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