When it comes to the controversial topic of cosmetic gynecology, the two physicians who participated in The Howard Taylor International Lecture debate yesterday agreed that the gynecologic specialty needs to take a greater role in what’s happening in the cosmetic gynecology space. However, they differed on what that role should be.
They also agreed that the proliferation of procedures being touted in the popular literature, including revirgination, clitoral unhooding, g-spot amplification and o-shots, cannot be categorized in the same way as procedures to treat genitourinary syndrome of menopause (GSM) or pelvic floor disorders.
“The first thing we need to do immediately is throw the term vaginal rejuvenation out the window. This is a terrible term,” said Mickey Karram, MD, director of urogynecology and reconstructive surgery at the Christ Hospital and medical director of the Christ Hospital Pelvic Floor Center in Cincinnati, Ohio, who argued the pro side and advocated for a standardization of terms for these procedures as well as a categorizing of their functions. He said the procedures should be considered either cosmetic, sexual enhancing, or addressing a disease state.
With the proliferation of laser technology, more and more plastic surgeons and dermatologists are offering cosmetic gynecologic procedures backed by marketing campaigns. Media campaigns and the overwhelming popularity of pubic hair removal have led women to these clinics in an attempt to improve the look of their vaginas with vaginaplasty or labiaplasty.
Dr. Karram argued that if anyone is offering these procedures, however, it should be those in the gynecology specialty.
“Who knows this anatomy the best? We do. If a patient is truly bothered by this and understands exactly what the outcome of fixing it would entail, then I feel strongly that she should be able to have this procedure done,” he said.
Cheryl Iglesia, MD, director of the section of female pelvic medicine and reconstructive surgery and director of the National Center for Advanced Pelvic Surgery at MedStar Washington Hospital Center, argued that the lack of consensus of technique or outcomes for these procedures coupled with unethical or false claims and potential damage due to scarring, altered sensation, or wound complication in otherwise healthy patients makes these cosmetic procedures something to avoid until safety and efficacy can be proven.
“I think we need to tame it down a little bit. I don’t think any innovation should be done without some formal evaluation for both efficacy and safety,” she said.
While there are medically appropriate indications of labiaplasty, such as repair of female genital cutting, labial hypertrophy, or excessive androgen hormones, she said, the pursuit of a “Barbie-doll” vagina isn’t such an indication.
“I think these web-based claims are horrendous. I think that people who are reading those don’t understand, and it’s our obligation as women’s health advocates and providers to set it straight,” she said.
She acknowledged that the cash nature of the cosmetic vaginal enhancements business was an appealing way to supplement a practice’s income, especially to help pay for pricey technology used also for medically indicated treatments.
“But there is a real blurring between cosmetic surgery and what is bonafide and covered by insurance for reconstructive pelvic surgery,” she added.
On rebuttal, Dr. Karram noted that patient demand and increasing technology means that the subspecialty must assume responsibility for setting standards and providing research and guidelines for the cosmetic gynecology space.
“There are a lot of things happening. Many are unethical and inappropriate,” he said. “But, I think that energy sources are going to be revolutionary in treating certain therapeutic areas such GSM and lichen schlerosus. We as a subspecialty need to get actively involved and take ownership of these things.”
Taylor International Lecture Streaming Colloquia Video