What is genital cosmetic surgery (GCS)?

There are several procedures that come under the term GCS. They include: 

Labiaplasty – This involves surgery to the labia minora (inner lips) and less frequently, the labia majora(outer lips). Labiaplasty of the labia minora is the most commonly performed GCS procedure. It generally involves reducing the size of the inner lips so they do not protrude below the outer lips. It is also used to correct asymmetry of the lips, where one lip is significantly different in size/length to the other. Some women have labiaplasty because their labia cause them chafing, irritation and also limit their participation in activities such as bike riding. However, many women also undergo labiaplasty because they are embarrassed about the appearance of their labia.

Vaginoplasty – This involves tightening the inside of the vagina and the vaginal opening by removing excess tissue from the vaginal lining. It effectively results in a vagina with a smaller diameter. Vaginoplasty is often promoted as a solution for women who have experienced a loss of vaginal tone due to childbirth. It is also referred to as ‘vaginal rejuvenation’. 

Hymenoplasty – This procedure reconstructs the hymen (the thin membrane of skin that partially covers the vaginal entrance in a virgin). The edges of the torn hymen are reconnected so that when sexual intercourse takes place the membrane will tear and bleed. While hymenoplasty is predominantly performed for religious or cultural reasons, it is also being promoted as ‘re-virgination’, for women who want to give their partner the ‘gift’ of their virginity.

Labia majora augmentation – This procedure seeks to plump up the outer lips by injecting them with fatty tissue taken from another part of the woman’s body.

Vulval lipoplasty – This procedure involves the use of liposuction to remove fat deposits from the mons pubis (the pad of fatty tissue covered by pubic hair). This results in the mons pubis being less prominent.

G-spot augmentation – This procedure involves injecting a substance such as collagen into the G-spot in order to enhance its size and, therefore, theoretically also a woman’s sexual pleasure. The effects will last 3-4 months on average after which the procedure needs to be repeated.

Clitoral hood reduction – This procedure involves reducing the hood of skin which surrounds the clitoris, exposing the glans (or head) of the clitoris that lies underneath. A clitoral hood reduction is aimed at providing more stimulation, therefore, heightening a woman’s sexual pleasure. The procedure is also known as hoodectomy. 

Who is having GCS?
There has been an increase in the number of women having GCS in the last decade. Medicare claims for vulvoplasty and labiaplasty jumped from 707 in the 2002/03 financial year to 1,588 in the 2012/13 financial year. Medicare statistics do not include women having their surgical procedures in the private health system so the true number of GCS procedures is likely to be higher. In November 2012, a cap was placed on the Extended Medicare Safety Net(EMSN) for vulvoplasty and labiaplasty. Essentially this means that the Medicare benefit amount that women can claim for these items is now capped, regardless of the fee charged by the doctor. It will be interesting to see what effect this change has on the number of procedures being carried out.

Why are more women seeking GCS?
The rise in numbers of women having GCS is in some part due to a greater awareness of the available procedures. There is a wealth of information about GCS on the internet and major women’s magazines have also featured articles on the topic. Similarly, many surgeons advertise GCS services on the internet and in other publications. While more women know about GCS, this doesn’t explain why more women feel the need to have it. What is causing women to modify their genitals?

The rise in popularity of Brazilian waxing appears to be one reason why GCS is on the rise. Removing the vast majority of pubic hair means that the genitals are less camouflaged and women are more aware of their appearance. Increased exposure has led women to feel more self-conscious about their genitals and worried about whether they are ‘normal’.

How the female genitals appear in pornography has also been given as a reason why women are pursing GCS. Professor Ajay Rane, an urogynaecologist recently remarked to Australian Doctor that GCS was “promulgated by internet pornography – it’s promoting a false idea of what genital anatomy should look like.”

In order for an adult magazine to be classified as ‘unrestricted’ and, therefore, sold on the shelf in a newsagent, a woman’s genitals must be ‘discreet’. Women’s genitals are, therefore, typically airbrushed so that the labia minora are not visible, often resembling those of a pre-pubescent girl. The internet has meant that women are more likely to encounter pornographic images and inevitably they may find themselves comparing their own genitals to those of the women featured.

What are the risks and complications of GCS?
GCS carries with it the associated risks of surgery, including the risks of anaesthetic, bleeding, infection and scarring. Other risks of GCS include:

Nerve damage and loss of sensation
Labia asymmetry
Permanent colour change
Scalloping of the labia edge
Tissue death along the wound
Blood clots
Pain during sex
Change in sexual arousal
Dissatisfaction with results
Damage to other genital areas

Some of these complications may require further surgery.