What the heck is a labiaplasty and why would I need one?

I really felt like this was worthy of a repeat blog. These are questions that I get asked all the time at the office.

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Well I am glad you asked! This would definitely fall under the “sensitive subject” category and it is difficult for many women to even discuss this, let alone undergo such a personal procedure. I am happy to say, that the stigma surrounding this procedure is starting to decrease and women are beginning to feel more comfortable about coming forward, at least in my office. I am hoping that the national trend is increasing as well. So often, women remain silent about sexual and anatomical concerns in this area. Interestingly, the same stigma or fear does not seem to apply to breast augmentations and tummy tucks. I am not sure why but I suspect that somehow the level of intimacy and privacy of the genital area is even greater. We see breasts and abs in the media all the time and somehow it is socially acceptable. However, the female genital area is only displayed in certain unsavory media or in the privacy of the bedroom. It implies the idea that it is taboo to even discuss them. Now, I am not suggesting that we start posting billboards about vulvas or anything. I am just suggesting that these kinds of inconsistent social stigma further add to the difficulty of attempting to address issues in this area. I find that patients initially seem embarrassed to even talk about their sexual or labial issues at first, even to me! I feel like I have to quickly prove to them that my office is a safe place, I am comfortable talking about the issues, and that there is nothing they can say that I can’t handle or haven’t heard before. Once we get that out of the way, then I can proceed to help them.

Now that we have gotten that out of the way, let’s talk about labiaplasty. First let’s talk about who might need one. I never realized how many women were dissatisfied with the appearance of their labia. Some of them even refrain from having intercourse due to embarrassment. Interestingly, if you speak to their sexual partners, 9 out of 10 of them have not noticed anything and or wouldn’t change anything. I am going to interpret that as good news. In other words, most women are not coming to the office because their partner called their genitals ugly. They are presenting of their own accord because of their own wants and needs. Some women have enlarged labia that make it uncomfortable to wear a bathing suit or yoga pants or sit on a bike. Some women feel like they literally have to move something out of the way in order to have intercourse. Some women complain of decreased sensation in their genital area because of loose skin that covers the clitoris. Some women complain of a pulling sensation because their mons pubis skin droops down and covers part of the clitoris. Some women complain that they just would like it to look “prettier” or “better” down there. There are many different types of complaints. The biggest thing to realize is, that with very few exceptions, these women do not have anatomy that is abnormal per say. It is very important to keep that in mind when having consultations with them. The reassurance that their anatomy is normal has a somewhat freeing effect. Once the fear of being abnormal is alleviated, the patient can proceed with confidence in addressing her concerns.

So, now that we talked about who might need a labiaplasty, let’s talk about what a labiaplasty is. A labiaplasty is a procedure, either surgical/excisional or non-surgical, used to alter the shape and appearance of the labia minora, labia majora, clitoral hood, or the mons- pubis, or sometimes all of the above. Surgical labiaplastys involve actually removing skin in these areas to reshape the areas. This requires at least 8 weeks of recovery with no lifting, no intercourse, no hot tubs or swimming. Sometimes it takes up to 6 months to see the final results. I usually reserve this option for more severe cases that have so much excess skin that surgery is the only option. Non-surgical labiaplasty involves using radio-frequency energy with tumescent( anesthesia under the skin) and local anesthesia and can be done in the office. The recovery is much quicker. Patients often get the procedure done on a Friday and are back to work on Monday. They can resume sexual activity, swimming, etc in a week to two weeks and the results have been pretty amazing so far. The final results, like with surgical labiaplasty, can be determined in six months because changes happen gradually over time. The non-surgical labiaplasty is my personal favorite option at this point.

Let me show you a video that describes the process from beginning to end.

Now here is a patient testimonial.

Alright then, now that you have had a chance to look at those videos, let’s talk about the costs involved with labiaplasty. On average in the US right now, labiaplasty can cost 3000 and up, depending on the extent of the procedure. These are not covered by insurance at this point. A lot of patients get sticker shock with this initial number. However, due to the costs to the physician in performing the procedure and the labor intensive nature of the procedure, that number is not likely to decrease any time soon. At my office, we try to be flexible with payment options to try to make this as accessible as possible for patients. As I have interviewed patients over the past year in particular who have had the procedure, all of them have said it was well worth it. Make sure if you are seeking a labiaplasty procedure that you do your research and look for a qualified physician. Get a consult. Get comfortable with the facility. This is a very personal decision that you should not take lightly. Have a fantastic day!

Dr. Katz

The Squeaky Wheel

The squeaky wheel gets the grease. This FANTASTIC ( Ok I am being facetious) American proverb is used often to express the concept that the problem that is the most obvious(or loudest) is the one most likely to get attention. The origins of this saying are unknown but the most current version of the saying is possibly attributed to the American humorist Josh Billings, who used it in his poem ” The Kicker” in 1870. It goes something like this.

I hate to be a kicker

I always long for peace.

But the wheel that squeaks the loudest,

Is the one that gets the grease.

The implication of this saying in our culture is that if you raise enough fuss, you will probably get noticed and have your problem addressed. It doesn’t say anything about the appropriateness of your level of fuss or the consequences to the people around you. In my mind, the use of this kind of logic has degenerated over generations to mean that stomping and screaming is the way to go to get what you want and that you don’t even need to consider others in the process. I see this every day in the world and it breaks my heart a little. It has become almost Machiavellian in terms of the ends justifying the means. I feel that people nowadays allow themselves carte blanche justification of any methods necessary to achieve their desired result. On top of that, this type of behavior gets rewarded every day, while we sit and wonder why it continues at the same time. It’s as if we can no longer hear those individuals who try to express themselves with dignity, respect, and tact. We skip right over their concerns because they are not loud enough. We are so distracted, overwhelmed and focused on the chaos of the squeaky wheels that we can no longer process quiet. Oddly enough, we do not actually recognize their behavior as acceptable, but we try whatever we can to make it go away anyway, rewarding them with what they want in the process. This tacitly sends the message to continue the bad behaviors because they are successfully getting the desired results. Why do we do it? Do we really think that the squeaky wheels will actually settle down if we give them what they want? Not gonna happen folks. Those wheels will just keep squeakin and sending us in every direction but the right one.

Have a great day everyone.

Dr. Katz

Teenage bliss?

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Remember how “they” always told us that high school and college were some of the best years of our lives? That these were the times to be free, live it up and soak up as much of life as we could? It always seemed like nothing would ever compare to our teen years and that they would be something we could look back on fondly for the rest of our lives. Well, that kind of thinking may have worked for other generations, but I am willing to bet that today’s teens just don’t see it that way.

Take a look around. Today’s teenagers face unprecedented obstacles that are unique to them. They have had regular school interactions ripped away. They have had to miss out on many important last firsts like their last sporting event, or prom, or even walking in a graduation ceremony. I realize that there are those of you out there puffing your chests as we speak stating that the challenges facing today’s teens are nothing like what you had to face. For example, some of you had to face the possibility of going off to war after high school. This cannot possibly be compared to missing prom or graduation. I get it, but, before you get all upset and entitled, who was trying to? Was anyone really trying to suggest that missing prom and being drafted were comparable? I really don’t think so. As I mentioned, this generation of teenagers is facing a different level of challenges that are unique to them. It is not an implied competition between current and past obstacles. No is better or worse off than anyone else. The situations are just different. Let these kids have their pain and attempt to deal with it the best that they can. Even if you chose not to embrace it, these kids are, in fact, in pain and this pain is very real to them.

I see examples of this every day. A few weeks ago, I had a group of my daughter’s friends over (under five kids and no hugging or snuggling allowed) and just observed. First of all, it was the first time some of them had really seen anyone else, much less each other. There were tears and rambling speeches about how much they had missed each other. Their conversations were particularly intense and loaded, as if they were trying to communicate as much as possible in the shortest amount of time, just in case the opportunity never presented itself again. There was a deep sadness and angst that pervaded their conversations. Instead of talking about gossip, boys and gum, they talked about their anxiety, their tics, their medications. They talked about how toxic school was. They spoke of parents as enemies of ideas. It was all so negative. They had spent so much time with their own thoughts with no one to bounce them off of that they had developed whole conspiracy theories about school and all of their relationships. It was as if their faith in any sort of return to normality had been destroyed and they developed a series of psychological walls to convince themselves that normality was truly overrated anyway and that there was really nothing to miss in the first place. I sat back and listened with my heart heavy. I wanted to interject and grab them all and hug them ( not very COVID PC) and remind them that it will all be ok at some point. Still, I didn’t make the gesture for two reasons: 1) I didn’t want to interrupt. These were the wild thoughts that they literally and physically needed to get off their chests. and 2) I wasn’t entirely sure myself that things would be ok eventually and I didn’t know what further harm I could cause by raising false hope.

As I said, these kids are in pain and they need help. Now more than ever they need us to listen and provide counsel and a sounding board. They need some kind of structure to cling to and see their way through life. I know that we all have our own frustrations right now economically, physically and emotionally as well, but we have to suck it up somewhat as adults. These kids haven’t had enough life experience or tools to effectively deal with all of the change happening around them just yet. Whether they want to accept it or we want to admit it, they need us more than ever right now. All of our roles have changed. We are no longer just parents or just teachers or even just friends for them. We are sometimes their only consistent connection to the world at the moment. We all need to be a little understanding and work a little harder to make sure that that connection is a healthy one. Otherwise, who knows what the future will hold for them….or us.

Forgiveness is more badass than hate

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I was listening to an old video with pastor Nadia Bolz-Weber the other day about forgiveness and it really blew my mind and changed my perspective all in 1 minute and 58 seconds. You see, I have been struggling with the concept of forgiveness for years. In my mind, depending on the level of heinousness of the act, forgiving someone is liken to being a proverbial doormat, offering tacit consent to whatever happened and opening the door for more misfortune in the future with no recourse. Instead I just hold on to my hate as if it offers me a strength or some kind of shield that I didn’t have when the original act of harm occurred.

According to her, I have it all wrong. She says that when someone harms us, we stay connected to that harm by a metaphorical chain, unless we chose to break it by forgiving them. She explains that forgiveness is like an act of fidelity to an evil-combatting campaign. It is not an act of niceness and has nothing to do with being a door mat. Forgiveness allows us to grab the proverbial bolt cutters and permanently sever the chain that is binding us to the mistreatment and truly be free for the first time. If we don’t sever that chain and let go of the hate, we run the risk of absorbing the worst part of our enemy and risk becoming just like them. It has nothing to do with tacit consent. It just means that we are officially refusing to be connected to the original harm anymore. She says that free people are the “dangerous ones,” but not dangerous in the way you might think. Free people are dangerous only to the manipulators and the inflictors of cruelty in the world because free people refuse to be controlled by the chains of resentment. Free people laugh more and are not easily offended. Free people are able to find more joy and live fuller lives and are able to shine through any darkness. I think I am ready to give freedom another try. How about you?

Dr. Katz

And in the end, the love you take, is equal to the love, you make.

This famous line from The End on the Abbey Road album proves that John, Paul, George, and Ringo knew what they were talking about. It was one of their last messages of love to the world toward the end of a phenomenal career. These words speak a simple truth that I feel like we are all forgetting lately: Whatever you put out into the universe is what is going to come back to you eventually. If you put love out there, you will get love back. If you put hate out there, you will get hate back. The formula is simple and logical, in a way. Notice that this quote does not mention anything about timelines. It doesn’t mean that the very second you offer something good to the world you will get immediate returns. It implies nothing about instant gratification. It doesn’t eliminate the possibility of having to invest a significant amount of your emotions and time into something before you see any results. It doesn’t say anything about what the world owes you at any point in time, regardless of your efforts. It simply bottom lines the idea that you will eventually get back what you give.

Dr. Katz

ANY publicity is good publicity? I am not buying it.

bad publicity cartoon

I am forever hearing the adage, “Any publicity is good publicity” or “There is no such thing as bad publicity.” This has been grounded into my head as a business owner for as long as I can remember. My interpretation of this statement is that it means that any attention is better than no attention. It implies that even if something is deemed bad, wrong, incorrect or immoral, it only draws more attention to it as a sort of forbidden fruit, somehow making it even more desirable. I just don’t think that this is universally applicable.

It may work in the case of a movie star or a rock musician. We hear something potentially unfavorable about them and it intrigues us and makes us want to know more. This increased interest is basically risk free because these people are not likely to impact our lives in any significant way. They are just on a screen or a concert stage that we watch to escape real life for awhile. If they turn out to be a terrible person, so what? We can choose not to watch their movies or concerts or continue to do so with no real consequence either way. On top of that, they probably don’t really care one way or the other what we think. They don’t really need to.

The exact opposite is true for me in the medical field. If someone leaves a bad review for me on Google or Health Grades or worse yet, makes a terrible comment on one of my social media posts, I just can’t see that bringing me any sort of attention that I would actually want. I am fortunate in that this happens rarely, but when it does, I can’t stop thinking about it. I find myself researching who the individual might be and even attempt to reach out to see what I can do to remedy the situation or ease their pain, even if I realize that I have never actually seen the person. This happens all too often. After extensive research I realize that I have no record of this person and yet it still haunts me. These kind of hurtful reviews or comments do not achieve anything productive that I can think of. In fact, depending on the vulnerability of my current patient population, it can potentially affect their perception of me as well. There are people that truly take in whatever is in print as fact, without questioning it’s validity. The initial questions that are raised by these types of feedback can potentially cause ripples of unease that can spread through patients like wildfire. No good can come of that. No one wants to hear something bad about their doctor…ever. You have to have complete trust in someone who is so intimately involved in your life. You have everything to lose and nothing to gain by entrusting a potentially bad or dangerous physician. No one finds themselves seeking some infamous physician who botched a procedure just because they saw them on Dateline or something. It just doesn’t work that way. Have a great day everyone.

Dr. Katz

I am a physician not a magician.

A family practitioner colleague of mine used to say this all the time to patients. ” I am a physician, not a magician.” Initially it always made me laugh because I am generally a fan of quippy sayings. But then, the truth of it really began to sink in…….A truer statement was never uttered. We are physicians not magicians. We are here to guide and provide evidence-based recommendations to attempt to better the lives of our patients. We are not here to bully or coerce. We cannot force anyone to do anything. The only time that I really get bossy is when it is a matter of life or death, which I feel is reasonable…lol When we take the time to advise a patient on their next move, it is essential that we are not in the game by ourselves. There needs to be a team effort relationship between the doctor and the patient in order to be successful and mold the desired outcome. This holds true for every type of patient that I care for: aesthetic patients, addiction patients and obgyn patients. In order for the doctor patient team relationship to remain stable and fruitful, there has to be personal investment on both sides. For me, that is guaranteed. I would not be in this profession if I were not invested in every single patient in every single scenario. That is the whole reason I got into the practice of medicine: to improve and save lives and to help as many patients as my faculties allow for as long as I can.

From the patient side, however, nothing is guaranteed. I have many wonderful patients that seem to value my advice, attempt to follow it to the best of their ability and actually are able to achieve the outcomes that they want to a reasonable extent. These patients are truly a joy to care for. They are the kind of patients that you reflect on to get you through a tough day and remind you why you are doing this in the first place.

Then, there is the other subgroup of patients. These are the ones that come in after years of absence and personal neglect with high expectations that you will be able to wave your magic wand and fix all of their issues with a single sweep of your arm. These are the morbidly obese diabetics who have never even attempted to modify their lifestyles or their mental relationships with food and demand that you refer them for a gastric bypass and are outraged when you hesitate. You try to explain to them how important it is to change their mental views about food and stick with some sort of weight loss plan and even psychological counselling for six months to increase their chances of success. This just further infuriates them since they are already frustrated and blinded by their quest for a quick fix for a problem that is many many years in the making. These are the patients that request CoolSculpting ( a non-invasive fat freezing procedure) thinking that it will shrink them from a size 24 to a size 2 with absolutely no effort on their part in terms of diet and exercise and then get angry when you advise them against it, because you are not out to take their money by doing something that you know won’t work. Shame on you right? Wrong. These are the kind of patients that frustrate you, make you second guess yourself, and leave you questioning if you will ever be able to make a difference in their lives. Every interaction with them is like walking an agonizingly fine tightrope. Fall off on one side and you may satisfy them for a second, but you compromise your ethics. Fall off on the other side and you have done what’s right but they may leave and never come back. Either way someone loses, whether it is you or the patient.

The bottom line is that the doctor and the patient have to be a team. It makes sense doesn’t it? Both parties should have the same goal: the well-being of the patient. It is ideal if both parties are on the same page, but not always possible. However, even if both sides are not in agreement, goals can be achieved as long as there is a personal investment on both sides. Both parties have to play an active role in order to achieve the desired outcome. The doctor has to be actively engaged in researching and recommending solutions for the patient and the patient has to be willing to take the necessary steps to attempt to follow those recommendations in order to achieve their goals. The doctor cannot wave a magic wand any more than the patient can just sit and wish for change without taking any action. It just won’t work. Have a great day everyone.

Dr. Katz