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  • Writer's pictureMarja J Sprock M.D.

Vaginoplasty and the “Designer Vagina”

The marketing language surrounding vaginal aesthetics is fascinating, with terms like "designer vagina" capturing attention. This phrase can mean different things to different individuals, including their partners. Vaginoplasty, a reconstructive surgery of the vaginal canal, is aimed at tightening a vagina that has become lax or loose, often as a result of vaginal childbirth. It also encompasses surgeries to create a vagina for women born without one or for transgender individuals.

In this discussion, we'll concentrate on Vaginoplasty related to achieving a "designer vagina." Over time, vaginal tissues can stretch, sometimes beyond their ability to return to their original tightness. While pelvic floor or "Kegel" exercises can correct muscle laxity to an extent, they cannot restore a significantly stretched vagina to its former tightness. This is akin to the loose skin that remains after significant weight loss, which no amount of muscle training can tighten completely. Despite the benefits of pelvic floor exercises, they fall short of returning an overstretched vagina to its prior state, leading many women to opt for surgical correction to regain vaginal sensation.

Vaginoplasty is typically classified as cosmetic surgery unless it's performed in conjunction with prolapse repair. Prolapse involves the descent of organs within the vaginal canal, such as the bladder, rectum, bowel, uterus, or the post-hysterectomy cuff. Correcting prolapse often results in a tighter vagina, which might mimic the effects of a vaginoplasty. Prolapse surgery is usually covered by insurance, whereas Vaginoplasty for purely cosmetic reasons is not.

Issues like bladder prolapse can complicate urination and disrupt sleep. Reconstructive surgery, such as anterior colporrhaphy, can improve functionality. As a cosmetic procedure, vaginaloplasty alters the aesthetics of what is considered normal anatomy. "Vaginal rejuvenation" often refers to both labiaplasty and Vaginoplasty, aimed at restoring and enhancing the vagina and vulva's function and appearance. Some women seek labiaplasty to reduce discomfort during sports or improve appearance. At the same time, Vaginoplasty focuses on tightening the vaginal walls and possibly the vaginal opening, depending on personal or partner-related preferences.

The American College of Obstetrics and Gynecology (ACOG) cautions that Vaginoplasty is not medically necessary and lacks documentation on safety and efficacy. ACOG highlights potential risks such as infection, altered sensation, pain during sex, adhesions, and scarring and emphasizes the importance of exploring non-surgical options for sexual dysfunction. However, the reality is that prolapse repair often results in the desired side effect of a tighter vagina, challenging the stance that discourages Vaginoplasty. Women seeking Vaginoplasty typically do so to enhance their sexual pleasure, not at their partner's behest. For those who feel their vagina has become "stretched out" and find no relief through muscle training, Vaginoplasty offers a viable solution to improve their sex life, supporting women's autonomy in choosing their path to sexual satisfaction.

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