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Patients Will Be Asking About Cosmetic Gyn.


 

CHICAGO — A patient wants her hymen reattached as a 30-year wedding anniversary present to her husband. Would you perform the surgery?

Would your answer change if the patient was a 20-year-old woman seeking the same procedure because religious practices dictate that she be a virgin at her upcoming wedding?

It's necessary to understand what aesthetic vulvovaginal procedures are being pitched to patients, and be prepared to address the ethical issues surrounding these procedures, Dr. Hope K. Haefner said at a conference on vulvovaginal diseases sponsored by the American Society for Colposcopy and Cervical Pathology.

Television programs, direct marketing, and the Internet are providing patients with information on a range of procedures, including revirgination, designer laser vaginoplasty, labial reduction, augmentation labioplasty, hymenoplasty, vulvar lipoplasty, and genital bleaching.

A recent Internet search revealed more than 100,000 hits for vaginal rejuvenation and over 300,000 hits for G-spot amplification/enhancement, while a Medline search revealed scarcely a mention of these topics, according to Dr. Haefner, professor of obstetrics and gynecology and codirector of the University of Michigan's Center for Vulvar Diseases, Ann Arbor.

G-spot amplification involves injecting the Gräfenberg spot with collagen in an effort to enhance sexual arousal or gratification temporarily. Anal and vaginal lightening products are sold to reverse the discoloration that comes with aging and hormonal changes in the body.

The exact procedure performed often is unclear because standard medical nomenclature is not used, notes the American College of Obstetricians and Gynecologists (ACOG), which takes up the issue in its Committee Opinion on Gynecologic Practice (Obstet. Gynecol. 2007;110:737-8).

The ACOGcommittee advises physicians to inform their patients about the lack of data supporting the efficacy of these procedures and their potential complications, including infection, altered sensation, dyspareunia, adhesions, and scarring.

What sets these aesthetic procedures apart from genital mutilation, such as female circumcision, is the age of the patient and consent, Dr. Haefner said.

Still, many cases demand a full work-up, including a psychological evaluation.

She presented a case of a young patient requesting clitoral reduction that included a complete physical examination, chromosomal and endocrinologic evaluations, and a visit to a pediatric urologist.

The issue of whether the patient is symptomatic or asymptomatic can help in determining if a procedure should be undertaken.

Dr. Haefner recalled two patients who requested labial reductions, one of whom had irritation of the labia with exercise and one who had a history of urinary tract infections that may have been associated with her enlarged labia. Even with those histories, both patients received extensive counseling before the reductions were performed.

The same request becomes more vexing in an asymptomatic patient who asks for the procedure because she doesn't feel her labia are “normal.” The average inner labia is thought to be 4.5 cm in width when extended to the side, but where that definition of normal came from, Dr. Haefner admits, is anyone's guess. What some patients and their physicians find acceptable, others will feel the need to alter.

Gynecologists aren't the only clinicians who may face these ethical dilemmas. Many procedures are being advertised to both men and women. Some centers package more traditional aesthetic procedures, such as breast augmentation, together with labioplasty.

But other centers are offering packages to couples, for example, who may want the man to undergo scrotal reduction or penile enhancement at the same time that the woman undergoes labial reduction or breast augmentation, she said.

In addition to the ACOG committee's opinion on cosmetic vaginal procedures, Dr. Haefner noted, differing opinions can be obtained from the American Academy of Cosmetic Gynecologists (www.aaocg.orgwww.iscgyn.com

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