Saturday, December 6, 2008

Labiaplasty: How Common, Really?

Just a quick follow-up to last week's post on how the media deals with plastic surgery on women's genitals. I cited an estimate from Time magazine that put the number of labiaplasties and similar procedures at about a thousand annually in the U.S.

A study just came out that makes me think that estimate is way too low. In the December issue of Plastic and Reconstructive Surgery ("Aesthetic Labia Minora and Clitoral Hood Reduction Using Extended Central Wedge Resection"), Dr. Gary Alter reports performing 407 surgeries over two years. This was just one particular procedure and just one physician - albeit one in Beverly Hills. I couldn't access the article's full text but Dr. Alter's website doesn't mention any partners, only that he's got a second office in New York and a teaching appointment at UCLA, so I assume he's a player in both of the main markets and is relatively prominent in his field. (He also has a hilariously perfect last name for his profession, doesn't he?)

If Dr. Alter alone is doing 200 surgeries per year, there's just no way only 1000 women are getting it done each year. Even if Dr. Alter is a big fish, he surely isn't covering 20 percent of this market. Googling "labiaplasty surgeon" turns up oodles of other practitioners scattered around the country.

My googling also enlightened me on some other aspects of this business. For one, I got the impression that dilettantism may an issue. While Dr. Alter specializes in genital surgeries (ranging from repair of botched surgeries on intersex people to penile enhancement and transsexual reassignment), he doesn't seem to be typical. Most surgeons who perform genital cosmetic surgery also offer a spectrum of other, purely cosmetic procedures ranging from facelifts to boob jobs (here's just one example among many). I'm not letting anyone with a knife near my O'Keeffean bits, but if I did, I'd go for the real specialist. I'd want that doctor to know the map of pelvic nerves better than his own hand.

Perhaps even more striking is the apparent absence of gynecologists and urogynecologists from this field - the specialists who repair the real functional damage that can result from childbirth. I can readily believe that large labia do pose functional problems for some women. But if that were the main issue, wouldn't regular gyns be more involved in labiaplasty?

I also found that most of these surgeons post before-and-after pictures on their sites. I'm far more curious than squeamish, so of course I looked. (They do not post pictures of the surgery or of fresh post-surgical wounds, in case you were wondering.)

What I saw: A few of the women who get these surgeries do have labia large enough that I can imagine it being uncomfortable. That wasn't the case for most, although obviously only the woman who inhabits that body can say for sure. It's also a little hard to tell, because many "before" photos show one or both lips being stretched to the sides as far as possible, while the "after" photos often omit the stretching.

My guess is that in most cases, "discomfort" is a label for insurance purposes. The discourse of discomfort may also help plastic surgeons conceive of themselves (and promote themselves) as serving a higher purpose than a pornified beauty ideal. It lends legitimacy when these surgeons publish their results.

Oh, and I learned that the amount of variation in normal color and shape really is tremendous. Even in the "after" photos. The flower analogy may be trite, but it is apt. And I have to wonder - once more - why bother taking dahlias and irises and tulips, and turning them all into uniform carnations?

I took this photo of a bearded iris in my garden last spring.

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