A comprehensive update about aesthetic vaginoplasty. indications, implications.

1. Aesthetic Vaginoplasty: A
gynecologist Perspective
Mahmoud Abdel-Aleem
Professor of Obstetrics and Gynecology, Assiut University

2. Definition
According to WHO; these are procedures involving
partial or total removal of the external female
genitalia or any injury to them for socio-cultural and
non-therapeutic reasons”.

3. • Reconstructive
Vaginoplasty
• Sex
Reassignment
surgery
• Aesthetic
Vaginoplasty
Vaginoplasty

4. Reconstructive
Surgery
Improving the
function of a
body part
Cosmetic Surgery
Changes the
aesthetics of
essentially normal
anatomy
Vaginal
rejuvenation" and
"designer vagina
Changing paradigm !!!

5. The story
In 1973, a French, Belgian, and Italian
dermatologist met on a Mediterranean
cruise ship while traveling on holiday.
The three friends little suspected that a
few days of chatting would give birth to
what they termed a “restless and
revolutionary Aesthetic Medicine”

6.  Diverse procedures from “chemically
remodeling the body’s silhouette” (SBME
2011) to “prevention and treatment of all
types of aesthetic pathology” (SEME 2011).
This field incorporates diverse specialties and
has already procreated new hybrids such as
“aesthetic gynecology” and “aesthetic
endocrinology”.

7. Concept of aesthetic medicine
Health
Beauty

8. Conflicts of aesthetic medicine
Hippocrates
Rule
Appearance
Vs

9. “Quotations”!!!
1- An aesthetic medicine presents a puzzle for critical
studies of medicalization.
2- An anomalous medical practice in that it makes
aesthetic improvement the exclusive aim of surgery, even
to the point of justifying health risks in an otherwise
healthy patient.
3- Cosmetic surgery is often combined with a growing
number of medical procedures that harm beauty and
sexuality.

10. 4- The boundaries between reconstructive and
cosmetic rationales in plastic surgery have
shifted. In the late 19th century, even
procedures such as correction of a cleft palate,
now widely perceived as reconstructive, were
considered cosmetic (Gilman 1998).

11. 5- The “inferiority complex”—a psychoanalytic
concept popularized in the United States in the
1920s—lent credibility to the idea that appearance
has profound effects on mental health.

12. Surgeons performing FGCS

13.  Gynecologists, urogynecologists, and urologists.
 Gynecologists are most comfortable with vaginal and
vulvar surgery.
 More plastic surgeons have been performing FGCS,
and have added modifications such as fat grafting.
 Formal survey: 50% only received formal training.

15. Indications
 Loose vagina 64%
 Change in sexual pleasure 30%
 Unattractive gaping introitus 48%
 To improve self-image 33%
Goodman MP, Placik OJ, Benson RH, et al. A large multicentre outcome
study of female genital plastic surgery. J Sex Med 2010; 7: 1565e77

16. Techniques

17. T
y
p
e
s

18. Vaginal Rejuvenation techniques
 Classic:
 Non-surgical.
 Surgical.
 Update:
 Laser technique
 Radiofrequency
 Collagen injection
 “G-Spot augmentation”

19. Surgical vaginoplasty
 Restore Youthful healthy vagina (Appearance, Function &
Sexual gratification)
 Techniques:
 Full depth & length repair.
 Muscles & torn Fascia are re-sutured.
 Relaxed Ligaments are shortened.
 Excess Vaginal skin removed.
 Disadvantages: Bleeding, Injury, Infection, Adhesions, Scarring,
Narrowing, Recurrence, Altered Genital Sensation.

20. Laser Rejuvenation
 Laser Vaginal Tightening by using a vaginal probe; laser energy is delivered
safely to full circumference of vagina to promote collagen production,
vaginal mucosa shrinkage, remodeling & strengthens the supporting
ligaments.
 Advantages:
 Non-invasive & Safe.
 Increased Sexual Gratification to both.
 Reduction in Stress urinary incontinence .
 No Surgery, Anesthesia, Pain, Downtime.
Disadvantages:
 A series of 3 settings, 4-5 weeks apart.
 More Cost & Experience.

21. Radiofrequency Rejuvenation
 This is in-Office Vaginal Rejuvenation surgery under mild
Sedation and local Anesthesia.
 Ellman Surgitron Radiofrequency device to make precise and
minimally traumatic incisions.
 Less destructive than lasers. It takes about 60 minutes.
 Enhance Sexual Gratification” as well as a Cosmetic procedure
Sekiguchi et al., 2013

22. Collagen injection “G-Spot
augmentation”
 A simple, non surgical collagen injection that can augment
the Grafenburg spot (G-Spot) in sexually active women to
amplify sexual sensation.
 80% effectiveness.
 Must be repeated every 4-6 months.

23. Labiaplasty= labioplasty
The best established female genital
cosmetic procedure is reduction
labioplasty.
Indications:
Aesthetic dissatisfaction or discomfort.
During exercise or sexual intercourse.

27. Designer vaginoplasty
It is a trade mark registered term for
the reshaping and resculpting of the
external vulva including
 Clitoral unhooding.
 Labiaplasty of the labia minora and majora,
 Augmentation labiaplasty of the labia majora.
 Liposuction of the vulva and mons pubis.

28. A gynecologist Perspective

29. 10. It’s not medically indicated.
9. It’s not been proven to be safe & effective;
potential long-term complications may occur.
8. Women are not educated about the wide range of
“normal.”
7. Women requesting these procedures often really
need psychological counseling.
6. Doctors are promoting an unrealistic ideal.
“Top 10 Arguments Against Performing
Cosmetic Gynecology.”

30. 5. Doctors are doing it just for the money.
4. It’s unethical.
3. Women are being forced by social
pressures.
2. Seminars offer industry secrets for a
high price.
1. ACOG doesn’t support it.

31. A woman Perspective

32. Do women know what is normal
?
 A wide variability in the appearance of normal female
external genitalia is a fact.
 Sexual function does not appear to be associated with
genital dimensions.
 This information is important for women and surgeons
alike when considering cosmetic vulvar surgery.
H. Krissi et al. /Anatomical diversity of the female external genitalia and its association
to sexual function. European Journal of Obstetrics & Gynecology and Reproductive
Biology 196 (2016) 44–47

33. Do women know “genital aging”?
Preadolescent Adulthood Aging vagina
Mons pubis Adherent to
periosteum.
More fat Atrophy
Labia
majora
Adherent to
periosteum.
More fat
(perineal
ptosis)
Atrophy
Clitoris and
prepuce
Small Wrinkled Dryness
Labia
minora
Pink and hidden Darker
Exposed
Wrinkled

34. On the other hand !
Pros clearly agree that there is a wide range of normality in the
external and internal female genitalia, both parous and
nulliparous, many women chose to modify their vulvas and
vaginas.
Data from a diverse group of experienced genital plastic
surgeons, outcome in both general and sexual satisfaction appear
excellent.
Goodman MP, Placik OJ, Benson RH III, Miklos JR, Moore RD, Jason RA, Matlock DL,
Simopoulos AF, Stern BH, Stanton RA, Kolb SE, and Gonzalez F. A large multicenter
outcome study of female genital plastic surgery. J Sex Med 2010;7:1565–1577.

35. Precautions !!
 Fine line between female genital mutilation and
female genital cosmetic surgery.
 Both plastic surgeons and gynecologists
performing this type of surgery should be aware
of potential damage being caused and which in
the future may be classified as ‘mutilation’.

36. Thank You