Gynecologists alarmed by plastic surgery trend

Trained as a gynecologist and reconstructive surgeon, Dr. John Miklos calls himself a “medical tailor,” specializing in surgery to reshape a woman’s private parts.

The Atlanta surgeon, who has performed gynecological surgery for nearly 20 years, cites cases of patients who say their sexual response improved after vaginoplasty, a procedure to surgically tighten a vagina stretched by childbirth or aging.

“Women come to me and say they don’t have the urge to have sex anymore because they don’t feel anything,” Miklos said. “I guarantee that if a man didn’t feel anything, he wouldn’t have sex either.”

Female genital cosmetic surgery is a small segment of the U.S. plastic surgery market, but it is growing, with thousands of women estimated to undergo such procedures every year. That growth comes despite a warning from the American College of Obstetricians and Gynecologists (ACOG), in a 2007 notice to member physicians, that strongly questioned the medical validity and safety of female genital cosmetic surgery. Earlier this year the group debated the trend at its annual meeting in San Diego.

“None of these procedures have proven effectiveness, and there is potential for harm,” Dr. Cheryl Iglesia, a Washington, D.C., gynecologist and former ACOG committee member, wrote in an editorial published in the June issue of Obstetrics and Gynecology. “Women are being misled or are confused about what is normal,” she wrote — and about what constitutes a condition that can actually be helped through treatment.

Critics say the trend is the latest service aimed at women pursuing an impossible ideal of physical perfection, hyped by Internet pornography and advertising by surgeons who may not explain all the risks, such as infections, scarring, pain and the loss of the very sensations some patients seek to enhance.

“Even when women are told of potential complications, like insensitivity of the clitoris … they still may be unstoppable if they have the notion that they need a younger-looking or more perfect or more desirable vulva,” said Harriet Lerner, a psychologist specializing in women’s issues.
More than 2,140 U.S. women underwent “vaginal rejuvenation” last year, according to the American Society for Aesthetic Plastic Surgery. The International Society of Aesthetic Plastic Surgeons put the U.S. total at nearly 5,200 in 2010. Experts note such figures do not include the many procedures done by gynecologists.

ACOG not only points to the risks of genital surgery but also emphasizes that female sexual response is driven by psychological factors rather than genital appearance. The group has asked its members to be aware of how they might unwittingly influence a patient to consider surgery.
In practices across the country, doctors say more women, from teenagers to those in their late 70s, want to discuss the procedures, which can cost between $2,500 and $12,000 and are usually not covered by insurance.

“I tell every patient you are normal the way you are,” said Miklos, who each year performs as many as 180 labiaplasties to cut back the skin flaps surrounding the vaginal opening. “I would never suggest that they get one. What is the right size of a nose, or a chin? That’s up to the individual. It’s her right to decide.”

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