Dr. Erin Tracy was surprised when a teenage patient came to her gynecological practice to request a surgical procedure.
Her young patient wanted a more attractive vagina. The girl sought labiaplasty — a procedure to trim down and shape the inner or outer lips of the vagina, often for cosmetic purposes.
"She came in specifically to ask me to perform this procedure because a girlfriend of hers had had this done as well," said Tracy, an attending physician at Massachusetts General Hospital and an assistant professor of obstetrics, gynecology and reproductive biology at Harvard University.
Such requests are becoming more common. Procedures including "vaginal rejuvenation," "designer vaginoplasty," "revirgination" and "G-spot amplification" are rapidly gaining popularity.
Television shows, as seen in a recent episode of Showtime's "Californication," have spurred such requests. Other times, it's word of mouth.
"In talking with my colleagues, I hear more and more anecdotal trends of this happening," she said.
The trend toward cosmetic vaginal enhancement prompted the American College of Obstetricians and Gynecologists to issue a committee opinion today with a warning on the procedures.
Such procedures are not "accepted and routine surgical practices," the opinion reads. "Absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable."
While doctors who perform these surgeries agree that only those with the proper training and expertise should be allowed to conduct them, they say that for many women the operations can relieve them of both physical and emotional anguish.
"Women have gone so far as to say, 'Doctor, I have a penis.' How can your heart not go out to them?" asked Dr. John Miklos, director of the Atlanta Urogynecology Associates, Laser Vaginal Rejuvenation Institute of Atlanta Medical Research Institute.
Miklos, whose clinic offers several of the procedures described, said that a key step is ensuring that women are fully aware of the balance between risk and benefit of the surgery.
"I think people should get to make their own decisions about their bodies as long as doctors are making them informed consumers," Miklos said. "It's a woman's right to say, 'I don't like the way my labia look.'"
Cosmetic, or Necessary?
While a growing number of women may be looking to the operations to improve the appearance of their vaginas, a significant portion of those seeking these surgeries may be doing it to relieve pain or discomfort.
"If we're talking about helping people who are in pain, it's a different situation," said Tracy.
And the number of those seeking the procedure for pain relief could be larger than once thought. At the June meeting of the International Urogynecological Association in Cancun, Mexico, Miklos and his colleague Robert Moore presented survey research showing that of 135 patients seeking labia reduction, about two-thirds reported that they sought the procedures to relieve pain or discomfort due to their vaginal structure.
"It's irritating and it hurts," he said. "They are uncomfortable in their clothes, and it hurts during intercourse."
Vaginal tightening procedures, Miklos said, are another category of treatment that can have medical indications. These operations involve surgery on the vagina to tighten and resecure the inner tissues to their anchoring structures.
While some women may seek the procedure to restore a tighter feel during sex, Miklos said such surgery is often intended to prevent and treat legitimate conditions such as vaginal prolapse that can follow childbirth or some other trauma.
"These are medical diagnoses," he said. "This isn't some made-up stuff."
Still, procedures such as revirginization, which seeks to create the effect of a restored hymen, and G-spot amplification, in which a filling agent is injected into the front inner wall of the vagina, have no clear medical indication and therefore little justification, according to the American College of Obstetricians and Gynecologists.
A Need for Research
Tracy said that more research is needed to weigh the potential benefits against possible risks from cosmetic and nonmedically indicated practice of these techniques.
"We already know that there is a significant, real risk to these procedures when they are done specifically for medical reasons," she said. "There is very little in the literature of what vaginal rejuvenation actually is. We need to be confident that these are safe procedures."
Miklos, however, noted that the best way to learn more about these procedures is for the surgeons who have expertise in the area to perform them and share their results with colleagues.
"I think we need to be cautious," he said, "but for people doing the procedure, we need to do the research to open the doors to doctors who are not so well-versed in vaginal reconstructive surgery. We're the people who do the research."
Women interested in such procedures should be certain to seek out a doctor with the proper credentials and expertise.
"The bottom line is that for any complications or any untoward side effects that patients can encounter, the incidence of these problems is based on the skill of the surgeon," Miklos said. "You get a bigger risk of complications with inexperienced hands."
"If it is for pain or discomfort, [patients] need to make certain they visit with a board-certified gynecologist who can outline the risks and the possible problems," Tracy said.