Designer Genitalia: Fad, Benefit, or Mutilation?

An Expert Interview With Cheryl B. Iglesia, MD

Janet Kim, MPH; Cheryl B. Iglesia, MD


January 28, 2013

In This Article

The Distinction Between Traditional vs Cosmetic

Medscape: How do female genital cosmetic procedures differ from traditional or corrective gynecologic surgeries?

Dr. Iglesia: We need to make a big point of this. I am a female pelvic medicine and reconstructive surgeon. "Reconstructive" means that we're putting things back to normal: eg, when the bladder or uterus has dropped, when there is urine leakage, or a woman suffers from bowel control issues. Bona fide vaginal repair surgeries and anti-incontinence operations can treat these conditions, and level-1 evidence is available for them.

What cosmetic gynecologists are suggesting is that they don't need to have a medical indication because they are operating on women who are healthy -- nothing is wrong with them. The women just don't like the appearance of their genitals, akin to a woman who doesn't like the appearance of her nose or her breasts.

I can respect a woman's right to undergo cosmetic procedures solely for aesthetic reasons. However, many cosmetic gynecologists' Websites have misinformation and false claims about outcomes of these procedures, with either no or very low-quality data to support the marketing claims. For example, these surgeries are being promoted in some cases to improve urinary incontinence or bladder control issues, but there are absolutely no data to support this. Claiming that tightening procedures are going to improve one's sex life also has little supporting evidence. Many components go along with satisfaction from sex, and the emotional, psychological, and physical aspects of sex are much more complex than just making a woman's vagina feel tighter for her partner.

In addition, cosmetic procedures cost an average of $4500 and are usually not covered by insurance. Bona fide pelvic reconstructive surgeries have documented evidence for safety and effectiveness and can be performed by urogynecologists or pelvic reconstructive surgeons, gynecologists, or urologists. These procedures are medically indicated and covered by insurance.

Furthermore, I'm not 100% certain that women are getting full disclosure about what is normal or about some of the potential risks and adverse events associated with these procedures, not to mention the potential for conflicts of interest for some cosmetic surgeons performing these procedures.

Medscape: What is the American College of Obstetricians and Gynecologists' (ACOG's) position on female genital cosmetic procedures?

Dr. Iglesia: The committee opinion was originally published in 2007.[6] Essentially, ACOG is against procedures that are not medically indicated or do not have significant safety and effectiveness data to support them. Female genital cosmetic procedures fall into this category. The medically indicated surgeries would include repair of genital mutilation or genital cutting; treatment of labial hypertrophy or asymmetry, where one lip is larger than the other; or treatment of congenital conditions or exposure to extra androgen that causes certain organs to grow excessively, such as congenital adrenal hyperplasia, where one has too much testosterone.

ACOG feels that it is deceptive to give the impression that vaginal rejuvenation, revirgination, and G-spot amplification are acceptable and routine. The reality is that they're marketed as such, and no evidence-based data have been published to support these procedures.

ACOG also is concerned that some kinds of procedures have been "franchised." You have to take a weekend course where you pay tens of thousands of dollars. You're supposed to use a particular laser, and then you can't share any information about these "trademarked" procedures. Such a business model that controls the dissemination of scientific knowledge is troubling, because in medicine, we're not supposed to be secretive. We're supposed to share best practices if they are in the best interests of the patient.