What is Botched Labiaplasty?
by Dr. Michael Goodman
As an experienced women’s genital plastic/aesthetic surgeon, having performed more than 650 aesthetic/functional labiaplasties and more than 125 aesthetic vaginal “tightening” procedures (combination of modified posterior repair/vaginoplasty/aesthetic perineoplasty), I and many of my experienced colleagues continue to be dismayed by the unintended avoidable mutilation of the labias of patients we see in consultation for possible re-operation or as an expert witness involved in a medical legal action resulting from their “botched labiaplasty” procedures. On other patients, we note the lack of vaginal tightening, aesthetic appearance and/or increased muscular strength encountered in “posterior repairs” performed by general gynecological and urogynecological surgeons untrained in the procedures of aesthetic labiaplasty, perineoplasty, and vaginoplasty operations. (More below on the reasons that general Gyns are untrained in these procedures). Invariably, these operations with poor results were performed by general gynecologists who are untrained in the plastic and aesthetic procedures of labiaplasty or vaginoplasty.
In all fairness, no one knows how many successful surgeries (labiaplasties or vaginal tightening surgeries) are performed by general gynecologists, as there is no reporting mechanism for these surgeries. The professional organization purporting to represent Ob/Gyns, the American College of Obstetrics and Gynecology or “ACOG”, has made its position clear in a Committee Opinion released in 2007 and reconfirmed in 2012: they do not support these aesthetic and restorative surgical procedures, nor do they encourage the teaching of these procedures either in gynecological residency or stand-alone training programs. “Official Gyn-dom” does not want women to have a say in how they wish to model or remodel their own bodies. The outcomes that I and other very experienced female genital plastic/cosmetic surgeons see from general gynecologists are the many botched and mutilated women who present to us for revision or to their attorneys to bring legal action. These are women who brought their labial (and frequently clitoral hood) hypertrophy to their family Ob/Gyn. That Gyn – while untrained in plastic technique and aesthetic surgery and totally untrained in how to sculpt a clitoral hood (or the “rules” necessary to avoid harm), trained neither in plastic technique or the choice of the several surgical techniques available – says to him/herself “Well, how hard can it be? I just pull on the labia, place a clamp on it, and cut off the excess,” and says to the patient “Sure. I’ve done that. No problem, I can do it!” While this gynecologist certainly knows the anatomy, and has been trained in general excisions and cancer operations, (s)he has received no training whatsoever in micro-plastic technique or working with small-caliber instruments, sutures, and needles. They have no training on how to determine tissue planes in the area, or how to deal with “folds” or the clitoral hood. The attitude is, “Well… how hard can it be?” and the resulting surgery may involve a simple resection bordering on amputation, leaving no labia at all and extra hood tissue hanging from the top. The surgeon has performed an “avoidable unintended genital mutilation.” The patient sees it as a “botched labiaplasty.”
What about sexually mandated vaginal tightening operations?
General Ob/Gyns are trained in their residencies to do what is called a “posterior repair” (aka “posterior colporrhaphy,”) which includes a “perineorrhaphy,” or a repair of the perineal incision necessary when doing this “site-specific” repair. The term “site-specific” is important, as it describes a procedure (“posterior repair”) which is ONLY an operation designed to reconstruct a vaginal floor hernia that causes defecation difficulties, then sew the thing up. This bears little resemblance to the functional and aesthetic operation of “vaginoplasty” and “perineoplasty” (sometimes colloquially termed “vaginal rejuvenation.”) A vaginoplasty is an operation that takes into account the GOAL of overall vaginal tightening, and specifically re-approximates the levator muscles throughout their course through the outer half of the vagina along with removing scarred and inflexible vaginal skin and all of the deep non-functional scar tissue from the outer third of the vagina and vaginal opening. The procedure adds deep sutures to reapproximate the viable tissue and rebuild the perineal body to strengthen the perineum and aesthetically reconstruct the introitus (opening) to appear more similar to its appearance “pre-childbirth(s).” This operation is not taught in routine Gyn Residency training. The whole idea of a woman “rejuvenating” the appearance and function of her vagina, perineum and opening for sexual and self-esteem reasons appears, unfortunately, to be anathema to ACOG’s philosophy and goals. Additionally, a true “perineoplasty” is a plastic operation that takes into account muscle reconnection, tissue bulking, and aesthetic reconstruction. It is distinct from the “perineorrhaphy” gynecologists learn in their residency.
So, what happens in the real world?
In the real world the organization that represents traditional Ob/Gyns (ACOG) has come out with “Committee Opinions” that discourage genital plastics and say there is no evidence-based research. These “opinions” are just that – the “opinions” of the ACOG Committee. These are conservative, non-community academic types who, because they are neither trained nor savvy in this new field of surgery, condemn it. In truth, there are over ten peer-reviewed, evidence-based studies (prospective and retrospective) supporting the positive outcomes of women’s genital plastic/cosmetic surgeries when performed by well-trained, high-volume plastic and cosmetic gynecologic surgeons. This data does not include the “botched” surgeries performed by untrained ACOG Fellows and is not recognized by the out-of-touch officialdom of an unresponsive conservative national organization.
Very unfortunately, this head-in-the-sand response to the revolution in women’s empowerment to take charge of their bodies and tighten and remodel as they please has led directly to the botched labiaplasties and avoidable unintended genital mutilations performed by otherwise competent gynecologists who are unfortunately not knowledgeable enough to “know what they do not know,” with occasional (?? frequent) disastrous results.
Your vagina and vulva are treasured assets. Do not trust them to a general Gyn who cannot PROVE to you that he or she has either taken a specialized course in Genital Plastics, or has performed (and can show you the before and after photos to prove it) at least 25 procedures (over 50; over 100 is best..!) Your first procedure is your very best chance to do things professionally and avoid poor results at best, and mutilation at worst.