rejuvenation” are actually using lasers, not surgery. Lasers have previously been used for skin treatments but are now being used internally for vaginal procedures. These devices provide a nonsurgical option for women who want to increase vaginal tightness and lubrication. These devices work by focusing energy and heat on the vaginal tissue to increase collagen production. There has been a lot of controversy about them in recent years.
Like any other cosmetic procedure, results can be excellent or disastrous. Laser-based vaginal rejuvenation is still relatively new, and these lasers are not approved by the FDA for this purpose. In fact, in July 2018 the FDA issued a warning against these devices, stating that the lasers and other energy-based devices “have serious risks and don’t have adequate evidence to support their use” for cosmetic procedures. Dr. Thomas G. Stovall, a former president of the Society of Gynecologic Surgeons, states “there is absolutely zero scientific literature that supports… the notion that firing a laser of any kind will tighten the [vaginal] muscles.”
Laser and radiofrequency devices were first created and used to treat precancerous vaginal or cervical tissue, but not “vaginal rejuvenation” procedures. There have been cases of these lasers causing vaginal burns, scarring, and pain during sexual intercourse.
Many women say they seek out these procedures to enhance their sexual experiences, but there is insufficient scientific evidence that the procedures increase sexual satisfaction. Experts warn that women who claim improved sexual satisfaction may be influenced by the “placebo effect” – they were told it would work, so they believe that it does. Dennis Sugrue, former president of the American Association of Sex Educators, says that, “… before even considering an invasive procedure like vaginal tightening surgery, it’s absolutely critical for a woman to consult with a sexual health professional to make sure that the cause of the sexual dissatisfaction is thoroughly assessed and diagnosed.”
The rising rates of these cosmetic procedures suggest that women are more willing than ever to take risks to enhance themselves. The idea of “designer vaginas” suggests a fountain-of-youth, mainstream procedure. Women who want to feel more satisfied and gain control over their sexual health might assume “vaginal rejuvenation” is a good option, but do the risks outweigh the rewards? So far, the benefits are unproven and the risks are real – and can even have the opposite effect to what is desired.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
The American Society for Aesthetic Plastic Surgery. Cosmetic Surgery National Data Bank Statistics, 2009. Surgery.org. http://www.surgery.org/sites/default/files/2009stats.pdf. 2009.
American Society for Aesthetic Plastic Surgery. Cosmetic Surgery National Data Bank Statistics. Surgery.org. https://www.surgery.org/sites/default/files/ASAPS-Stats2017.pdf. 2017.
American Society for Aesthetic Plastic Surgery. Cosmetic (Aesthetic) Surgery National Data Bank Statistics. Surgery.org. https://www.surgery.org/sites/default/files/ASAPS-Stats2018_0.pdf. 2018.
American Society of Plastic Surgeons. Nonsurgical Vaginal Rejuvenation. PlasticSurgery.org. https://www.plasticsurgery.org/cosmetic-procedures/nonsurgical-vaginal-rejuvenation
American Society of Plastic Surgeons. Vaginal Rejuvenation. PlasticSurgery.org. https://www.plasticsurgery.org/cosmetic-procedures/vaginal-rejuvenation
Barbara G, Facchin F, Buggio L, Alberico D, Frattaruolo MP, Kustermann A. Vaginal rejuvenation: current perspectives. International Journal of Women’s Health. 2017;9:513-519. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560421/
US Food and Drug Administration. FDA Warns Against Use of Energy-Based Devices to Perform Vaginal ‘Rejuvenation’ or Vaginal Cosmetic Procedures: FDA Safety Communication. Silver Spring, MD: US Food and Drug Administration; 2018. https://www.fda.gov/medical-devices/safety-communications/fda-warns-against-use-energy-based-devices-perform-vaginal-rejuvenation-or-vaginal-cosmetic
US Food and Drug Administration. Statement from FDA Commissioner Scott Gottlieb, M.D., on efforts to safeguard women’s health from deceptive health claims and significant risks related to devices marketed for use in medical procedures for “vaginal rejuvenation.” Silver Spring, MD: US Food and Drug Administration; 2018. https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-efforts-safeguard-womens-health-deceptive-health-claims