Intimate makeover

[Guest guest]

Intimate makeover

In a quest to look younger, feel prettier and have better sex, women

are turning to genital plastic surgery. And the look many want is

that of a porn star.

By Healy

Times Staff Writer

March 13, 2006

SINCE the dawn of its days as a medical specialty, plastic surgery

has been marching inexorably down women's bodies, straightening,

slimming, tucking as it goes, restoring the appearance of youth to

features sagging with age and smoothing those marked by eccentricity.

Plastic surgery's southward expansion has now entered territory long

thought sacred. Today, the vagina and its neighbors — the labia

majora, the labia minora, the clitoral hood — are the latest bit of

feminine real estate considered to be blighted by age or otherwise

in need of renovation, beautification and rejuvenation.

Across the country, post-pubescent and peri-menopausal women alike

are having their vaginas tightened, their mons pubis liposuctioned,

their labial folds nipped and their clitoral hoods tucked. Most are

seeking to restore what plastic surgeons are calling " a more

youthful look " to this long-secreted corner of the female anatomy

and often to improve their sex lives in the process. (In some cases,

women with few pretensions to virginity are surprising their

partners by having their hymens surgically restored.)

Other women, bothered by the imperfect proportions of their

genitalia, undergo surgery just to bolster their self-image — a

boost that often pays sexual dividends as well.

" I was the type who always wanted to have the lights down low " when

having sex, says Holly, a 50-year-old medical assistant who recently

had surgery to trim her labia minora and who asked that her last

name not be used to maintain her privacy. " Just being comfortable

with my body, this was huge for me. I was able to be sexually

confident. "

Even as the small but growing group of genital plastic surgeons

devise new and better surgical techniques, they acknowledge the

standards women hope to achieve are set mostly by adult film

actresses, strippers and nude denizens of the Internet.

" I know what women want, " says Dr. L. Matlock of Los Angeles,

an obstetrician turned plastic surgeon who has been a pioneer in

devising and popularizing the procedures. He knows, he says, because

so many of his patients tote their husband's or boyfriend's

magazines into his office and point to photos almost as explicit as

the before-and-after ones posted on many surgeons' websites.

More traditional plastic surgeons and gynecologists may be reluctant

to endorse such procedures, but the demand is undeniable. Vulvar and

vaginal plastic surgery is one of the fastest-growing areas in

plastic surgery, say some in the field.

Many of the techniques have been practiced for decades by

obstetricians and gynecologists to repair childbirth-related

injuries, and by urologists and reconstructive surgeons who repair

birth defects or perform sex-reassignment surgery. But in the late

1990s, a few surgeons began offering the procedures as a means to

enhance the aesthetic appearance of women's genital organs and, in

some cases, to improve sexual function.

Today, in a field that assiduously tracks the demand for tummy

tucks, butt lifts and breast implants, there is no data to gauge the

scale of demand for these procedures. But there are signs that

genital plastic surgery has appeared on the radar screens of social

trend-watchers and the medical profession itself.

Next year, the American Society of Plastic Surgeons expects to begin

collecting data on the number of vulvar and vaginal procedures its

members are performing. Several practitioners of the new procedures,

including a pair of Los Angeles plastic surgeons, have been profiled

on cable TV shows pitched to viewers hungry for news of the

beautiful and famous. And members of the American College of

Obstetricians and Gynecologists have begun grumbling that it's an

issue on which they need to weigh in.

But Dr. V. Leroy Young, who chairs the Emerging Trends Task Force of

the American Society for Aesthetic Plastic Surgery, says the true

gauge of these procedures' popularity may lie precisely in the fact

that, far from either coast, conservative heartland women are paying

doctors like him to perform them.

Young performs about two to three vulvar procedures a month on women

who " would never dare ask the question at a church social, " but who

can now learn about such procedures on the Internet and on TV. " It's

right here in middle America, " says Young, whose practice is based

in Creve Coeur, Mo., a suburb of St. Louis.

Porn-star standards

Southern California — the seat of the adult entertainment industry —

is undeniably the birthplace of this fledgling field of surgical

alteration.

In 2000, many Americans learned about a new procedure called

labiaplasty when a porn star known as Houston had her labia-

reduction surgery filmed and distributed to subscribers, then later

auctioned off the excised flesh over the Internet.

Sharon , executive director of the Adult Industry Medical

Healthcare Foundation in Sherman Oaks and Woodland Hills, says few

of today's adult film actresses are having the surgery because so

many are already very young. But , an adult film actress for

25 years before she earned a doctorate in human sexuality, says the

adult film industry's emphasis on youth, as well as its growing

audience among beauty-conscious women, is almost certainly driving

the upsurge in the surgery.

And many women take the standards set by sex workers very much to

heart, say doctors performing the surgeries.

" I hear it time and time again, " says Dr. Alter, a urologist-

turned-plastic-surgeon who operates out of offices in Beverly Hills

and New York City. " The woman says, 'I thought I was normal and I

watch these movies with my boyfriends and now I feel like I must be

a freak.' They feel they're the only ones in the world. "

As the procedures have grown in exposure and popularity, a few

mainstream gynecologists have sounded the alarm.

" You're basically taking a risk for no or very little benefit " with

most of these surgeries, says Dr. G. Stovall, immediate past

president of the Society of Gynecological Surgeons. Stovall warns

that with labiaplasties and vaginal tightening, patients run the

risk of developing infection and scar tissue, which can decrease

sensation — or worse, cause pain — in the areas where incisions have

been made.

As for the claim that vaginal tightening can enhance sexual

gratification, Stovall insists " there is no scientific basis " to

support it. " It might make it better for her partners, " says

Stovall, but the female patient is taking a risk without much

prospect of personal benefit.

Feminists too have criticized the trend. Judy Norsigian, co-founder

and author of the feminist health tract " Our Bodies, Ourselves, "

says women who have these surgeries are taking risks to adhere to

standards of feminine beauty that are fleeting, unnatural and,

ultimately, dictated by a society in which men are fixated on barely

pubescent girls.

Norsigian and others have spoken out against Brazilian waxes, a

popular hair removal trend that leaves all but a tiny wisp of pubic

hair intact, as a reflection of that fetish. In turn, by making

women's genitals more visible, the Brazilian wax trend has naturally

led more women to take the risky next step of having their genitalia

surgically altered, she says.

" We live in a country where people are always thinking up new

things, new practices, new ways to make money, " says Norsigian. " And

if you can play upon an insecurity, you can get a lot of people to

do a lot of things. "

But many of the patients who pay from $7,000 to $18,000 to have

their genitals nipped, tucked and rejuvenated aren't buying the

arguments of those who would portray them as feckless pawns.

" I consider myself a feminist, and I feel this is so empowering, "

says Sokey, a 36-year-old South Pasadena resident on whom

Matlock recently performed laser vaginal rejuvenation. " It was a way

to take charge of my own sexuality " after giving birth naturally to

three strapping babies.

Why women risk it

Women seeking plastic surgery in the genital area vary in their

motivations, say those in the field. Many are prompted strictly by

aesthetics: They are, says Alter, " women who are in tune with what

they should look like. "

But a number of patients, including Sokey, turn to plastic surgeons

with complaints about physical discomfort, whether from lengthy

labia, weakened vaginal walls or a clitoris enlarged by steroids or

hormone imbalance. And in many cases, these patients report their

concerns have been dismissed, played down or greeted with an

unsympathetic shrug from the obstetricians and gynecologists they

consulted first.

Sokey had three children at home with a midwife and breast-fed them

well into their toddler years. She laughs sheepishly at the thought

that she has become a champion of vulvar plastic surgery. " I would

have never thought I'd end up in a Beverly Hills plastic surgeon's

office; this is not my world, " she says.

But in the two years after the birth of her third child, Sokey says

she consulted three physicians for symptoms that had grown more

dramatic with each childbirth. Her vaginal walls felt loose, she

felt a " bottoming-out " feeling when she ran or lifted the baby and

the downward pressure of her reproductive organs, urinary bladder

and rectum had caused her labia to swell so much that normal

underwear rubbed and chafed. " Sex, " she adds, " just wasn't as much

fun, " and feeling her marriage was in jeopardy, she went looking for

help.

One gynecological surgeon told her she " had the vagina of a 50-year-

old woman, " and sent her home with orders to do more Kegels, a

pelvic-squeezing exercise long recommended to reestablish vaginal

tone after childbirth. Another suggested corrective surgery and the

implantation of a pessary, a supporting device that would hold her

uterus and other organs in place and prevent them from intruding

into the vagina. But the physician cautioned that convalescence

would be long and insisted stop breast-feeding so that the

weakened surface of her vagina would hold sutures. A third

recommended a hysterectomy, which would have plunged Sokey into

early menopause.

Sokey felt the options that obstetrics and gynecology had offered

her ranged from ineffective to frighteningly radical. Her physical

problems and the demands of motherhood were taking a toll on

intimacy, even as her marriage, she discovered, was coming apart.

Sokey says she was overwhelmed with " the despair of going forth in

the world of singlehood feeling broken and used up, and there was

nothing I could do about it … I felt very old. "

When a friend suggested she go to Matlock, Sokey felt a twinge of

hope. " It seemed overall like a gentler procedure, " she says, and

Matlock's staff assured her they had sent women in her situation

home repaired, happy and hopeful. She went for Matlock's trademarked

Laser Vaginal Rejuvenation package, an $8,000 procedure in which

Matlock uses lasers and layers of sutures to make incisions along

the front and back of vaginal walls, stitch the urinary bladder and

rectum in place, remove excess tissue and tighten the vaginal

opening.

Today, Sokey says she feels, simply, " rejuvenated. " When she blew up

a balloon for her son recently, she did not have to brace against

the bottoming-out feeling. Her labia have returned to normal, making

her choice of underpants a fashion decision again. And as she makes

the first tentative steps back into single life, she says, " sex has

been great. " Matlock says his colleagues in the obstetrics and

gynecology specialties have treated women — and patients such as

Sokey — shabbily. He says he is listening to them and giving them

options that many desperately want.

" If these were male problems, [the medical profession] would have

looked at these symptoms and solved them long ago, " Matlock says.

His patients, he says, are voting with their feet — and their

pocketbooks because virtually none of the services he provides is

paid for by insurance. " They all have gynecologists, but they're

coming to me. "

Even Stovall, of the Society of Gynecological Surgeons, acknowledges

that many ob-gyn specialists are wary of asking about vaginal

function after childbirth because women's sexuality is such a

complex matter. " Most doctors don't have the expertise, " he says,

adding " since they don't have anything to address the problem,

they'd just as soon not ask.

" That may be a problem, " says Stovall. " But getting your vagina

lasered is not going to solve that problem. "

But for every woman like Sokey, there is probably at least one like

Holly, the 50-year-old medical assistant from Southern California.

Holly conceived the idea that her labia didn't look right while in

her late teens, just as she became sexually active. Looking

furtively at adult magazines or at her friends convinced her " this

didn't look normal. "

For almost 30 years, her sense that her labia minora were too

long " constantly made me sad and not [feel] good about myself. " When

she would confide the cause of her sexual shyness to a man, he would

invariably tell her she was fine, but she never bought it. Now, with

her labia reduced by Alter, " there's a little jump in my step

because I just feel so good about myself. "

A range of normalcy

A plastic surgeon must always consider whether a patient's request

is reasonable or is a symptom of an unhealthy body image. To do so

requires an understanding of what is normal and what is, by

society's current definition, beautiful. When it comes to female

genitalia, the standard of beauty, at least, is an evolving

standard. And that leaves plastic surgeons little firm basis for

deciding which patients are unstable and should be turned away.

Matlock is perhaps clearest in his definition of female genital

beauty. The porn stars his patients most frequently hold up as

exemplary, says Matlock, sport " a nice, clean look, " with a smooth

clitoral hood hugging the clitoris like " a piece of paper draped

tightly around a pencil " and petite, wrinkle-free labia flanking

a " slit-like introitus " (or vagina) that appears never to have

endured the indignities of childbirth.

But that is hardly the norm among American women, and physicians

such as Stovall argue that before they reach for plastic surgery,

women should be made to understand that " there are a multitude of

normal variations. " In plastic surgery, however, that's often a

tough sell — not to mention a low priority. Young says he often

tries to reassure women who seek him out that their genitals " are in

the range of normal. " Most often, he adds, " they don't want to hear

it. They want the problem fixed. "

Young echoes an often-heard conviction of plastic surgeons offering

the new procedures: " I don't want to hear from a patient that

they're doing it for someone else, that 'my husband or boyfriend

said he doesn't like the way I look,' " he says. " That's a dead-end. "

But he acknowledges there's at best a " subtle difference " between a

woman seeking surgery to increase her own self-confidence and the

one who does so in hopes of pleasing the man or men in her life.

Many women who come to Alter's office are more focused on improving

the look of their genitals than correcting a defect in their

function, he says. But he refuses to dismiss their concerns as a

form of " body dysmorphia " — the kind of wildly distorted body image

that afflicts, for instance, those suffering the eating disorder

anorexia nervosa.

For women whose sexuality is profoundly linked to self-esteem, Alter

insists that improving appearance does improve sexual function, and

helping women improve the quality of their lives is worth the risks

that come with surgery.

" I hear people say, 'Who cares anyhow how someone looks down

there?' " says Alter, who performs about 15 labia reduction

surgeries, one of his specialties, a month. " My response is, 'You

look down there and the other person who counts most of all, your

partner, does, and that's enough. People do look down there, and no

one likes to feel they're a freak.

" My view is that the operations I do are extremely safe, they have

negligible risks and an incredibly high satisfaction rate. What's

the problem? " Alter says.

The problem, says of the Adult Industry Medical Healthcare

Foundation, is that women, whether they are porn stars or would like

to look like them, would do better to accept themselves — to " dance

naked in front of the mirror until they like what they see. "

And those tempted to go under the knife after admiring the genital

proportions of a porn star should remember, she adds, that there is

more than just youth and beauty at work in adult films: There is

considerable cinematic sleight of hand.

" It's still a fantasy, still a projection, " says , who notes

that vaginal wrinkles or asymmetrical labia can be airbrushed as

readily as a pimple. " This is still moviemaking, regardless of how

cheap. "