Aesthetics or esthetics surgery for woman genital area....

FAQ LABIA REDUCTION SURGERY, LABIAPLASTY

2008-12-16T02:21:00.000-08:00

Will the surgery hurt?

At the time of your surgery there will be an Anaesthetist to ensure that you are both comfortable and will feel no pain. You will be asleep throughout the operation and the operation site is numbed with local anesthetic at the time of surgery. This will be explained to you during your initial appointment with your surgeon. The anaesthetic means that there is very little discomfort felt in the first 2-3 hours but following that time there will be a period of pain and discomfort which can last for up to ten days. This can be controlled through the use of pain relief medication. The surgeon and nursing staff will instruct you on pain relief when you leave the hospital.

Will there be swelling and bruising?

There will be temporary swelling and bruising following the surgery. This varies with the extent of the operation being performed. It also depends on the individual. Some people bruise easily whilst others do not. You can generally expect some swelling and bruising after surgery. Both should last for no more than ten days. Your will be given instructions on how to take care of your wounds at the time of your consultation when your doctor. The nursing staff will also instruct you on how to take care of your wounds when you leave the hospital.

Will there be scars?

Yes, all surgery produces scars. However a skilled surgeon makes sure that incisions and stitches are carefully placed in the natural folds and creases of the genital area so that any scars are well hidden. During the first 2-3 weeks the stitches will gradually dissolve. This means no stitches need to be removed which allows the tissues to heal the most natural way possible. If you follow the post-operative instructions you will notice that over time the scars will fade and become barely noticeable.

How soon can I go home after the Procedure?

You will be discharged 1-3 hours after surgery. Your doctor and nurse will discuss any specific discharge information at that time, as well as information on pain relief, care of your wound etc.

How should I look after my wound at home?

Post operative care is important and care needs to be taken to ensure that your wound heals without infection and to promote healthy skin. This is done by keeping your incisions and the skin area around them clean, dry and to also avoid any rubbing or friction. Your doctor will talk to you about what to expect from your surgery and give you information on what you should do when you go home. Sometimes women may feel quite depressed or anxious before surgery. Sometimes during the rest and partial isolation following surgery, they may start to think about

aspects of their life that normally wouldn’t bother them. This can be temporarily depressing. We recommend that to help you cope during this stage of your healing and recovery from surgery that you have someone in the home with you.

What can I do to help recovery?

At the time of your initial consultation and discharge from your surgery your doctor will advise you on care regarding your wound, daily routine and activities. It is important to follow these instructions as well as any specific discharge information given when you go home following your procedure and take plenty of rest!

When will I be able to start exercising?
As with any surgery, activities will be restricted for a while. Restrictions include no heavy lifting, sport or exercising for about 4 weeks. It can take 6-8 weeks to fully recover from your surgery.

How long will it take to completely heal?
All women respond to surgery differently but usually complete healing can take up to three months.

Phalloplasty Risks

2008-03-01T12:27:00.000-08:00

It is important to note that most phalloplasty procedures require multiple surgical visits as well as some revisions, can be quite painful, require significant recovery time, and often leave large areas of visible scarring. Because of the nature of using skin grafts, there is always a risk of tissue death and loss of part or all of the penis. Other potential complications include the extrusion of testicular implants, the formation of a stricture (an abnormal narrowing; blockage) or fistula (an abnormal connection; leakage) in the newly constructed urethral passage, and infection. There may also be damage to the nerves of the donor area, resulting in numbness or loss of function. Erotic sensation may be changed or diminished. And the results may not be as aesthetically pleasing as one might like them to be. Also, one must consider the usual risks of any surgery, including bleeding, infection, problems from anesthesia, blood clots, or death (rare).
Phalloplasty procedures also tend to be very expensive (between $50,000 to $150,000) and are not typically covered by insurance.
However, if one desires an average-sized penis that looks acceptable in the locker room, through which he can urinate, and with which he can engage in penetrative sex, a phalloplasty is certainly a way to achieve that end. Additionally, many trans men do not feel complete without a penis, and so may pursue a phalloplasty with that in mind. It is often reported by trans men that the forearm free flap phalloplasty provides the most realistic-looking penis of the options currently available, if you are willing to accept the surgical risks and the forearm scarring.

Scrotoplasty

2008-03-01T12:26:00.000-08:00

In general, the creation of the scrotum is usually accomplished by hollowing out the labia majora, inserting solid silicone implants, and eventually joining the labia to create a single scrotal sac (similar to the procedure used in metoidioplasty). However, other techniques are sometimes employed to create a scrotum, such as the creation of a scrotal sac from donor tissue from the abdomen or thigh. Sometimes fat is harvested from the pubic mound and transplanted into the constructed sac rather than using implants, though often this does not produce adequate size and symmetry.

Phalloplasty

2008-03-01T12:24:00.000-08:00

Phalloplasty involves the construction of a penis using donor skin from other areas of the body. Depending on the type of phalloplasty procedure, skin is typically taken from the abdomen, groin/leg, and/or forearm and grafted onto the pubic area. Phalloplasty often involves a urethral lengthening procedure so that the patient can urinate through the penis. Erections are usually achieved with either a malleable rod implanted permanently or inserted temporarily in the penis, or with an implanted pump device.
Phalloplasty techniques vary widely from surgeon to surgeon. Be sure to research carefully the surgeons you are considering in order to get an exact account of the procedure as they perform it. Summarized below are a number of terms and procedures related to phalloplasty. Keep in mind that these descriptions are generalized and are meant as a introduction to the topic; this list is not necessarily exhaustive.

Gillies technique

This refers to one of the earliest types of phalloplasty, in which a flap of abdominal skin is rolled into a tube to create a flaccid penis. Over the years, this procedure was improved to include a urethral extension by utilizing a second section of abdominal skin wrapped "raw side out" to form a "tube within a tube," nested inside the constructed phallus. This method usually produces a penis that is not erotically sensate (i.e., does not have feeling) and is often not very realistic in appearance. Usually, a flexible rod must be inserted into the penis in order to achieve an erection.
Suitcase handle

In order to help prevent tissue death in the penis, the Gilles procedure was improved by the development of the "suitcase handle" technique, where the rolled flap is left attached to the abdomen at the top and bottom (like the handle of a suitcase) for a number of weeks in order to ensure a proper blood supply. In a second stage operation, the flap (handle) is detached from the top end, and that end is brought down to graft onto the genital area. It is again allowed to develop a proper blood supply over a period of time. In a third operative stage, the other end is detached from the abdomen, leaving the new penis to hang naturally from its grafted place in the genital area. Variations of the suitcase handle technique are used in the pedicled flap procedures described below.
Pedicled pubic flap phalloplasty

In this procedure, the penis is constructed from an tubed pedicled flap running from the pubic area to just underneath the belly-button. (The term "pedicle" here refers to the fact that the flap of donor skin is left attached to the body, as described in the suitcase handle technique, in order to improve proper blood supply and prevent tissue death). This procedure may also utilize grafted skin from the thigh area to wrap around the outside of the pedicle, mimicking the loose outer skin of the penis. A urethral extension may by created using tissue from the labia or vaginal wall, or simply from creating an "inside-out" inner tube from the donor area. This operation is usually performed in several stages in order to ensure proper blood supply to the pedicled flap. The clitoris is usually left intact near the base of the penis; the exact placement of the base of the penis with regard to the clitoris should be discussed with the surgeon. This method usually produces a penis that is not erotically sensate. The aesthetic appearance of the penis is also sometimes unrealistic. Usually, a flexible rod must be inserted into the penis or an implanted pump device used in order to achieve an erection.
Because the donor skin used in this type of phalloplasty is typically hairy, some patients may choose to undergo electrolysis in the donor areas for a period of months to help minimize hair growth on the new penis. Indeed, some surgeons require electrolysis of the donor areas before they will proceed with the procedure. If electrolysis is not chosen, the patient will have to periodically shave the skin of the penis or use depilatory cream.
Pedicled groin flap phalloplasty

This procedure is similar to the pedicled pubic procedure listed above, except that it employs a skin flap that runs sideways outward from the groin area (usually around the area where the upper thigh meets the pelvic bone). A urethral extension may by created using tissue from the labia or vaginal wall, or simply from creating an "inside-out" inner tube from the donor area. This operation is usually performed in several stages in order to ensure proper blood supply to the pedicled flap. The clitoris is usually left intact near the base of the penis; the exact placement of the base of the penis with regard to the clitoris should be discussed with the surgeon. This method usually produces a penis that is not erotically sensate. The aesthetic appearance of the penis is also sometimes unrealistic. Usually, a flexible rod must be inserted into the penis or an implanted pump device used in order to achieve an erection.
Because the donor skin used in this type of phalloplasty can be hairy, some patients may choose to undergo electrolysis in the donor areas for a period of months to help minimize hair growth on the new penis. Indeed, some surgeons require electrolysis of the donor areas before they will proceed with the procedure. If electrolysis is not chosen, the patient will have to periodically shave the skin of the penis or use depilatory cream.
Free tissue flap transfer (FTFT)

The FTFT procedure is a more recent and improved approach to phalloplasty which uses a flap of skin and tissue from the groin, thigh, or forearm area. In FTFT, a skin flap is removed completely from the donor area and transferred, with its existing nerves and blood vessels intact, to the groin area. There the flap's nerves and blood vessels are connected microsurgically to the nerves and blood vessels of the groin. This is done with the aim of the new penis becoming erotically sensate, while also helping to ensure proper blood supply to the penis.
Forearm free flap phalloplasty

This procedure is considered by many to produce a more realistic-looking, more erotically sensate phallus than other phalloplasty procedures. This is due to the nature of the skin of the forearm (areas on the underside of the forearm are of good consistency and often are fairly hairless) as well as the nerves and blood vessels that are able to be harvested with that skin. The main drawback to the procedure is that it leaves a very large scarred area on the forearm, and there is some risk of damage to the overall function and feeling of the arm. The donor area on the arm is usually covered with skin from the thigh or groin, leaving a secondary scar in that area as well.
The forearm skin is shaped into the new penis and grafted into place on the groin, where the nerves and blood vessels are microsurgically connected. Some surgeons will connect the brachial nerve of the forearm to the pudendal nerve of the clitoris (with the goal being erotic sensation in the penis). A urethra is typically created using tissue from the labia or the vaginal wall, or with a section of relatively hairless skin from the forearm donor site, shaped into an inverted tube. The clitoris is usually left intact near the base of the penis; the exact placement of the base of the penis with regard to the clitoris should be discussed with the surgeon. Usually, a flexible rod must be inserted into the penis or an implanted pump device used in order to achieve an erection.
Because the donor skin on the forearm can be hairy (depending on the patient and the area from which the skin is taken), some patients may choose to undergo electrolysis in the donor areas for a period of months to help minimize hair growth on the new penis. Indeed, some surgeons require electrolysis of the donor areas before they will proceed with the procedure. If electrolysis is not chosen, the patient may have to periodically shave the skin of the penis or use depilatory cream.
Modified forearm free flap phalloplasty

In order to address the issue of major scarring on the forearm, some surgeons have combined the benefits of forearm free tissue flap transfer with other methods such as the pedicled groin flap. A surgeon may choose to create the main shaft of the phallus from a non-sensate source such as a pedicled groin flap, but in a later surgical stage, use sensate tissue from the forearm to create the head of the penis. In another approach to minimize scarring, tissue expanders may be inserted into the forearm and used over a period of months so that when the tissue is harvested from the forearm, the donor area can be closed without an additional skin graft. Such options should be carefully researched and discussed with the surgeons you are considering.

Metoidioplasty Infomations

2008-03-01T12:23:00.001-08:00

(Also sometimes spelled "metaoidioplasty," a term meaning "a surgical change toward the male")Metoidioplasty--a surgical procedure developed in the 1970s--takes advantage of the fact that ongoing testosterone treatment in a trans man typically causes his clitoris to grow longer. The amount of clitoral growth varies with each individual, but it is not uncommon to see an increase in size to about the length of one's thumb. By cutting the ligament that holds the clitoris in place under the pubic bone, as well as cutting away some of the surrounding tissue, the surgeon is able to create a small phallus from the elongated clitoris. This is why metoidioplasty is sometimes referred to as a "clitoral free-up" or "clitoris release"-- the clitoris is freed from some of its surrounding tissue and brought forward on the body in a manner that makes it appear like a small penis. In order to further enhance the result, fat may be removed from the pubic mound and skin may be pulled upward to bring the phallus even farther forward.
Metoidioplasty may also involve the creation of a scrotum (scrotoplasty) by inserting testicular implants inside the labia majora, then joining the two labia to create a scrotal sac. This is often done in two stages, where in the first stage, tissue expanders are inserted in the labia in order to gradually stretch the skin in preparation for the insertion of permanent testicular implants at a later date. Some surgeons may insert the implants in the first procedure, and join the two labia in a later procedure.
Metoidioplasty may additionally involve a urethral lengthening procedure to allow the patient to urinate through the penis while standing. Surgeons may employ tissue from the vaginal area or from inside the mouth/cheeks to create a urethral extension. Usually, a catheter is placed inside the urethral extension for 2-3 weeks while the body heals and adapts to the new arrangement.
Depending on the surgeon and the desires/goals of the patient, the vaginal cavity may or may not be closed or removed (this is typically referred to as a "vaginectomy," "colpectomy," or "colpocleisis"). Often, a vaginectomy is performed in conjunction with scrotoplasty and/or urethral lengthening.
The typical operating time for a metoidioplasty procedure is about 3-5 hours, and may require additional follow-up procedures and revisions at a later date. Time required may differ depending on the options chosen by the patient (i.e., if he chooses scrotal implants and/or urethral lengthening), as well as the available tissue for the procedure, and the overall health and condition of the patient. Recovery time is usually between 2 to 4 weeks of very limited activity.

Metoidioplasty Risks

2008-03-01T12:23:00.000-08:00

The advantages of metoidioplasty are that it results in a natural looking (albeit small), erotically sensate penis. Additionally, since the clitoris is made of erectile tissue, the patient can achieve an unassisted erection when aroused. The procedure takes advantage of existing genital tissue, and doesn't leave visible scars on other parts of the body.
The disadvantages are that the resulting penis is usually quite small, and as such often cannot be used for penetration. It also may not be a good choice for a transman whose clitoris has not grown substantially as a result of testosterone therapy (most surgeons recommend being on testosterone therapy for at least 6 months to 2 years in order to maximize growth of the clitoris). And, as with any surgery, there are potential risks of complication, such as the extrusion of testicular implants, the formation of a stricture (an abnormal narrowing; blockage) or fistula (an abnormal connection; leakage) in the newly constructed urethral passage, and potential problems of infection and tissue death (though tissue death is less common in metoidioplasty as compared to phalloplasty). One must also consider the usual risks of any surgery, including bleeding, infection, problems from anesthesia, blood clots, or death (rare).
Metoidioplasty procedures range in cost from about $2,000 (for clitoral release only) to $18,000 (including urethral extension and testicular implants), and perhaps more if hysterectomy/oophorectomy is performed at the same time. Fees will vary among surgeons.
When considering a metoidioplasty procedure, it is important to research the surgical options carefully and discuss them with the surgeons you are considering. Each surgeon has a different approach and technique, and some may offer an array of options, such as clitoris release only, different types of scrotoplasty or urethral lengthening, etc. Also, if you are unsure if you wish to have additional genital surgery (such as phalloplasty) in the future, discuss with your surgeon which procedures will leave you with the most options for later surgery.

Metoidioplasty (Clitoral Release) By Michael L. Brownstein

2008-03-01T12:17:00.000-08:00

Metoidioplasty is a procedure that enables the clitoris to be released from its "hood" and then appear as a small penis. A form of circumcision can be performed at this time to enable the tip of the clitoris to appear as the male glans.
Besides dehooding the clitoris, the undersurface of the structure, known as the chordee, must be freed of its dense fibrous tissue to allow the entire structure to be free of surrounding tissues and release it to allow more exposure. This technique may also provide some additional length, though it is somewhat limited in this regard. Care must be taken to avoid injury to the internal erectile tissues during removal of this fibrous band so as not to lose that important function.
The labia minora are used as flaps to provide protection of this denuded undersurface of the clitoris and to provide additional girth and circumference.
The labia majora are descended from their natural position using plastic surgical techniques, and pockets are created within them to allow the placement of testicular implants. This simulates a male scrotum with testicles. At a later stage, or in the initial procedure this divided scrotum may be joined centrally to have the appearance of a single scrotum with two testicles within. Expanders may be used to enlarge the "scrotal" pockets prior to placement of permanent implants, but this is usually not necessary. It does also require additional surgery. The testicular implants usually descend further on their own due to their weight and the effects of gravity.
As an option, along with metaidoioplasty the urethral may be advanced to the tip of the new penis. A vaginal mucosal flap is used for the extension of the urethral from the native urethral opening (without disturbing that opening directly and endangering sphincter function). In this situation the labial minora flaps are used to protect the vaginal flap urethral extension as well as provide girth. This procedure is more complex and entails additional risks such as fistula formation (urinary leakage).
It is important to recognize that this is not formal phalloplasty and that the result will depend in great part upon the size of the clitoris and its enlargement under the influence of hormones.

Formation of gender identity

2008-03-01T12:16:00.000-08:00

The formation of a gender identity is a complex process that starts with conception, but which involves critical growth processes during gestation and even learning experiences after birth. There are points of differentiation all along the way, but language and tradition in most societies insist that every individual be categorized as either a man or a woman. When multiplicity is arbitrarily reduced to absolute dichotomy, conflicts are sure to result.
When, for instance, the gender identity of a person makes him a man, but his genitals are female, he may experience what is called gender dysphoria, i.e., a deep unhappiness caused by his experience of himself as a man and his lack of male genitals.
Some research has been done that indicates that gender identity is fixed in early childhood and is thereafter static. This research has generally proceeded by asking transsexuals when they first realized that the gender role that society attempted to place upon them did not match the gender identity that they found in themselves and the gender role that they chose to live out. These studies estimate the age at which gender identity is formed at around 2-3. Such research may be problematical if it made no comparable attempt to discover when non-transsexual people became aware of their own gender identities and choice of gender roles.
Some critics question this research, claiming that the studies suffer from a sampling bias. The acquisition of hormone replacement therapy and Gender reassignment surgery is generally controlled by doctors. One of the questions some doctors ask to distinguish between "real" transsexuals and others is to ask them when they first felt identification with the opposite sex. The researchers may then be unintentionally eliminating some subjects from consideration when they try to determine a typical time of gender identity formation. There is also a possibility of reporting bias, since transsexuals may feel that must give the "correct" answers to such questions in order to increase the chances of obtaining hormones. Pat Califia, author of Sex Changes and Public Sex, has indicated that this group has a clear awareness of what answers to give to survey questions in order to be considered eligible for hormone replacement therapy and/or sexual reassignment surgery:
"None of the gender scientists seem to realize that they, themselves, are responsible for creating a situation where transsexual people must describe a fixed set of symptoms and recite a history that has been edited in clearly prescribed ways in order to get a doctor's approval for what should be their inalienable right".

Transmen

2008-03-01T12:14:00.000-08:00

Transmen or trans men are transsexual or transgendered people who were assigned female gender at birth (or, in some rare cases of intersexuality, later) and who feel that this is not an accurate or complete description of themselves. They therefore assume a male gender identity or strive to present themselves in a more male gender role.
Transmen can come from the whole of the female-to-male (FtM) side of the transgender spectrum, from female-to-male transsexual persons to drag kings (female cross-dressers or transvestites are very rarely used designations) who consider themselves transgendered.
Many transmen however do not use this particular word to describe themselves. Some transmen, who consider their change of gender role to be completed, prefer to be called simply men. Others either do not consider their gender identity to be the same as that of cisgendered men, or have other, individual reasons to prefer another self-identification. The American Boyz, a transmale support organization, lists the following self-descriptions for some transmale-identified people:
"FTM/F2M (Female-To-Male), Butch, Trans man, FTV (Female TransVestite), Gender Outlaw, Genderqueer, Transsexual, Drag King, New Man, Boychick, She-Bear, Shapeshifter, Transfag, Tomboy, Passing Woman, Two-Spirit, Amazon, Tranny Boy, Intersexual, Female Guy, Tranz, Boss Grrl, Bearded Female, Transgenderist, Sir, Kurami, Hermaphrodite, Questioning".
Please note that many of these previously listed designations are considered wrong or sometimes offensive to those transmen who identify in with another self-description, and should not be used unless specifically requested.
The sexual orientation of transmen is very varied. Based on observations from many groups, the following applies: One third prefers male partners and identifies as gay, one third prefers female partners and identifies usually as straight, and the last third either identfies as bisexual, pan- or omnisexual, undecided, or asexual. These are approximations due to the lack of accurate scientific statistics.
People who identify as lesbian and queer transmen who prefer female partners are also known, these are transmen who do indeed changed their gender role, but do not want to leave the lesbian community they were part of for a long time entirely behind them.

Phalloplasty

2008-03-01T12:12:00.000-08:00

Phalloplasty refers to the (re-)construction of a penis or, sometimes, to artificial modification of the penis by surgery, often for cosmetic purposes. It is also often used to refer to penis enlargement.

A complete (re-)construction of a penis is done on both cisgendered men who have lost their penis through either illness or accidents, and transmen, that is, female-to-male transgendered or transsexual people.
The basic procedures are the same, although surgery on cisgendered men is usually a lot simpler, since the urethra still ends in the front of the genital area, whereas the urethra of transmen ends near the vaginal opening and has to be lenghtened considerably. The lengthening of the urethra is the most difficult part of phalloplasty, and also the one where most complications occur.
With all types of phalloplasty in transmen, the labia (see vulva) are united to form a scrotum, where prosthetic testicles can be inserted
An erectile prosthesis can be inserted into the neo-phallus to replace the erectile tissue and enable sexual penetration. This is usually done in separate surgery for healing reasons. There are several types of erectile protheses, ranging from simple rods that have a hinge so that the neo-penis can either stand up or hang down, to elaborate pumping systems.
Basically, there are three different techniques for phalloplasty:

This technique involves using a free graft of tissue, usually from the inner side of the forearm, sometimes from the upper arm or the leg. This tissue is removed from its original place, rolled up, with a part of it forming the new urethra, and grafted to its new place between the thighs.
For transmen, the urethra up to this point is formed from the inner labia. Often, this is done in a separate procedure, sometimes a full-scale metoidioplasty is done a few months before the actual phalloplasty to prevent complications or make intervention easier when they occur.
Sensation is retained through the clitoris which is at the base of the neo-phallus; also, often a large nerve in the graft is connected to nerves either from the clitoris or other nearby nerves. Also, nerves from the graft and the tissue it has been attached to usually connect after a while, thereby allowing additional sensation.
This is by far the most common surgical technique for phalloplasty today, and also the one which produces the best results in both functioning and esthetics.

Metoidioplasty

2008-02-26T13:42:00.002-08:00

Metoidioplasty Web Site

Metoidioplasty, sometimes referred to as a meto or meta, is an alternative to phalloplasty for Transmen. With the effects of testosterone treatment, the clitoris enlarges, over time, to an average of 4-5 cm. In a metoidioplasty the enlarged clitoris is released from its position and moved forward to more closely approximate the position of a normal penis. In some cases the urethra is lengthened to end at the tip of the neophallus. The clitoris and penis are developmentally homologous organs.
The labia majora can be united to form a scrotum, where prosthetic testicles (usually made of silicone) can be inserted.
This procedure is technically simpler than a phalloplasty, and has fewer complications. Surgery itself is also considerably shorter (1-2 hours vs. 8-10 hours) and it is much less expensive (perhaps US$15,000 instead of US$85,000). Unlike a phalloplasty, an erectile prosthesis is usually not needed to achieve erection. The clitoris contains erectile tissue which responds to sexual arousal. In most cisgender females, the clitoris is too small for the person to detect this erectile change significantly. In transmen and other female-bodied people whose clitoris is larger, this may be more visually apparent as it is in cisgender men.
If a metoidioplasty is performed without a urethral lengthening or scrotoplasty (formation of a scrotum from the labia majora), this is sometimes called a clitoral release. This is less expensive than a complete metoidioplasty but does not allow for urination (through the new penis) while standing. However this also offers surgery with less risk because the urinary system remains unaltered without a urethral extension and still affords some of the visual effects of a complete metoidioplasty.

More Informations

Vaginal Prolapse

2008-02-26T13:22:00.000-08:00

The network of muscles, ligaments, and skin in and around a woman’s vagina acts as a complex support structure that holds pelvic organs, tissues, and structures in place. This support network includes the skin and muscles of the vagina walls (a network of tissues called the fascia). Various parts of this support system may eventually weaken or break, causing a common condition called vaginal prolapse. A vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall, out of their normal positions. Without medical treatment or surgery, these structures may eventually prolapse farther and farther into the vagina or even through the vaginal opening if their supports weaken enough. The symptoms that result from vaginal prolapse commonly affect sexual functions and bodily functions such as urination and defecation. Pelvic pressure and discomfort are also common symptoms.

Approximately 30-40% of women develop some presentation of vaginal prolapse in their lifetime, usually following menopause, childbirth, or a hysterectomy. Most women who develop this condition are older than 40 years. Many women who develop symptoms of a vaginal prolapse do not seek medical help because of embarrassment or other reasons. Some women who develop a vaginal prolapse do not experience symptoms.

Procedure may rejuvenate sexuality By Judith Salkin

2008-02-21T13:19:00.000-08:00

No matter how sophisticated we think we've been become as a society in terms of sexuality, we're not.

Books tell us that we're responsible for our sexual pleasure, and that healthy, active adults can enjoy sex long into their lives.
But that's not always the case. Our bodies change, and women (especially mothers) often experience vaginal relaxation - a gradual weakening of elasticity in the vaginal muscles - which can lead to a loss of sensation, and therefore satisfaction.
While there have been a number of significant advances for men, from surgical procedures to Viagra, doctors haven't paid nearly as much attention to women.
Until now.
Enter the G-Shot (or G-Spot amplification), an injection of human-engineered collagen into the Grafenburg spot, a small area behind the pubic bone on the anterior wall of the vagina.
"It's a relatively non-invasive way to enhance a woman's sexual pleasure," said Dr. Elliot B. Lander, a urologist with offices in Rancho Mirage, La Quinta and Del Mar.
As a urologist, Lander has performed more than 4,000 pelvic floor reconstruction surgeries and understands the causes of vaginal relaxation.
He was trained in the use of the G-Shot by its developer, Dr. David Matlock of the Laser Vaginal Rejuvenation Institute of Los Angeles. Matlock, who has appeared on the E! network's "Dr. 90210," trained in laser vaginal rejuvenation, anterior and posterior repair and vaginoplasty surgery.
"Years ago it was taboo to talk about these things," said Matlock. "Women were told that it was just a normal part of the aging process."
But with women living longer and expecting more out of life, "There were definitely questions that needed to be addressed."
The G-Shot does that, according to Lander and Matlock, in a relatively non-invasive and non-permanent way.
With the exception of the numbing shot and the 28-gauge needle (the same gauge needle used for daily insulin shots) used to inject the collagen, there are no other disturbances to the patient's body.
While the collagen itself is FDA approved and comes from a qualified medical supply company, the G-Shot is patent pending.
The shots, according to Matlock are $1,850 for a single shot and $2,500 for a double.
"Some feel they need more or want it to last a bit longer (than the normal four-month period of a single shot)."
Enhancing sensation
Tara is a tall, pretty woman who works in the Wright Building on the Eisenhower Medical Center campus where Lander also has his office.
"I heard about it and I was curious," she says. In her early 30s, Tara decided to try it and evaluate it "for the future."
Following instructions on how to manually locate the G-spot with her finger, "because it's a little different for every woman," and showing Lander where it was, "the whole thing took about a half hour from start to finish."
Once a woman's G-spot has been located, the measurements are noted in her chart and do not need to be repeated on subsequent visits.
A local anesthetic then numbed the area before Lander injected the collagen.
"I really noticed a difference," Tara said. "The feeling was much more intense, much more pleasurable. I'll definitely do it again."

Let’s get (more than) physical By Linda Bolido

2008-02-18T12:22:00.000-08:00

MANILA, Philippines--“Everything is vanity,” King Solomon said.
But for people who undergo some form of reshaping or reconstruction of any part of their faces and bodies, the reason may not be quite as simple as that though the publicity over the various procedures high-profile personalities proudly announce may give that impression.
Dr. Manuel O. Fernandez, head of the Makati Medical Center’s Aesthetic Surgery Center (ASC), said for some people, what is referred to as cosmetic surgery may be important to their “psychological health.”
Sometimes reshaping a nose may be all it takes to boost a person’s self-esteem and self-confidence.
“Any improvement can help improve a person’s confidence,” Fernandez said.
Knowing a procedure could seriously change a person’s life, Fernandez said the professionals at the ASC did not simply do what patients asked. People who insist they want a nose like Tom Cruise’s or Angelina Jolie’s will have to go elsewhere because, unless the ASC professionals feel that their faces will match such a proboscis, they cannot have it.
Fernandez stressed the ASC would not simply give a patient what he/she wanted if it knew it would not be right or appropriate.
There is, for instance, a limit to the extent breasts can be enlarged without causing serious medical problems like severe back pains. Believe it or not, large boobs are a heavy load to be lugging around everywhere.
A French woman who used to hold the record for having the largest breasts reportedly could not sleep lying on her back because her boobs were putting a heavy pressure on her chest making it difficult for her to breathe.
It is also for reasons other than vanity that ASC hopes women will consider the newest procedures it is offering, the Laser Vaginal Rejuvenation (LVR) and Laser Vaginoplasty.
Vaginal repair
LVR is more than just a frivolous wish to turn back the clock, in a manner of speaking. The procedure was designed to repair the so-called “vaginal relaxation,” according to Dr. Annebelle D. Aherrera, obstetrician-gynecologist.
An accredited associate of the Laser Vaginal Institute of America founded by Dr. David L. Matlock, who pioneered the two procedures, Aherrera said vaginal relaxation was when “muscles are no longer firm and have poor tone, strength and control.”
Such a condition results in more than just a change in physical appearance. It also results in discomfort and inconvenience that can seriously affect a woman’s self-esteem.
“Women who suddenly burst into laughter, sneeze or cough may experience involuntary urine loss or spill. More often than not, women are embarrassed during these situations,” Aherrera said.
The LVR decreases the internal and external diameters of the vagina, almost returning it to its original state thus minimizing the problem.
Aherrera said vaginal relaxation occurred because of childbirth and aging. But even women who are still young and have not given birth may have the problem. “Women who have inherited weakness of the supporting tissues, those who have experienced unusual strain from chronic coughing or have suffered obesity, may [suffer from] relaxed vaginal tissues,” the expert said.
For normal women
Aherrera said LVR was suitable for women with normal sexual functioning. But “it is not for patients with sexual dysfunction such as those who experience discomfort during sex or those who do not achieve orgasm,” she stressed.
Laser vaginoplasty is very much like rhinoplasty or the nose job except that it is performed on the opposite end of the body. Aherrera describes it as, “a group of aesthetic enhancement procedures of the vulvar structures.”
She said, “Many women are embarrassed by the appearance of their external genitalia which are more often than not the result of childbirth, trauma, aging or hereditary characteristics.” Designer laser vaginoplasty, she added, repaired, enhanced and beautified the genitalia to make it more attractive and youthful looking.
Fernandez stressed that while the aesthetic procedures offered by ASC might be available in “stand-alone beauty enhancement facilities,” the center had the advantage of being hospital-based. He said some of the reported botched and fatal liposuction procedures in some “beauty clinics,” for instance, could have been averted simply by having the proper equipment for giving the patient oxygen.
He added that ASC only had certified surgeons performing the job. “Being a doctor does not mean you are a specialist,” Fernandez pointed out. One has to be certified by the right bodies before he/she can perform aesthetic surgery. Fernandez said many of the high-profile beauty experts did not do the actual surgery themselves because they did not have the proper credentials.

St. Valentine's Day Wishes: Perfume? Jewelry? Labiaplasty?

2008-02-14T22:24:00.000-08:00

St. Valentines Day hasalways conjured up images of eager boyfriends and husbands rushing to buythat perfect gift that says, "I Love You." Over the decades, women havebecome better able to communicate more specific wish lists to theirsignificant others rather than simply accepting generic and, sometimes,short lived gifts such as flowers.

Such was the case for Carl and Kristina of suburban Chicago. Aftertwelve years of marriage and five very large children, sex for Kristina hadbecome, physically and emotionally, a mind numbing experience. Her anatomyhad changed and sensation had disappeared during sexual relations. Thevulvar appearance no longer looked "trim and youthful," said Kristina. "Iwas so embarrassed; I no longer wanted him near me without the lights off."That's when the Chicago couple began their internet research. Kristina wasgoing to get the ultimate gynecologic cosmetic makeover for St. Valentine'sDay.

The couple discovered the website for the Laser Vaginal RejuvenationInstitute of Michigan and phone consulted with the director, boardcertified gynecologic surgeon Dr. Joseph Berenholz. When queried whethershe had spoken with her gynecologist, Kristina explained that, "She said itwas all a normal consequence of childbirth, not to worry and just keepdoing my kegel exercises. I was so disappointed. I had been doing kegelsfor two years with no results!" The couple booked their flight for Michiganand arranged a date for surgery.

The consultation took place at the Laser Vaginal Rejuvenation Instituteof Michigan. During the exam, Dr. Berenholz realized that Kristina was alsosuffering from stress incontinence, a condition where women lose urine whenthey laugh, sneeze, cough, jump or run. The surgery was scheduled for thefollowing day. Kristina had a Laser Vaginal Rejuvenation to tighten hervagina. She also had a Laser Labiaplasty and a sling procedure to cure herincontinence.

The procedure took two hours. The couple spent the night at alocal hotel and then saw Dr. Berenholz in the morning. After being givenfinal medical approval, the couple returned to Chicago happy and hopeful. "I took a mirror and looked down below," said Kristina. "I was sosurprised how wonderfully normal I looked. It was as though I had gone backin time prior to having my children!" Tears welled up in her eyes. "I wasso ashamed to discuss my problem with nearly anyone. Dr. Berenholz justmade it all so comfortable." Carl just smiled, happy to see the joy inKristina's face. Dr. Berenholz was the first Gynecologic surgeon in the Midwest to offerLaser Vaginal Rejuvenation. He trained in Beverly Hills with Dr. DavidMatlock, the originator of the technique and a regular appearing physicianon "Dr. 90210." Asked why he thought patients come to him from the entireMidwest including Michigan, Dr. Berenholz simply replied, "People wantexperience. This is the most delicate part of the female anatomy and istied in very closely to the female psyche." Dr. Berenholz is still amazedat how women tell him of the dismissive attitude of their Gynecologists.When asked if he found it humorous that a woman would ask for this type ofsurgery for St. Valentine's Day, Dr. Berenholz laughed and said, "It beatsgetting a box of chocolate."

A Guide To Plastic Surgery From Postpartum

2008-02-14T03:50:00.000-08:00

That this Hollywood star Zeta-Joneses and Madonnas and Cindy Crawfords-Catherine that never cease to be amazed with their bodies and fabulous good looks ravishing even after childbirth.
While motherhood brings immense joy and happiness for any woman, any changes to the audit that follow pregnancy and birth are not pleasant at all. Still, women Common generations of our mother had to tolerate their misery cosmetic something that used to take for granted. But women today do not have that; there is now a range of exciting options for plastic surgery to give the figure behind without defects was so proud of you!AdvantagesWhy are these cosmetic procedures are of postpartum seem as exciting?
Because come with a host-in advantage of the addition of the help you recover their pre-pregnancy shape or even better than that, they are characterized by simple and quick recovery, allowing you in most cases the return home the same day of the operation. It requires no other breakage of the workplace or the game with his newborn for days long.
These procedures help you enjoy your maternity in a way relaxed.Here are your options for cosmetic procedures of postpartum:Elevation Of Chest (Mastopexy)Due to the increase in the numbers of the milk glands, the breasts are expanded in size during pregnancy and after childbirth, as you go on to breastfeeding, milk glands shrink gradually, and fat tissues also lose causing a comba chest. To get behind the eyes entonada above, you can take the help of this procedure the patient is not placed called mastopexy "which reduces the yield removing excess skin. After the fur on the bottom half of their chest tighten, the breasts get a lift in the beginning that seem stronger.
Abdominoplasty or LipectomyHis abdomen became the home of her baby for nine months and the sample stays this habitation there in her abdomen for life long. Not only do most women get a belly after birth, abdominal skin also begins to appear and give these brands ungainly and another stretching from scratch marks. The procedure Lipectomy can help you get rid of excess skin that lies beneath your navel, giving her abdomen and a plane disappears look entonada and in the process marks and scars stretching too. However, if you have only a small amount of excess skin, a mini-lipectomy can do to you.Stomach pressing for pumping muscleThe stomach muscles are separated often an enlarged uterus, and many women find it difficult for them to reconnect despite rigorous exercise. But this condition can be repaired with surgery that is usually covered by health insurance.LiposuctionNew mothers often complain of their inability fat perdidosas certain areas of their bodies such as thighs, buttocks and upper arms.
These localized fat deposits can be removed by a procedure called liposuction patient is not interned. However, for larger quantities removing fat, you need the ultrasonic liposuction.LabioplastyThe labias in the vaginal area get severely damaged during a normal delivery. This damage can be repaired by a labioplasty that can be made on basis of the patient is not placed under local or general anesthetic takes only time that the recovery of a few days.Nothing gives him more pleasure than having a baby. The cosmetic procedures of the post partum allow you to enjoy double free maternity uncomfortable about the obvious physical damage followed by childbirth.

The genital surgeries, fashionable among Italian

2008-02-14T03:49:00.000-08:00

Reduced vaginal lips or reconstruction of the hymen are among the most requested, in the female genital surgery Besides increasing breasts, the stretch of the face and reducing abdomen and buttocks, the latest fad of cosmetic surgery in Italian women is the part of the "intimate", ie the genital area, according to a study by the The Italian clinic specializing Clinique. Interventions are most in demand reduction of the labia genitals, and that for many women the excessive size of the same will produce discomfort and pain when doing sports activities as horseback riding, motorcycle and bicycle or their sex. One such intervention ranges between 3,500 and 4,500 euros, according to data of this cosmetic surgery clinic. Second in the classification of the most performed in the female genital tract is the reduction of excess fat in the pubic area, which creates gaps regarding the abdomen, according to the study, collected by the agency AGI. The intervention includes the reduction of fat in the abdominal area and the cost is between 3,000 and 4,000 euros. Moreover, in recent years have doubled the operations of the hymen reconstruction to restore virginity "anatomical", an intervention that costs about 5,000 euros and those on the same day the patient can go home. For women who have been mothers, there is also an operation that is to reduce the vagina to enhance sensitivity during sex and is reducing its final part. This statement, however, is discouraged for people who have problems like urinary incontinence or prolapse of the uterus. This is an intervention that requires general anesthesia, the patient must spend a night in the hospital and cost close to 6,000 euros.

An advocate for the transgendered By ANDREW HANON

2008-02-10T10:42:00.002-08:00

Psychiatrist is considered to be almost a saint by some of his patients

Dr. Lorne Warneke shakes his head whenever he hears the "official" statistics.
"They're way off," Alberta's only psychiatrist who specializes in transgender issues says with a rueful smile.
The generally accepted numbers are that one in every 67,000 males is transgendered, or a woman inside a man's body.
Men trapped in women's bodies are much more rare, about one in every 107,000.
But Warneke's own informal research in the Edmonton area suggests a much more staggering number - a combined average of one in 3,000.

"There have been recent studies that are much closer to my numbers," he said. "A U.S. study found one in 4,000 and a British study found one in 2,000."
Warneke, 65, runs the province's only transgender clinic out of the psychiatric outpatient ward at the Grey Nuns hospital in Mill Woods, where he approves 16 sex-change (or gender reassignment) operations each year.
In 2007, for the first time, he could have approved more, but 16 is the maximum number of operations Alberta Health agrees to fund in a year.
"It's now gotten to the point where I'm going to have to negotiate with the government for more money," Warneke says.
Turning a man's body into a woman's costs about $21,000.
Female-to-male gender reassignment, a much more complex process that involves fashioning a penis out of a skin graft taken from the inside of the patient's forearm, is more than double the cost at $45,000.
But it takes years before a patient reaches the surgery stage, involving strenuous assessments and the opinions of at least two psychiatrists (Warneke has a few colleagues who do "second consults").
After that, patients must live as the opposite sex full-time for a year or more to be absolutely certain it's right for them.
The surgery isn't performed here. There are only two surgeons in the entire country - in Montreal - who do the operations, and nearly all gender reassignment patients in Alberta are sent there. A few have gone to the U.S.
Warneke is hopeful another surgeon will start performing the more common male-to-female procedures in Vancouver, where a new transgender clinic recently opened.
In the meantime, however, he's trying to find a younger shrink willing to take over his duties here in Alberta.
"I'm good for another few years," Warneke says over coffee in a crowded bookstore. "But at some point, I'm going to have to start slowing down."
Some of his patients consider Warneke a saint, a dedicated advocate who has worked tirelessly on behalf of transgendered Albertans.
"He's such a unique individual," says Michael, who had gender reassignment five years ago. "In Alberta, we're about as redneck as you can get in Canada and he's here fighting for us."
Warneke shrugs it off, saying he's only doing what's right. He spends a lot of time lobbying schools, employers and even judges on behalf of his patients.
In one child-custody case, a judge originally ruled that a transgendered father with no history of abuse, drug use or criminal activity was such a threat to his child that he was restricted to supervised visits and ordered to dress and act like a man at all times with the child.
Warneke convinced the judge that the father posed no risk and that, in fact, the original order was more likely to be harmful to the child.
"We've come a long way, but these people are still very marginalized," he says.
Warneke admits he began to specialize in transgendered issues almost by accident.
When he was starting out in the 1970s he encountered a transgendered person and worked with them, assuming it was an interesting, but one-off case.
But more and more transsexuals began calling him for help and by the mid-1980s, Warneke had developed a reputation as an expert on the subject.
He opened the clinic in 1996 and nowadays, 40% of the patients in his private practice are transgendered.
He says there's no great mystery to the growing numbers of people coming forward and being diagnosed.
They've always been here - it's just that growing understanding is giving more people the courage to get help.
And they're getting diagnosed earlier.
It used to be nearly all of his transgendered patients were middle-aged, but a growing number are in their 20s. A few are even in their teens.
Warneke is also seeing more parents bringing in their children who are displaying "atypical" behaviour.
Most, he said, don't want him to "fix" their tomboy daughter or feminine-acting sons. They just want to know what's best for their kids.
"I tell them your job is to raise your child so that he feels good about himself."

FAQ Vaginoplasty

2008-02-02T14:12:00.000-08:00

Can vaginoplasty assist with bladder incontinence and sexual satisfaction for a 33-year-old woman with three children?

Vaginoplasty is an operation performed to repair structural damage to the pelvic floor. The supporting tissues that keep the pelvic organs in proper position are vulnerable to injury in childbirth and with aging. Loss of support results in the condition called prolapse. Prolapse can affect any of the pelvic organs, including the bladder, uterus, vagina, and rectum.
The symptoms of prolapse depend on the precise location of the damage in a given individual. Some women are aware of pressure or an uncomfortable bulge of tissue at the opening of the vagina. This is like having a hernia of the vaginal walls. The walls of the vagina become stretched and loose, resulting in impaired sexual function. When the supports of bladder neck are prolapsed, urinary incontinence can result.
Good bladder control and sexual satisfaction are both complex functions that depend on many factors. Not all of these factors can be addressed with surgery. However, to the degree that a woman's symptoms are caused by the anatomic disruption of prolapse, relief of symptoms can often be achieved by surgical repair.

Designer Vagina Surgery Is a $5,500 Risk, Doctors Say By Lisa Rapaport

2008-02-02T13:58:00.000-08:00

So-called designer vagina surgeries costing as much as $5,500 for G-spot amplification and revirginization should be banned as risky and ineffective, medical groups for gynecologists and plastic surgeons say.
The operations, marketed by cosmetic surgeons as a way to enhance sexual pleasure, can involve injecting collagen into the vaginal wall, altering the organ's outer lips, or labia, or restoring the hymen, the membrane sealing the vagina before first intercourse. The procedures were opposed by the American College of Obstetricians and Gynecologists, or ACOG, in guidelines in its journal today.
U.S. women spent $2.3 million last year on cosmetic vaginal procedures and the number of such surgeries grew 30 percent, to 1,030, according to the American Society of Plastic Surgeons, which also opposes the operations. The two groups say surgery is a bad fix for problems with body image and sexual function.
``It's like getting a tummy tuck instead of going to the gym,'' said Gail Wyatt, a certified sex therapist and clinical psychologist at the University of California, Los Angeles.
Risks include loss of sensitivity to the genitals, infection and pain from permanent scarring. No studies document benefits of the cosmetic procedures, making risks unacceptable, ACOG said in its journal commentary.
The most common reason women seek sex counseling is for loose vaginal muscles, Wyatt said. A better alternative than surgery is Kegel and other exercises that have proven successful in helping strengthen and tighten the vagina.
Sex Education
For women dissatisfied with their appearance, doctors need to ``cover the basics of sex education,'' and show women pictures of enough vaginas so they see how many different images are normal, she said.
``Patients who are anxious or insecure about their genital appearance may be further traumatized by undergoing an unproven surgical procedure with obvious risks,'' ACOG warned in its journal today. The caution comes three months after doctors in the British Medical Journal said women were needlessly reshaping their vaginas to match pornographic pictures.
Richard D'Amico, president-elect of the American Society of Plastic Surgeons, agreed with ACOG. He said potential benefits of the operations, such as women experiencing improved sexual confidence or better relationships, wouldn't justify doing surgery until studies prove it's safe.
``I do all kinds of aesthetic plastic surgery,'' D'Amico said. ``I don't do these procedures.''
Medically Necessary
Surgery can be medically necessary to repair muscle damage from childbirth, or to reduce the size of the labia in women who have discomfort caused by unusually long flaps of skin, doctors say. The procedures can also be needed to repair damaged tissue after rape, or to reconstruct the vagina after women have suffered genital mutilation.
In the U.S., vagina enhancements are not as popular as other cosmetic surgery options. The number of nose jobs rose 2.9 percent to 307,000 and breast implants increased 13 percent to 329,000, according to the plastic surgery society.
The U.K.'s National Health Service in 2004 and 2005 paid for elective surgery on 800 women who had the size of their labia reduced, according to a May commentary published in the British Medical Journal. That's more than double the number of procedures funded by the government six years earlier.
`Extreme and Unproved'
``Surgery is an extreme and unproved intervention in this instance and should be thought of as a last resort, not the first port of call,'' according to the British journal commentary.
The authors argued that appearance isn't a good enough reason to undergo the procedure.
George Beraka, a plastic surgeon in private practice in New York, said he does two or three of the vaginal operations a month. Women typically ask for procedures after childbirth or because self-consciousness about their appearance is preventing intimacy, he said.
``I'm on Park Avenue with a very sedate, upper-middle - class patient base,'' Beraka said. ``I can't imagine one of them coming in and asking specifically for something called revirginization.''
``I've been doing this over 13 years, and it has become much more popular,'' said Robert Rho, a cosmetic gynecologist at the Labiaplasty Master Surgery Center of New York.
Rho said he began doing the surgery when one of his patients complained she was having discomfort while exercising, a common reason for the surgery. Many also request it because they are inhibited by their appearance.
`Confident and Comfortable'
``Patients tell me afterward they are more confident and comfortable,'' Rho said. ``Some patients say having a sleeker, thinner labia makes a tremendous difference in their lives.''
Bernard Stern, a surgeon with Emerald Lakes Professional Center in Fort Lauderdale, Florida, said his patients told him they had better sex because they felt more comfortable.
``It's more based on the self-esteem issue than how the labia look,'' he said after the British commentary was released in May. ``Even though nobody on the street sees it, they feel more self-assured.''

Long-Term Results in Patients after Rectosigmoid Vaginoplasty.

2008-02-01T05:08:00.000-08:00

Many methods are used for vaginoplasty, including the split-thickness skin graft, full-thickness skin graft, and inverted penile skin flap. However, these procedures are not entirely satisfactory in cases of reconstructed vaginal stenosis, inadequate vaginal length, or poor lubrication. The small intestine, ascending colon, and sigmoid colon can be used in the intestinal flap method, and the authors modified the operation first described by Baldwin in which a loop of rectosigmoid is isolated, closed at one end, and brought down on its vascular pedicle as a neovagina and then anastomosed to the perineum.
Vaginoplasty using the rectosigmoid was performed in 36 patients (28 male-to-female transsexual patients, five patients with congenital vaginal atresia, and three with cervical cancer). The follow-up period ranged from 1 to 10 years. The postoperative results were analyzed through physical examination and interview regarding the patient's functional status and satisfaction during sexual intercourse. The mean depth and width of the vaginal cavity were 12.5 cm and 3.9 cm, respectively. Excessive mucosal discharge was seen in 8.3 percent, and malodor was found in 8.3 percent. All patients who had partners were able to have sexual intercourse; 2.8 percent of patients used lubricants and 5.6 percent used dilators before intercourse for more than a year postoperatively. During intercourse, 88.9 percent of the patients experienced orgasm. The cosmetic and functional results of rectosigmoid vaginoplasty were excellent. Thus, the advantages of rectosigmoid vaginoplasty are (1) rare contraction of the reconstructed vagina, (2) vaginal width and depth maintained without long-term vaginal stent, (3) spontaneous mucus production facilitating sexual intercourse, (4) avoidance of the malodor frequently accompanying skin graft, and (5) texture and appearance similar to that of the natural vagina. The authors concluded that rectosigmoid vaginoplasty is the best choice for transsexual patients who have previously undergone penectomy and orchiectomy, patients with unfavorable previous vaginoplasty, those with short vaginal length after cervical cancer surgery, and patients with congenital vaginal atresia.

Kwun Kim, Seok M.D.; Hoon Park, Ji M.D.; Cheol Lee, Keun M.D.; Min Park, Jung M.D.; Tae Kim, Jeong M.D.; Chan Kim, Min M.D.

Post Pregnancy Labiaplasty or Vaginoplasty by Asheesh Mani

2008-01-28T10:10:00.000-08:00

Getting pregnant can be a most anticipated event in a woman's life and she expects to have a healthy pregnancy without any complications. Her pregnancy planning worked and she had a happy pregnancy and a safe childbirth. She comes home with her bundle of joy and life seems perfect. However, it is a rude shock when she finds that her sex life is no longer as pleasurable as it once had been. Labiaplasty/Vaginoplasty could be the solution.

Labiaplasty or Vaginoplasty – Plastic Surgery of the Female Genitals

At times the vagina of a woman may be torn or excessively stretched due to childbirth. The vaginal tissues also lose their tone increasing the size of the vaginal canal after childbirth. This condition can cause less friction during intercourse reducing the pleasure both partners feel. Some women may also experience pain during intercourse and experience discomfort due to the abnormal genitalia. Some women do not like the way they have changed after childbirth and consider getting a Labiaplasty or Vaginoplasty. There have been many women who have opted for Labiaplasty or Vaginoplasty even before getting pregnant. However, doctors recommend that they opt for surgery after a healthy pregnancy and childbirth.

Labiaplasty is a procedure when the labia or the inner lips of the vagina are surgically reduced/re-shaped to enhance the appearance of the genitals. In Vaginoplasty, the size of the vaginal canal is reduced by removing excessive vaginal tissue. The procedure also corrects other supportive vaginal tissues. This procedure helps improve friction, enhancing sexual pleasure for both partners. Some women opt to have both surgeries performed together. The surgery aims to ensure that the vagina returns to its pre-pregnancy state.

Some clinics offer patients a choice of anesthesia such as local, general, epidural, spinal etc. The procedure usually takes about a couple of hours to perform and the women can get back to work within a week and have an active sexual life within 4-6 weeks. Labiaplasty or Vaginoplasty can also correct incontinence an embarrassing situation for the mother.

Some associated risks are hemorrhage, infection, injury to rectum, bladder, etc. Scarring and vagina overcorrection are other risks. Doctors recommend that mothers wait for about a year after childbirth before they opt to have a surgical correction of their genitalia.

Labiaplasty or Vaginoplasty is being preferred by more women who want to improve the appearance of their genitals. However, those who have not had babies and who are desire a healthy pregnancy need to postpone the operation until after they have had their babies. There are some claims that Labiaplasty or Vaginoplasty may cause complications during pregnancy in some instances. The procedure usually costs between $4000 and $13,000. More women are opting for laser Labiaplasty or Vaginoplasty procedures to enhance the appearance as well as functioning of their genitalia.

Terms to know

2008-01-20T11:39:00.001-08:00

CROSS-DRESSER: A person who dresses in clothing culturally associated with the other sex.

DRAG QUEEN/DRAG KING: Biological males and females who present occasionally as members of the opposite sex, generally for entertainment.

FTM: An acronym that stands for female-to-male, or, the direction in which a person is transitioning. MTF stands for male-to-female transition.

GENDER: Generally defined as a set of sociologically and culturally constructed roles, behaviors, practices and attributes that a society considers appropriate for men and women. There are many definitions of gender.

SEX: Classification of people as male or female based on biological characteristics, such as chromosomes, hormones, reproductive organs and genitals.

GENDER EXPRESSION: The external display of a person’s gender identity, usually expressed through masculine or feminine behavior.

GENDER IDENTITY: A person’s internal, personal sense of being a man, woman, transgender or other.

GENDER IDENTITY DISORDER: A controversial psychological diagnosis that can be given to transgender people, which identifies the incongruence between the person’s biological sex and their gender identity. Some contend the diagnosis inappropriately characterizes the condition as abnormal. Others say they country’s health-care system needs such a label to justify medical or psychological treatment.

INTERSEX: A person born with the condition of having sexual attributes, such as genitals, hormones and chromosomes, that are neither clearly male or female. Replaces the term, hermaphrodite.

SEXUAL ORIENTATION: A person’s physical and emotional attraction to another person.

TRANSGENDER: An “umbrella” term for people whose gender identity or expression differs from their sex. This term includes, but is not limited to, cross-dressers, drag queens and kings, transsexuals,

SEX REASSIGNMENT SURGERY OR SEX CONFIRMATION SURGERY: A procedure that physically transforms the genitals. MTF surgery is a vaginoplasty; FTM surgery is either a genitoplasty or a phalloplasty.

TRANSSEXUAL: An older term that describes a transgender person who wishes to live full-time as the gender opposite their birth sex.

OTHERS: Androgynous, bi-gendered, gender queer, all with varying definitions to generally describe the blending of genders. Terms largely considered problematic or derogatory:SEX CHANGE OPERATION: The preferred term is sex reassignment surgery or sex confirmation surgery.

TRANSGENDERS OR A TRANSGENDER: The word “transgender” should be used as an adjective, not a noun. The preferred terms are transgender people or a transgender person. TRANSVESTITE: The preferred term is cross-dresser.

OTHERS: She-male, he-she, tranny.

Sex reassignment surgery Route

2008-01-19T12:36:00.002-08:00

Sex reassignment surgery (SRS), gender reassignment surgery, or sex-change operation is a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other sex. It is part of a treatment for gender identity disorder in transsexual and transgender people. It may also be performed on intersex people, often in infancy. Other terms for SRS include gender reassignment surgery, sex reconstruction surgery, genital reconstruction surgery, gender confirmation surgery, and more recently sex affirmation surgery. The commonly used terms sex change or sex change operation are considered factually inaccurate. The terms feminizing genitoplasty and masculinizing genitoplasty are used medically.
The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery (GRS).
The meaning of sex reassignment surgery usually differs for transwomen (male to female) rather than transmen (female to male). For transwomen, sex reassignment usually involves the surgical construction of a vagina, whereas in the case of transmen, this term may entail any of a variety of procedures, from the mastectomy (removal of the female breasts) to the shaping of a male-contoured chest to the construction of a penis. Additionally, transmen usually undergo a hysterectomy and bilateral salpingo-oophorectomy.
Chest (or "top") surgery is often the only surgical procedure female-to-male transsexuals choose to undergo, as GRS techniques for transmen are still rather unrefined and typically produce genitalia of compromised aesthetic and functional quality.
For some transwomen, facial feminization surgery and breast augmentation are also important parts of the sex reassignment process.
People who pursue sex reassignment surgery are usually referred to as transsexual; "trans" - across, through, change; "sexual" - pertaining to the sexual characteristics (not sexual actions) of a person. More recently, people pursuing SRS often identify as transgender instead of transsexual.

Medical considerations

Those with HIV or hepatitis C may have difficulty finding a surgeon able or even willing to perform surgery because many surgeons operate out of small private clinics that cannot adequately treat potential complications in these populations. Some surgeons charge higher fees for HIV and hepatitis C positive patients (some surgeons in developing countries prefer to dispose of surgical instruments used on these populations).
Other health conditions such as diabetes, abnormal blood clotting, and obesity do not usually present a problem to experienced surgeons, but do increase the anesthetic risk and the rate of post-operative complications. Some surgeons require that severely overweight patients reduce their weight by a certain amount prior to surgery and that patients refrain from smoking for a period of time before and after surgery, although this is considered common practice regardless of the operation performed.

Standards of care

Sex reassignment surgery can be difficult to obtain. There are very few surgeons willing to perform SRS. Most jurisdictions and medical boards require a minimum duration of psychological evaluation and living as a member of the target gender full time, sometimes called the real life experience (RLE) or real life test (RLT) before SRS is permitted. However, transsexual and transgendered people are often unable to change the listing of their sex in public records until SRS is completed, due to the laws of many jurisdictions. (See legal aspects of transsexualism.)
In many countries or areas, an individual's pursuit of SRS is often governed, or at least guided, by documents called Standards of Care for Gender Identity Disorders (SOC). This most widespread SOC in this field is published and frequently revised by the Harry Benjamin International Gender Dysphoria Association (HBIGDA). Standards of Care usually give certain very specific "minimum" requirements as prerequisites to SRS. For this and many other reasons, both the HBIGDA-SOC and other SOCs are highly controversial and often maligned documents among transgender patients seeking surgery. Some alternative local standards of care exist, such as in the Netherlands, Germany, and Italy. Much of the criticism surrounding the HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the HBIGDA-SOC. Other SOCs are entirely independent of the HBIGDA. The criteria of many of those SOCs are stricter than the latest revision of the HBIGDA-SOC. The majority of qualified surgeons in North America and many in Europe adhere almost unswervingly to the HBIGDA-SOC or other SOCs

Who Pays for Sex Reassignment Surgery? By Nina

2008-01-19T12:31:00.002-08:00

Denise Lavoie, an Associated Press Writer in Boston reported on the case of a Transgender Inmate Seeking a Sex Change. She writes, “Wearing lipstick, a scooped-neck sweater and nearly waist-length hair, the witness cried while describing what it feels like to be a woman trapped inside a man’s body. ‘The greatest loss is the dying I do inside a little bit every day,’ said Michelle Kosilek, an inmate who is serving a life sentence for murder.”
“Kosilek was Robert Kosilek when he was convicted in the killing of his wife. In 1993, while in prison, she legally changed her name to Michelle. Since then, Kosilek has been fighting for the state Department of Correction to pay for sex-change surgery, which can cost from $10,000 to $20,000. After two lawsuits and two trials, the decision now rests with a federal judge.”
“Kosilek’s case has become fodder for radio talk shows, often provoking outrage among callers on topic of whether the state should pay for a convicted murderer’s sex-change operation. The case is also being closely watched by attorneys and advocates across the country who say Kosilek is an example of the poor treatment transgender inmates receive in prison.”
Ramon Johnson at Gaylife.About.com offers this commentary. He writes, “No one likes to feel trapped- in a bad job, a bad place or a bad situation. Imagine feeling trapped in your own body. The pain of living in heterosexual situations while suppressing same gender loving feelings is destructive enough.”
“For biological men that feel like a woman trapped in a man’s body (or vice versa), the pain and internal conflict is often unbearable. Sex reassignment surgery (often, but less appropriately, called gender reassignment surgery) is the only option for those with psychological and emotional identities trapped in the wrong physical body.”
“Our psychological and emotional identities should match our physical makeup; and for most seeking reassignment- surgery is a need not a want. So, who should cover the cost? Is the burden of sex reassignment a public obligation or solely that of the individual? Or, should the expense be shared?”
What do you think? Should taxpayers have to pay for these operations?
In the State of Washington, Medicaid officials are taking steps to end publicly funded sex-change surgeries. Fox News reports, “While the disorder has been recognized for more than two decades by the American Psychiatric Association, few government or private insurance programs pay for treatment.”
“Washington is one of a few states where sex-change surgeries have been covered. The number here has been small: six during the past 15 years. Medicaid officials said the state has paid for two sex-change surgeries since 2000, at a total cost of about $113,000.”
Most transgender individuals have to save for years in order to afford an operation. I can see if some think a felon doesn’t deserve a state-funded operation, but what about law abiding citizens? Anyone care to comment on the subject?

Male to Female Sex Reassignment Surgery By Vaginoplasty

2008-01-19T08:40:00.002-08:00

Transsexualism is not a "modern discovery". Instead it is a not-uncommon, naturally-occurring variation in human gendering that has been observed and documented since antiquity. In many cultures, including native tribes in North America, transsexual individuals have long had the choice to cross-dress and live their lives as women, including taking husbands. The surgical alteration of genitalia to relieve intense cross-gender feelings was also not "invented in the twentieth century". In some cultures, even ancient ones, many transsexuals have voluntarily undergone surgeries to modify their bodies in such a way as to "change their sex". The surgical methods and the effects of castration were everywhere for the ancients' to see. It's use in the domestication of animals quickly taught ancient people that removal of a human male's testicles at a young enough age would prevent his masculinization too. Such a person would forever be childlike - or "girly". These surgeries were also often forcibly done upon captive adult male slaves in order to "domesticate them" as "eunuchs". Performing such surgeries on normal post-pubertal males does not change their gender feelings or gender identity, although is lessens their sexual drives somewhat and sharply reduces their ability to develop male musculature. The accumulating knowledge about the effects of castration was further extended to help MtF transsexuals: Untold millions of transsexuals over thousands of years have voluntarily sought and undergone surgeries vastly riskier and more dramatic in effect than mere castration. In these surgeries transsexuals are completely emasculated by total removal of the testes, penis and scrotum. In addition, the external pubic area is often roughly shaped to look like a girl's vulva. No one knows precisely how it started, but such transsexual surgeries were well known by the time of ancient Greece and especially in sexually-permissive ancient Rome, and were often traditionalized in various "religious rituals" that provided the resulting "women" with a place in society. By undergoing these surgeries, young MtF transsexuals (if they survived) not only avoided becoming men, but also gained genitalia that looked somewhat like those of a woman. Although lacking vaginas and lacking the powerfully feminizing effects of female sex hormones, young transsexuals in the past could nevertheless live life better as women after undergoing such surgery. Even today, very large numbers of desperate young transsexuals in India and Bangladesh run away from home to join the "Hijra" caste. To become Hijra, these teens voluntarily undergo fully emasculating surgeries under primitive conditions, just as they would have in ancient times, with only opium as an anesthetic. Most undergo the surgery in their teens shortly after the onset of puberty, with results as seen in photo below. By being castrated just early enough, many avoid the development of male secondary sex characteristics (except for the breaking and lowering of the voice), and their bodies can remain permanently soft, childlike and girly. Contrary to popular myth, total external emasculation after puberty does not necessarily "de-sex" the person. Complete castration after puberty leaves the young Hijra with her newfound feelings of sexual arousal and her newfound orgasmic capabilities. While the psychological impact of such surgery would usually cripple the libido of a normal male, the effect on a young transsexual girl is usually just the opposite: The surgery can be liberating and can enable a fuller expression of her sensuality and her female libidinous feelings. Just as in the case of modern post-operative transsexual women, many Hijra can have strong feelings of sexual arousal in the inner remnants of their genitalia (even though they lack the external nerve tissue left by modern SRS, they retain the internal portions of the erectile corpora cavernosa and of course the prostate, with its spasmodic orgasmic capabilities). Although Hijra lack vaginas, many greatly enjoy (to orgasm) penetrative (anal) sexual activities with men. Because of their complete external emasculation, Hijra genitalia and pelvic regions look very "girly", and many men in India greatly enjoy lovemaking with them. The Hijra in turn accept their fate and their limited, but real, possibilities for finding at least a little bit of love as a woman in this life.

Early Sex Reassignment Surgeries in the U. S.

2008-01-19T08:39:00.005-08:00

Finally, in 1966, surgeons at the John Hopkins Medical Center began performing a limited number of MtF SRS operations in effort to help some intensely transsexual patients under care of Hopkins' new gender identity clinic. The Hopkin's staff believed that transsexuals were mentally ill, but they also believed that there was no psychological method for reversing the "incorrectly formed gender identity". In an experimental program they began to explore the possibility of helping patients via surgery, as was being recommended by Dr. Benjamin. The Hopkins' Surgeons used a variant of Dr. Burou's method.

In the fall of 1966, newspapers around the country propagated the following item from a column in the New York Daily News: "Making the rounds of Manhattan clubs these nights is a stunning girl who admits she was a male less than one year ago and that she underwent a sex change operation at, of all places, Johns Hopkins Hospital in Baltimore. Surprisingly, the hospital confirms the case, saying surgery followed psychotherapy. Such operations, although rare in this country, are neither illegal nor unethical, according to a Johns Hopkins spokesman. Officials at a number of major hospitals here agreed with Johns Hopkins on the legality and ethics of the operations but none could recall such an operation ever having been performed in New York." Then, on November 21, 1966, the New York Times published an extensive front-page article on transsexualism. The Times article provided extensive information on the surgical and hormonal treatments then being done abroad, and on the new program at John's Hopkins University Medical Center, where several surgeries had recently been done. The article also identified Dr. Benjamin as being the world's leading authority on transsexualism, and as author of a new textbook on the subject entitled The Transsexual Phenomenon (see this link for an online version of the original text).

Dr. Benjamin was the pioneer of the whole new area of medical knowledge of transsexualism. His paradigm-shifting medical text described his experiences with many patients over several decades. He was the first researcher to recognize how gender identity and sexual orientation are two independent dimensions of each person's human nature. Dr. Benjamin recommend how "intense transsexuals" could and really should be treated, in order to enable them to live in the gender they sought. His book documented the results of the new, innovative surgical and hormonal treatments and put those treatments into a rational context as therapy for transsexualism. This book gave fresh hope to many transsexuals, and opened the door for the modern medical approaches that we now take for granted. At the same time, the fact that Johns Hopkins was actually doing transsexual surgeries greatly enhanced the visibility of Dr. Benjamin's theories and the attention that his research results received by the medical community.

The Development of Modern Sex Reassignment Surgery (SRS)

2008-01-19T08:39:00.004-08:00

With the rapid advances in knowledge of sex hormones and plastic surgery following World War II, it finally became possible to contemplate complete medical and surgical solutions for transsexualism. During the 1950's, transsexual women began to benefit enormously from the newly available female sex hormones, which enable the development of breast, soften the skin and over time produce female body contours. Also during the 1950's, a few surgeons began exploratory surgeries to construct vaginas in MtF transsexuals by using skin grafts taken from the thighs or buttocks, drawing upon then recently developed techniques for constructing vaginas in intersexed girls.

Christine Jorgensen, a U.S. citizen, was among the first small group of transsexuals to undergo such a surgical "change of sex". She was "outed" in 1952 by U.S. print media shortly after her initial surgery, and her story became a national sensation. Through her story, many transsexuals for the first time learned of the existance of the new hormonal and surgical treatments. However, access to this new, experimental surgery was limited to a tiny handful of patients in Europe.

At the time of Christine's surgery in the '50's, doctors first removed the transsexual's male organs in one or more surgeries. The patient then waited through an extended period for healing. Then, in a surgery similar to those done to create vaginas for intersexed patients, surgeons constructed the patient's vagina by using skin grafts taken from her thighs or buttocks (Christine's vaginoplasty surgery was in 1954).
Although patients were extremely pleased with the results (especially when compared to their previous situations), there were major problems with this early method. The skin grafts were unreliable, and sometimes partially failed to "take". The use of extensive grafts also left large disfiguring scars at the donor sites. In addition, a lot of sensitive genital tissue was forever lost in the first step, affecting patients' feelings of sexual arousal and capacity for orgasm.

During the late 50's and into the 60's, several hundred transsexuals in the United States came under the care of Harry Benjamin, M.D, a compassionate physician and endocrinologist who had offices in New York, N.Y. and San Francisco, CA. Dr. Benjamin was the first physician/researcher to sort out the distinction between cross-gender identity and homosexuality. Instead of viewing transsexuals as mentally ill deviants as did most psychiatrists of the day, he began to visualize transsexuals as truly suffering from a genuine mis-gendering condition of unknown origins. In efforts to ease their suffering, he began prescribing estrogen to selected patients in response their profound pleas for medical feminization. He also maintained close watch on the results of transsexual surgeries being performed, and began to refer his most intensely transsexual patients to those surgeons who were obtaining the best results.

Then, in the late 50's, a french plastic surgeon named Georges Burou, M.D. invented the modern form of penile inversion MtF sex reassignment surgery for MtF transsexuals. Variations of Dr. Burou's technique have been used ever since. Dr. Burou's classic innovation was to use the male genitalia as source of skin and sensitive erotic tissue to create the new female genitalia, including the vagina.
Dr. Burou performed these surgeries in his clinic in Casablanca, Morocco. In 1958-60, several famous and very beautiful young "female impersonators" from the club Le Carrousel in Paris, France, including Coccinelle (more info), Bambi and April Ashley, were successfully transformed into women by Dr. Burou. Many of the young Le Carrousel girls had received female hormones as a side-benefit of working at the club, and as a result had become incredibly beautiful, feminine and sexy. Several returned to perform at the club after their genital surgery. Their successful "sex changes" became widely known about, and they became sought after as love objects by many prominent, wealthy men. Some very wealthy men (including Aristotle Onassis) would occasionally "sponsor" the sex change surgery of a Le Carrousel girl, who would then became their mistress for a while.
Dr. Burou became both famous and notorious as news spread of his work. His "Clinique du Parc" at 13 Rue La Pebie in Casablanca, Morocco eventually became besieged by transssexual patients from all over the world. Dr. Burou began performing many hundreds of these operations every year. In 1973, Dr. Burou gave his first formal public presentation on his innovative surgical technique at a major interdiciplinary conference on transsexualism held at the Stanford University Medical School. By the time of that 1973 conference, he had performed over 3000 MtF surgical sex reassignments. By that time many other surgeons around the world had inferred and adapted Dr. Burou's technique, and were applying it in similar SRS surgeries.
Among the keys to the success of these surgeries were (i) the use of the skin of the penis and scrotum to form the new labia and a sexually functional vagina (thus avoiding the source area disfigurement caused in earlier operations by the use of large, deep skin grafts), and (ii) the careful dissection and placement of the terminated corpora cavernosa and the saving and relocation of some of the sensitive nerves and a small amount of erectile tissue. If done properly, the post-operative patient can have powerful feelings of sexual arousal (erection of the corpora stumps remaining inside her body) and can easily be orgasmic (the prostate is left intact, and can spasm during orgasm just as before SRS - while the nerve tissues throughout the corpora, the clitoris and the vulva spasm, throb and release at the same time, just as in any other woman).

Dr. Benjamin's practice grew rapidly as more and more transsexuals learned that they could obtain compassionate treatment from him. He began referring ever larger numbers of patients to surgeons, especially to Dr. Burou in Casablanca. By the mid 60's, several other top surgeons abroad began performing SRS surgeries on transsexuals using Dr. Burou's techniques, and Dr. Benjamin referred patients to these surgeons too. The most notable of these was Jose Jesus Barbosa, M.D., a prominent plastic surgeon in Mexico (Dr. Barbosa was Lynn's SRS surgeon, and had performed over 300 SRS's by 1973).

However, such surgeries were still virtually unheard in the U.S. even in the mid-to-late 60's. Under intense pressure from religious groups following the publicity of the Jorgensen case in 1952, most U. S. hospitals installed policies that explicitly forbade such operations, and religious strictures were frequently drawn upon to support the witholding of any hormonal or surgical treatments of transsexuals. Then too, the U.S. medical community in the 60's thought of transsexuals as "severely psychotic" rather than biologically mis-gendered. Instead of receiving help for gender-transition from medical professionals, many transsexuals were forced into mental institutions, where psychiatrists tried to "cure them of their mental illness" by electroshock therapy and aversion therapy.

During the late 50's and into the early 60's, a number of intensely transsexual girls in the U.S. resorted to castrating themselves in order to become more feminine and to bypass hospital restrictions on removal of testicles from "intact males" during SRS. Once no longer intact, the girl might hope to obtain complete SRS in some hospitals here - if she had the money to pay for it. See for example, the story of transsexual pioneer Aleshia Brevard. At a young age and feminized on estrogen, Aleshia became a star performer at Finocchio's, the world famous "female impersonator" nightclub in San Francisco. After a self-castration to further feminize herself, Aleshia was able to undergo SRS in the U.S. in 1962 with the help of Dr. Benjamin. As did so many postop transsexual women in the 1960's (including Lynn) Aleshia left her past life behind and entered stealth mode. She went on to become a showgirl, a "Playboy Bunny" (a hostess at one of the famous "Playboy" clubs), a widely recognized movie, stage and TV actress, and got married three times! Aleshia only recently came out to tell her story in a wonderful book about her amazing life.

Early Sex Reassignment Surgeries in the U. S.

2008-01-19T08:39:00.003-08:00

The Development of Modern Sex Reassignment Surgery (SRS)

2008-01-19T08:39:00.002-08:00

Diagrams of the early John's Hopkins MtF SRS Procedure

2008-01-19T08:38:00.002-08:00

Figure 1. A sketch of the perineum showing the line of primary incision.

Following are illustrations that sketch the basic steps in the early Hopkins surgical method, which is a variation on Georges Burou's method. These figures are taken from Chapter 22, by Howard W. Jones, Jr., M.D. in Transsexualism and Sex Reassignment, Richard Green, M.D. and John Money, Ph.D., Editors; Johns-Hopkins Press, 1969. By this time it was common to refer to this type of surgery as "sex reassignment surgery" (SRS). The illustrations were reproduced from an original article by Howard W. Jones, Jr., Horst K. A. Schirmer, and John E. Hoopes, " A Sex Conversion Operation for Males with Transsexualism", American Journal of Obstetrics and Gynecology 100 (1968): 101-9. (Note: See comments following the diagrams regarding the anatomically misleading/incorrect sketching in the final sketch, Figure 10.)

Figure 2. The right spermatic cord is clamped and ligated.

SRS Becomes an Accepted Treatment for Transsexualism in the U.S

2008-01-19T08:36:00.005-08:00

The early Johns Hopkins announcement and publications coincided with the publication of The Transsexual Phenomenon, by Harry Benjamin, M.D. in late 1966. The result of many years of research observations and clinical practice by Dr. Benjamin became the seminal text on transsexualism. The book finally identified transsexualism as a distinct, major medical affliction in which patients have an innate gender identity opposite to the genital sex of their bodies. These theories and results obtained considerable attention within the U.S. medical community over the next several years - but most of it was highly skeptical. Then, following interactions with Dr. Benjamin and some of his patients, physicians at the Stanford Medical Center started a exploratory gender clinic in 1969, led by Norman Fisk, M.D. and Donald Laub, M.D. SRS operations were undertaken on selected MtF patients, and the Stanford clinical and surgical results further validated the concept of SRS as treatment for those suffering from intense transsexualism. Acceptance of SRS as a serious and valid treatment for transsexualism began to slowly spread among thought leaders in the U.S. medical community. Hospitals around the country began gradually lifting their bans on transsexual surgeries, and surgeons at various locations began performing these surgeries on small numbers of selected patients in the U.S. In 1969 Stanley Biber, M.D. (1924-2006*), a surgeon in Trinidad, Colorado, began performing MtF SRS vaginoplasty operations using information he obtained from the surgical team at Johns Hopkins. The excellent successes of his surgeries became widely known, and patients streamed to him. For many years Dr. Biber performed over 150 MtF SRS's per year, and by the year 2000 had performed over 4500 of them. A USA Today article told Dr. Biber's story, as follows:

SRS Surgery Details

2008-01-19T08:36:00.004-08:00

Figure 1. A sketch of the perineum showing the line of primary incision.

Figure 2. The right spermatic cord is clamped and ligated.

Figure 3. The primary incision is continued up the ventral side of the shaft of the penis.

Figure 4. The anterior flap is developed from the skin of the penis.

Figure 5. The urethra is dissected from the shaft of the penis.

Figure 6. The corpora cavernosa are separated to assure a minimal stump.

Figure 7. The perineal dissection.

Figure 8. The perineal dissection has been completed and the anterior flap perforated to position the urethral meatus.
Figure 9. The skin flaps are sutured and placed in position in the vaginal cavity.

Figure 10. The preservation of the vaginal cavity is assured by use of a suitable vaginal form.

Figure 4. The anterior flap is developed from the skin of the penis

Figure 5. The urethra is dissected from the shaft of the penis.

SRS Becomes an Accepted Treatment for Transsexualism in the U.S

2008-01-19T08:36:00.003-08:00

The Current Protocol for Referring Transsexuals for Vaginoplasty (SRS)

2008-01-19T08:35:00.002-08:00

Vaginoplasty (sex reassignment surgery) is a dramatic and irrevocable final step in male to female gender transition. This step is usually taken only after the deepest introspection and counselling regarding all the options. For those needing complete gender correction, this surgery is a life saving and life enhancing miracle, and can enable them to live a full and joyous life afterwards. However, carrying out of a mistaken urge for such a complete transformation could lead to permanent and terrifying emotional and psychological consequences. The background for this process is discussed in the introduction to the concepts of gender identity, transgenderism and transexualism found elsewhere in Lynn's website.

The Standards of Care of the Harry Benjamin International Gender Dysphoria Association (HBIGDA) defines the currently accepted protocols for the medical treatment of transsexual women. These Standards cover all aspects of medical treatment, including the requirements for Real Life Experience (aka, Real Life Test), and other requirements that must be met before a trans woman is recommended for SRS. Most surgeons who perform vaginoplasty will only operate on transsexual women who have been treated under these Standards and who present the corresponding letters of recommendation for surgery from their case-counsellors.

For more information on the overall TS treatment and transition procedures, see Andrea James' TS Roadmap website, which contains outstanding planning information for anyone contemplating MtF gender transition. For more details on Vaginoplasty, see Andrea's Vaginoplasty page and follow the many links there.

What is Gender and Who is Transgendered? By Carl W. Bushong

2008-01-19T08:31:00.002-08:00

When we speak of gender, in a context other than language, it is a recent concept in our culture, both lay and professional. It was not until 1955 that John Money, Ph.D. first used the term "gender" to discuss sexual roles, adding in 1966 the term "gender identity" while conducting his gender research at Johns Hopkins. In 1974, Dr. N.W. Fisk provided our now familiar diagnosis of Gender Dysphoria. Previously, one's sexual role was considered one of two discrete, non-overlapping congenital attributes—male or female determined by one's external genitals. These two mutually exclusive categories allowed for no variation. Of course, we acknowledged the cultural differences in sexual roles, but there still could be only two modes of expression - of being. We then began to see one's gender as a continuum, a blending, analogous to a "gray scale." But, our distribution of gender was still bimodal, that is, most people are lumped at the two ends (see graphic) with only a minority in the middle. The great majority would be either male or female with all that implies.
But, my review of current research and experience with gender dysphoric, gay and traditional clients has led me to see gender not as a bimodal male or female dichotomy but as a matrix—a possible mix of male and female development within the same individual. From research and observation, I have developed a list of five semi-independent attributes of gender, as a map to help you to understand this complex often hotly emotional issue of gender. Consider sexual identity/behavior (gender) springing from five semi-independent attributes:
It is my contention that it is possible for an individual to view oneself and function as male or female to varying degrees in each of the five sub-categories independent of the others. From a few weeks after conception until two to three years of age, our brains develop gender in at least three independent dimensions which I have called "Brain Gender." [How the brain is wired along gender lines.] "Brain Sex" How we perceive sex, relationships and goals along male or female sets] and Gender Identity [how we perceive ourselves-male or female.] Not only are these three dimensions independent of each other, but of one's Physical Gender as well. That is, a person can have a male body, male Brain Sex and Identity, but have female Brain Gender. [In fact, most writers and artists do.] Such a person would look, act and feel male, but have a female's sensitivity to emotions, words and sensations: Although, they may overcompensate in public and in interpersonal relationships [e.g., Ernest Hemingway] Like our Genetic and Physical Gender, our Brain Gender, Gender Identity, and Brain Sex, expression usually remains constant from childhood throughout one's life. Since each of these independent attributes is graded, it is easy to see the possible combinations and degrees number in the thousands. With regard to gender, we can be in a category of one—ourselves. Perhaps only individuals who are homogeneously male or female at the highest degree in all five attributes could convincingly describe themselves as only a single gender— the rest of us are a matrix [a mixture]. As for the transgendered, they appear to be uniformly one gender in all three brain dimensions, but of the opposite gender, both physically and genetically. Genes and Gender The first sub-category, Genetics, is only beginning to be understood. What mechanism and to what degree does genetic influences effect one's expression of gender? We do know that besides the traditional XX chromosome of a typical female and the XY of a typical male, that there are other combinations such as XXY, XYY, and XO. A XXY combination results in 47 rather the 46 chromosomes. This condition is called Klinefelder's syndrome and occurs in one in every 500 births. Individuals with Klinefelder's are sterile, have enlarged breasts, small testicles and penis, and a eunuch body shape much like the "Pat" character on "Saturday Night Live." They show little interest in sex. Another 47-chromosome occurrence is XYY Syndrome. In this syndrome, the hormonal and physical appearance of the individual are evidenced as a normal male, but behavior is effected. Typically, XYY Syndrome people are bisexual or paraphilic (pedophilia, exhibitionism, voyeurism, etc.), and show very poor impulse control. Where Klinefelder's and XYY Syndrome are examples of an extra chromosome, Turner's syndrome is a case of a missing sex chromosome. These individuals possess 45 chromosomes (written as XO), are unable to develop gonads, and are free of all sexual hormones, except that crossing over from the mother during fetal life. Turner's Syndrome people have external sex organs approximating a female, and their behavior is characterized as hyper-feminine, baby care oriented, and showing very poor spatial and math skills. The Turner's personality, free of all influence from testosterone, tends to be in direct opposition to the typical set of "Tom Boy" traits. But, none of the above conditions describes the transgendered individual. Transgenderism is far more subtle, involving probably only a few genes on a single chromosome. Physical Gender To discuss this aspect of gender we need to examine hormonal involvement, in particular testosterone. During fetal life, the amount present, or the absence of testosterone and other androgens determines our sexuality — physically, mentally and emotionally. There are key times or periods during development when the fetus will go towards the male or the female depending on the level of testosterone. These windows of opportunity may be only open for a few days and if the needed level of testosterone is not present, a basic female orientation develops regardless of the testosterone levels before or after this critical period, and the resulting sexual imprint. The first critical period is at conception when the presence of the SRY gene (Sex-Determining Region of the Y chromosome) will determine our physical gender. The SRY gene is normally found on the short arm of the Y chromosome, but can detach making for a XY female (the Y missing its SRY gene) or a XX male (the SRY attaching to the X).
The SRY gene causes the fetus to release TDF (Testes Determining Factor) which turns the undifferentiated gonad into testes. Once testes have formed, they release androgens such as testosterone, dehydrocorticosterone, and anti-mullerian hormone. Before the release of TDF, the developing fetus has two tiny structures, the mullerian and wolffian ducts, and two small-undifferentiated gonads, neither testes nor ovaries. Without the influence of TDF and testosterone, the gonads form into ovaries and the mullerian duct forms into the female internal sex organs, the wolffian duct disappears and the external sexual tissue becomes the labia major, clitoris, labia minor and clitoral hood. With the influence of TDF, the gonads become testicles and the wolffian duct forms the male internal sex organs, the mullerian ducts dissolve and the external tissue develop into the penis, scrotum, penile sheaths and foreskin. In other words, without testosterone all fetuses develop into females. Adam springs from Eve, not Eve from Adam.
As the primary sexual differentiation proceeds towards our physical gender, sometimes deviations occur. These anomalies are sometimes called "experiments of nature." One such "experiment" is a condition termed congenital adrenal hyperplasia (CAH) when the female fetus releases a steroid hormone form her adrenal glands which resembles testosterone. The resulting child often has confusing genitals ranging from deformed female genitals to an appearance of male genitals. If the child is raised as male, following any "adjusting" surgery and given male hormones at puberty, the individual develops as a "normal" but sterile male with XX chromosomes. On the other hand, if the infant is surgically corrected to female and given female hormones, there is a 50/50 chance of lesbian or transgender expression. This "correction" is the source of much unhappiness, and most "intersexed" individuals have this condition. Another revealing "experiment of nature" is Androgen Insensitivity Syndrome. In this case, there is a normal amount of testosterone circulating in a XY chromosome fetus, but each cell of its body is unable to react to it. This is similar to Turner's Syndrome in that neither the mullerian or wolffian ducts (see above) mature and the external genitalia develops into an approximation of normal female genitals, but differs in that TDF stimulates the gonads into becoming functioning testicles in a XY chromosome body. The child is raised as a girl and is seen as a normal female until she fails to menstruate because she has no uterus. If her testes produce enough estrogen (excess testosterone is converted into estrogen), she develops into a completely normal appearing (but lacking a uterus and upper vagina), sterile female with XY chromosomes and internal testicles. Brain Gender Dr. Simon LeVay, in his book, "The Sexual Brain," argues that one's brain receptors for hormones may also play a significant role in our gender development. Dr. LeVay writes, "There is much to recommend...that there are intrinsic, genetically determined differences in the brain's hormone receptors. This would provide a mechanism that involves hormone-induced brain differentiation (along gender lines) but does not require there to be differences in the actual levels of hormones, and there is opportunity for selective effects on different brain systems." At all times keep in mind that Physical Gender does not always indicate "Brain Gender," while most physical male and female infants have Brain Gender matching their physical gender, a significant (but unknown) percentage do not. And in transgendered individuals, the Physical and Brain Gender are the opposite, and begin to express themselves at birth. Even a few hours after birth, significant behavioral differences are noted between morphologically "normal" boys and girls. Newborn girls are much more sensitive to touch and sound than their male counterparts. Several day old girls spend about twice as long looking back at an adult face than boys, and even longer if the adult is speaking. A girl can distinguish between the cries of another infant from other extraneous noises long before a boy. Even before they can understand language, girls do better at identifying the emotional context of speech. Conversely, during the first few weeks of infant life, boys are inattentive to the presence of an adult, whether speaking to the infant or not. However, baby boys tend to show more activity and wakefulness. At the age of several months, girls can usually distinguish between the faces of strangers and people they know—boys usually do not demonstrate this ability. As infants grow into children, the differences seem to intensify and polarize. Girls learn to speak earlier than boys and do a better job of it. Boys want to explore areas, spaces and things, girls like to talk and listen. Boys like vigorous play in a large space where girls like more sedentary games in smaller spaces. Boys like to build, take things apart, explore mechanical aspects of things and are interested in other children only for their "use" (playmates, teammates, allies, etc.). Girls see others more as individuals—and will likely exclude a person because they're "not nice," and will more readily include younger children and remember each other's names. Girls play games involving home, friendship, and emotions. Boys like rough, competitive games full of "'zap, pow' and villainy." Boys will measure success by active interference with other players, preferring games where winning and losing is clearly defined. In contrast, girl play involves taking turns, cooperation and indirect competition. Tag is a typical boy's game, hopscotch is a girl's game. As we grow into adults, these differences become both more subtle and entrenched. Female brained individuals are naturally socialized, tend to prefer cooperation, group discussions and compromise, but are rigid rule followers. Male brained individuals need to be forced into a social conscience, see everything as winning or losing, and are very territorial (my idea, my place, my person, etc.). Competitive and keenly aware of their place in the pecking order, males view rules as something to avoid, ignore or use against others. (The legal profession is very male.) Female brained individuals are very aware of emotional states, both in themselves and others, and have a gift for, and need to express themselves in language. These two needs/abilities combine so that there is a great deal of discussion and description of everyday things (food, experiences, involvements and other people) with an emotional context and value judgment. Male brained individuals have great difficulty identifying emotional states of any kind beyond anger, fear and lust, either in themselves or others. Language tends to be restricted and used sparingly, and hardly ever to describe emotional states. But male brains do have superior spatial and non-verbal skills, such as mathematics, map reading, 3-D conceptions, and with increasing intelligence, abstractions. In fact, for reasons not understood (at least by this writer), gender differences seem to decrease as our IQ points increase. One study indicated that one-third of physical females in graduate school had brains wired more like a typical male brain. Transgendered folk tend to be born with a female brain gender, but shortly after eight years of age begin to forsake it for a makeshift male brain type of response. It is like abandoning a four-lane highway and taking a little dirt road beside it -- and making the best of their choice. Why do such a thing? To fit in. Around eight or nine years of age, the differences between male and female behavior become obvious. In order to fit in, the physical male with a female brain begins to mimic and then perfect (as much as they can) a male response, leaving their natural female self unexpressed or underdeveloped. Some transgendered physical males are very good at this subterfuge and produce a flawless macho male persona. Others are less successful, and some produce a "Swiss cheese" persona where glimpses or whole chunks of their natural female thinking showing through. But, no matter how efficient an individual is in hiding their natural gender from others, they will always be aware (at least at times and to some degree) of it themselves. The non-transgendered would typically be able to live with their female gendered brain (most writers, artists, actors), forming some sort of truce or overcompensation which even they would usually come to accept as being true. But, alas, the transgendered also have a female gendered Brain Sex and Identity. Brain Sex There appears to be a male and female pattern of psychosexual behavior. These are modes of behavior -- one male, one female which are laid down, like Brain Gender, in early life and seem to be independent of environment (how, where, and by whom we are raised) and can be independent of both Physical Gender and Brain Gender. Before I delve into what Brain Sex is, let me state what it is not -- it is not sexual orientation. While sexual orientation can be an attribute of Brain Sex, it is not a primary one. More on this later. What is Brain Sex? Brain Sex is the primary hard-wired patterns which dictates how we view and relate to others on a social, interpersonal and sexual level. Although, like Brain Gender, most physical females will have female Brain Sex and physical males, male Brain Sex. But, this is far from absolute, and in the case of transgendered folk, it is the reverse. A physical male transgendered person will have female Brain Sex as well as female Brain Gender. When referring to female and male brained individuals in this section, I will be referring to their Brain Sex regardless of the physical or Gender Brained states. Female brained individuals cannot and do not separate how they feel about a person (good, bad, nice, boring, etc.) and how they see them sexually. They must feel positive about a person as an individual in order to sexually desire them. Male brained individuals have a distant disconnect between feelings about a person as an individual and as a sex object. Males can easily, sometimes preferably, have sex with a person they don't know, don't like or even actively dislike. Love and sex are two different worlds for the male brained. These two worlds can come together, and for most this is preferred, but it is not necessary, and for some, not even desired. For female brained individuals, environmental factors are very important when it comes to sexual contact. Such things as lighting (candles, soft lighting), smells, sensual bedding, music and a "romantic" ambiance are important to erotic feelings and fantasies. Males can have sex anywhere, any time, any place with equal gusto. Sex in the bed, car or dark room with a stranger are all equivalent. While environmental concerns are low on the male totem pole of desires, sensual attitudes come very high. How their partner looks, feels, even smells, is very important. Males prefer their partner young (or with young features), smooth and "sexy." Looks and sensual components are much less important to the female brain, with social status and acceptance given greater weight. The importance given to the senses in males and their disconnect between romantic feeling and sex objects, help explain male interest in pornography and their ability to have sex to orgasm almost indiscriminately (sex dolls) and often counter to the stated attributes of a desired partner (sex in prison). While female brained individuals are highly influenced by what society expects or rejects in regard to their general and erotic behavior; males are often most influenced by what display value and "bragging rights" their behavior and partner possesses. As for sexual orientation, this is an attribute which I feel to be limited to male brained individuals. I know this is heresy and very socially incorrect in some circles. But, allow me to illustrate my point. While male brained persons are capable (at least while young) of having sex with almost anything (animal, vegetable, or mineral), they are from an early age romantically and sexually drawn to a specific physical type, male or female. No matter what their socially influenced sexual activity may be, or for how long, their basic attraction (even if denied) is not acted on, their orientation does not change. Female brained individuals, on the other hand, appear to be much more fluid and less physically restricted in their choice of sexual partners. Women routinely become romantically attached to each other, but physical expressions remain atypical for most. While periods of lesbian experimentation is not rare among women, for a straight male to become romantically involved with another male in mid-life without previous gay feelings unexpressed is all but unknown. Female brained persons are far more influenced by a person's personality and "niceness" than their body, and being great rule followers, they are highly influenced by what "society" expects of them. This society can be anything from the greater society to their neighborhood, family, friends, religious or social group. If a female brained individual meets an emotionally compatible woman in a socially accepting or nurturing environment, a romance can take place. A male might have sex, but never romance. Because transgendered physical males have female brain sex, they lack a hard-wired sexual orientation. Therefore, while some transgender women retain a "lesbian orientation," the majority, in spite of their behavior, feelings and expectations before transition, develop an attraction to males and desire a "normal" romantic and sexual relationship with a man. They follow the rules first as a physical male later as a physical woman. Gender Identity
The last of our five attributes, Gender Identity, is the last to be identified, and the least understood and researched. Gender identity is one's subjective sense of one's own sex. Like pain, it is unambiguously felt but one is unable to prove or display it to others. One's subjective gender is just as real and immalleable as one's physical gender but unfortunately not recognized in our culture. When one's Gender Identity does not match their Physical Gender, the individual is termed Gender Dysphoric. Like minority Sexual Orientation, Gender Dysphoria is not pathological, but a natural aberration occurring within the population, like blue eyes. As with minority sexual orientation, the percentage of the population having gender dysphoria is in dispute, with estimates ranging between one in 39,000 individuals up to three percent of the general population. My experience leads me to feel that the higher figure (3%) is closer to the actual prevalence. Physically male gender dysphoric individuals have been described, either by themselves or by others, as falling into three distinct groups: crossdressers, transgenderists and transsexuals. While these categories are the generally accepted classifications both within the gender community and among helping professionals, during my work with gender folk I have come to the belief that there is only one cause, one conflict, one condition — but there are many reactions and adjustments to it. I have gradually come to the conclusion that one's coming to terms with the conflict between one's knowledge of their true gender and one's need to be "normal" fosters the same conflict in all gender folk. Because a child's greatest desire is to be normal (like everybody else), the great majority of transgendered individuals create an artificial self which meets this goal. They are often so successful at this that they not only fool everyone else but themselves as well — at least part of the time, in some way. Once created, physically male gender folk live in their male role — a 3-D personality with its own goals, likes and dislikes, values, hobbies, etc. Although indistinguishable from the "real thing," it isn't themselves. It is an artificial creation for them to be able to fit in. This is achieved at the expense of denying, locking away, their natural female self. (See Brain Gender and Brain Sex.) Their desire to be "normal" has denied them their natural selves. But, as the nagging reality of the deception becomes harder and harder to suppress, one has to express their true gender somehow, in some way. For most, dressing is the obvious compromise. If one cannot be female, one can at least express femininity. But the more one expresses one's true self, the desire for more becomes greater. Some individuals continue expressing themselves more and more, others panic and purge only to start again later. One's gender identity classification (crossdresser, transgenderist, transsexual, etc.) is due to each individual's adjustment to first the conflict between one's natural gender and their need to be "normal," and later to the conflict between one's natural gender and their "male persona." There is no objective "best solution," only a subjective, personal best solution. After years or decades of living, working and building within their male persona, it is often too "expensive" to give up the life, perks, family, etc., one has built up—in order to go back to basics and have an emotionally 12 year old girl grow up—and live in a once male 40+ year old body. But no one is too old to transition. I have had many people in their 40's and 50's transition very successfully. I have even had some clients in their 60's and 70's. However far one is able to go toward dismantling the male persona and allowing their female subjective gender to develop, one generally seems to have the following three levels of transition: 1. Recognition that one's Brain Gender is different from one's Physical Gender —This first phase comprises the majority of transgendered persons (75 – 95%) and can take the form of seeing one's self as a "woman trapped in a man's body," a need to express one's "feminine side," etc. This stage is mainly concerned with physical/surface changes such as crossdressing, passing, makeup, wigs, etc. In this first part, many gender folk don't even venture from their own home in female attire or restrict their expression to undergarments (bra, panties) in public. They often have a juvenile (before age 15) and later, an adult phase. There is often years or decades between the two phases. This level is filled with confusion, conflict, guilt, panic, and purging. The so called "Primary Transsexual" is an individual who never constructs a male persona and therefore never accepts their male genitals or challenges their female Self Map/subjective gender. 2. Accepting one's True Self— This stage is much more varied than the first, and has less emotional turmoil. This is the stage where one begins to accept their female self in some way and to make lifestyle changes to accommodate this acceptance. One may only accept the need to appear female, still denying their female true self (crossdresser) or begin to accept their true female self, but concentrating on a superficial physical level of change (transsexual, transgendered). The self-identified crossdresser may begin to bring his significant other into his dressing, begin going to crossdresser meetings and events, or even going out into public. Those individuals more accepting of their true self will start to look for help in physical transitioning, such as hormones, electrolysis, and surgery, as well as wigs, makeup and clothes. The major insight lacking at this stage is that they are still under the control of the male persona with all of its unnatural fears, drives, expectations, and knowledge. Even their view of their "female self" is his view, not their freed and autonomous female self. They are still trapped in the belief that physical form alone determines gender. 3. Becoming one's True Self — This is the last but unfortunately least experienced part of transitioning. This is the stage when that little girl trapped inside an artificial male persona in order to fit in, breaks free, grows up and has her own life — often with markedly different values, temperament and interests. It has been my observation that the female self needs little help in growing up and developing if the overpowering weight of the male persona is removed from it. The transgender individual has spent years, decades developing, reinforcing and living in their male role. Dismantling the male persona takes a great deal of time, effort and outside help. But, an individual's sense of happiness and success is directly parallel with the degree they have dismantled their male identity, not on their age, physical size, hormones, surgery, etc.

Gender Expressions By Carl W. Bushong

2008-01-19T08:28:00.002-08:00

During my years of work and study with gender folk, I have consistently been surprised and amazed at both the depth and breath of change that has occurred during transition. And when I say transition, I am not just speaking of individuals described (either by oneself or by others) as “transsexuals,” but also “crossdressers,” “transvestites,” “transgendered people,” etc.
As I discussed in my article, What is Gender and Who is Transgendered, one’s Gender Identity is only one of our five semi-independent aspects of gender (Genetic, Physical, Brain Gender, Brain Sex and Gender Identity). One’s Gender Identity is established early in childhood and is our Self Map. Gender identity is one's subjective sense of one's own sex. Like pain, it is unambiguously felt but one is unable to prove or display it to others. One's subjective gender is just as real and more immalleable than one's physical gender but unfortunately not recognized in our culture. This internal map forms how we see ourselves as a sexual individual (our affiliation to a gender), just as Brain Sex is our Love Map—how we identify our love/sex partner.
When our gender Self Map does not match our Physical Gender (genitals), along with our society providing no niche or role (although most other societies do) for this varied gender expression, a conflict usually develops. Although gender folk’s combination of the five gender factors is just as natural as any other, it is not perceived as “normal” (what you are supposed to be or do) in our society.
Because a child’s greatest desire is to be normal (like everybody else), they create an artificial self which meets this goal. They are often so successful at this that they not only fool everyone else but themselves as well — at least part of the time, in some way.
I have gradually come to the conclusion that for most physically male gender folk, the male persona is an artificial construction produced by the early adolescent individual (ages 12 to 15) in order to fit in and be like everybody else. For the physically female person, there is a separate and different, but still consistent pattern, which I will address in a separate writing.
Once created, physically male gender folk live in this role — a 3-D personality with its own goals, likes and dislikes, values, hobbies, etc. Although indistinguishable from the “real thing,” it isn’t themselves. It is an artificial creation for them to be able to fit in. But, as the nagging reality of the deception becomes harder and harder to suppress, one has to express their true self somehow, in some way.
For most, dressing is the obvious compromise. If one cannot be female, one can at least express femininity. But the more one expresses one’s true self, the desire for more becomes greater. Some individuals continue expressing themselves more and more, others panic and purge only to start again later.
One's transgender classification (crossdresser, transgenderist, transsexual, etc.) is due to how each individual adjusts to first, the conflict between their natural female subjective gender (Self-map) and their need to be “normal,” and later to how and how much they resolve the conflict between their female subjective gender and their “male persona.” There is no objective “best solution,” only a subjective, personal best solution, which may change over time.
After years or decades of living, working and building within their male persona, it is often too “expensive” to give up the life, perks, family, etc., one has built up—in order to go back to basics and have an emotionally 12 year old girl grow up—and live in a once male 40+ year old body.
Therefore, while all gender folk need to transition, not all need to use hormones, let alone surgery. The only person who truly knows where and how far to go is the transgendered person, themselves. But even they cannot do it alone. When one has spent decades fooling everyone, including oneself, it is difficult to tell what is true and what is smoke and mirrors. As we need a reflection to see our own face, we need a knowledgeable, experienced helper to see our true self.
How does one find such a helper? —With great difficulty, I’m afraid. In my opinion, a psychotherapist’s role is to be a helper, a teacher, and a guide. To help the transgendered with those areas and conflicts resulting from a lifetime of living a double life, one inside or hidden from others, one out in public. The therapist needs to be a teacher in making available all the accumulated knowledge, skills and choices one has as well as clearing away the myths, lies and misinformation. And as a guide, the therapist aids the client through the social, legal, medical and emotional mine fields toward one’s true self. Here are some must have’s you will need to find in your helper.
1. Is your helper knowledgeable and up-to-date about transgender needs and problems?2. Has your helper previously helped at least two other people transition successfully before you?3. Is your helper knowledgeable about electrolysis, hormones, surgery, transgender law, etc., to guide you through your transition?4. Does your helper know and understand the difference between transitioning and psychotherapy.5. Last but not least, does your helper have a working relationship with other knowing, experienced and successful practitioners such as electrologists, endocrinologists, surgeons, attorneys, etc.
While gender folk have problems and need psychotherapy, and marriage and family counseling like any other group, transitioning, itself, is not psychotherapy. Transitioning is being given the tools and knowledge to ask the questions whose answers set them free. The old artificial male persona falls away piece by piece, revealing underneath a brand new self. The new self may be female or just more feminine. Whatever transitioned people may appear to others, to themselves they are happy, and sometimes for the first time, whole individuals.
I am pleased to say that those who have stayed to complete their transition with me have all become both happy people and very happy with their decision to transition. Never have I had so many people use the word “giddy” to describe themselves and their new life.
However far one is able to go toward dismantling the male persona and allowing their naturally female subjective gender to develop, one generally seems to have the following three levels of transition:
1. Recognition that one's Brain Gender is different from one's Physical Gender —This first phase comprises the majority of transgendered persons (75 – 95%) and can take the form of seeing one's self as a "woman trapped in a man's body," a need to express one's "feminine side," etc. This stage is mainly concerned with physical/surface changes such as crossdressing, passing, makeup, wigs, etc. In this first part, many gender folk don't even venture from their own home in female attire or restrict their expression to undergarments (bra, panties) in public. They often have a juvenile (before age 15) and later, an adult phase. There is often years or decades between the two phases. This level is filled with confusion, conflict, guilt, panic, and purging. The so called "Primary Transsexual" is an individual who never constructs a male persona and therefore never accepts their male genitals or challenges their female Self Map/subjective gender.
2. Accepting one's True Self— This stage is much more varied than the first, and has less emotional turmoil. This is the stage where one begins to accept their female self in some way and to make lifestyle changes to accommodate this acceptance. One may only accept the need to appear female, still denying their female true self (crossdresser) or begin to accept their true female self, but concentrating on a superficial physical level of change (transsexual, transgendered).
The self-identified crossdresser may begin to bring his significant other into his dressing, begin going to crossdresser meetings and events, or even going out into public. Those individuals more accepting of their true self will start to look for help in physical transitioning, such as hormones, electrolysis, and surgery, as well as wigs, makeup and clothes.
The major insight lacking at this stage is that they are still under the control of the male persona with all of its unnatural fears, drives, expectations, and knowledge. Even their view of their "female self" is his view, not their freed and autonomous female self. They are still trapped in the belief that physical form alone determines gender.
3. Becoming one's True Self — This is the last but unfortunately least experienced part of transitioning. This is the stage when that little girl trapped inside an artificial male persona in order to fit in, breaks free, grows up and has her own life — often with markedly different values, temperament and interests.
It has been my observation that the female subjective self needs little help in growing up and developing if the overpowering weight of the male persona is removed from it. The individual has spent years, decades developing, reinforcing and living in this male role. Dismantling the male persona takes a great deal of time, effort and outside help. In those individuals identified as "transsexual," their subjective sense of happiness and success is directly parallel with the degree they have dismantled their male identity, not on their age, physical size, hormones, surgery, etc. Another interesting aspect of a female subjective gender with a male physical gender is the concept of Sexual Orientation. To classify a M/F individual as either homosexual or heterosexual would be equally false. If one views their gender as that established by their subjective gender, then having sex with a physical/ subjective female would make them homosexual (lesbian). But, if one viewed their actions from their physical gender, they would be committing a heterosexual act. In other words, no matter which gender they have sexual relations with, they are simultaneously committing both a homosexual and heterosexual act. (See What is Gender and Who is Transgendered for details.)
Informed Choice
My method for transitioning I term “Informed Decision Making.” In this, the client makes their own decision to go down whichever road they choose and how far, upon being given the information and insight needed to do so. I find most gender folk focus on their dress and body at first not realizing that the whole persona changes during successful transitioning. This is why physical transitioning (clothes, makeup, hormones, surgery) is only a minor part of the whole transition process. Values, lifelong hobbies, musical tastes, temperament, and goals, can and often do change. The new self which emerges from under the male personality often grows into a person no closer to the male persona than a sister. It is often a rebirth in slow motion (it takes one to two+ years). One becomes their true natural self, which is far greater than just a change in physical gender.
But, while transitioning offers great promise, there are also great dangers if one does not use care in choosing who they listen to and ask for help. All too often individuals in transition, or for that matter, those who feel they have arrived, become a collection of disparate traits and cosmetic changes instead of a complete package. Naturally, some individuals are stubborn and refuse to accept any guidance and support. But the real culprits that hold many from achieving their best are often the treating professionals themselves.
Many times providers remain ill informed about transgender issues or worse, remain uncaring and expect the transgendered client to fend for oneself. They never aid or foster an informed consumer’s mind-set. Who’s best interest is served when a provider is often unprepared to provide the client with the broad based understanding needed to make the proper choices?
If an individual happens upon “professionals” who offer no guidance or sense of priority while making available hormones or surgery with little or no life-style preparation — a disaster may be in store. The individual’s future happiness is threatened when the outcome of such “professional” intervention may be a bearded, baritone post-op lady with large breast implants but little or no training or understanding of how to walk, talk, or sit, let alone a strong sense of “female-self.”
In an area such as gender, where myth and ignorance often exceed knowledge within the professional community, it is only expected that the lay persons in need should be confused, frustrated, and uninformed. The transgendered often begin life feeling as if they are the only person in the world to have such a problem; that something is wrong with them - and not just in society’s view. When at last they try to be themselves, to throw off sometimes decades of deception, frustration and denial, they are often both fearful and resentful. So much of their life is felt to be “lost,” and naturally there is an eagerness to get on with their “new self,” right now! Unfortunately, many gender folk have collected a lot of “excess baggage” in the form of a marriage, family, children, and educational/professional development that doesn’t properly translate to one’s desired gender status. And just like society as a whole, the transgendered individual may focus far too much on the physical aspects of gender, down-playing or even missing the mental, behavioral, social and emotional aspects. Their male persona is not realized or appreciated, let alone its need to be dismantled.
When it comes to gender, our culture is genitally obsessed. What’s between your legs and on your chest determines your gender (sex). Body form and plumbing are all our society sees and therefore all the transgendered person may be aware. Actually, most conventional wisdom regarding sex and gender is incorrect. (See What is Gender and Who is Transgendered for details.)
The most important service a professional can provide for the transgendered individual is to provide the knowledge, support and resources needed for a series of “informed choices” as to what, how and where their transformation will take them.
Today quality gender based services are becoming increasingly available, although they are still geographically spotty. While some regions of the country are very “gender knowledgeable,” others are not so gifted. Even in areas with minimal professional services available, the dynamism that a conscientious and self-aware gender support group can provide is tremendous. But sometimes support groups and Internet “chat rooms” can be counterproductive, if the blind are leading the blind. All too often those with the least knowledge and most misinformation are the most eager to share their “insights”—not as an opinion, but as “fact.” When a transgendered individual who is new to the community comes across these self-appointed experts, they are often swayed by this mis- and dysinformation. Even with the gender community’s growing size, knowledge base and opportunities, groups of individuals suffering from the consequences of misinformation and the quick-fix mentality are living in a small world of their own—still trying to influence others along the same ill-fated path. Group knowledge, resources, and a desire for personal growth are essential. While the transgendered now can take a long overdue control of their destiny, one should keep in mind that success is heightened by “informed choice,” not just choice.
Counseling, though, need not be weekly. In fact, very few of my clients receive weekly sessions after the first few months. Of course, the more intensive the effort, the quicker one will reach their goal. But counseling more than once a week doesn’t seem to help — unless there is more than one problem being worked on, such as transitioning plus marriage problems.
For example, let’s say Mary (who was Bob) has recently come to accept she is transgendered, and has a wife, Betty, who she cares for, and three children ages seven, nine, and twelve. Mary is a successful engineer at a large company making a very good wage. Her wife does not work outside the home.
Mary has several problems to solve. One — what does “transgendered” mean to her? Two — how does she now relate to her wife who is fearful and upset? Three — how, when and what to tell the children? Four — what should she do about work, friends, family, etc.?
The first problem is part of transitioning and by far the most important. As Mary answers, “What does being transgendered mean to me?,” the solution to her other questions will become clearer and clearer. But at some point, as Mary gets to know and accept herself more, she and Betty will probably benefit from couple/marriage counseling as there are many issues between them they need to resolve.
Because a person’s core personality often changes greatly during transition, making too many decisions too soon is a mistake. At the beginning of transition, Bob’s values, goals and baggage (personal responsibilities, etc.) are still in charge — at this stage Mary is only a gleam in Bob’s eye. It takes time to tear down the walls and fill in the gaps. As Mary is learning and growing, Betty needs to be brought along too — at least as far as she is willing or capable of going. Remember, this a very trying time for the spouse as well as the transgendered person. The partner’s whole life is being turned upside down and she has no control over it. The partner often feels betrayed, angry and frustrated. Betty can even see Mary as her enemy, her competition. But, the more and the sooner a knowing, experienced professional is brought into the picture, the easier it is for both parties, and the better the outcome for everyone. Betty’s willing cooperation is needed for best dealing with the children, family, and future living arrangements.
With Betty brought into the process, as Mary’s transformation continues they can decide as a couple what their relationship and living conditions will be. Not always, happily, but truthfully with everyone’s needs acknowledged and discussed.
If Mary realizes she must transition fully into a female body and role, they are now positioned to deal with this together including the telling of children, family and friends. Often a completely new job description is called for upon transition — sometimes because of the difference in Bob’s and Mary’s personality and values, and other times because a woman is not as accepted or respected in the old employment. And, of course, sometimes the prejudice of the employer leads to a loss of job. But, I have found that prejudice is the least common reason for job change if the transition is done correctly on all levels — emotional and psychological as well as physical. In fact, over the last few years, I have experienced very few negative reactions from employers, family and friends towards my transitioning gender clients. So few that I have began to feel that most negative reactions stem from gender folks not being given good help during transition rather than the transition itself. The exceptions to this rule are often spouses and best friends, because in both cases, the very basis of the relationship are often threatened by transitioning.
There is a global need for all gender folk, whether CD, TV, TS or TG to transition, although the road taken and the distance traveled may vary greatly from individual to individual. Transitioning is much more than a physical/superficial journey. And transitioning in itself is not psychotherapy but a rebirth of an individual long buried under the layers of society’s imposed expectations. Like all births, it can be long, difficult, very painful and full of doubts at times. But who can deny the joy and expectation of a new life, a new beginning, even if the death of the old is needed to give room for the birth of the new

A Source Of Happiness By Eugene A. Schrang

2008-01-19T08:24:00.002-08:00

Of all the afflictions humankind must endure, Gender Dysphoria must certainly be one of the most unusual and distressing, and not because it produces great morbidity or mortality, but because the accompanying emotional conflicts can engender much unhappiness for the patient and her family with possible later problems involving her social activities and associations with colleagues at work. The etiology of this condition is obscure but we are quite certain that the problem occurs in utero and is therefore Congenital in nature and not Genetic, that is, it is not something that is passed from generation to generation. Management and treatment are difficult since the mind’s gender is immutable. We cannot change a person’s gender no matter what we do; historically we know of no case where a mind changed spontaneously from Male to Female or vice versa. Compounding the problem are the varying degrees of severity which, from a practical point of view, simply means that Sex Reassignment Surgery is not for everyone. SRS is only for those individuals who have been diagnosed as transsexual, who have been properly screened and evaluated and who have fulfilled the basic requirements for the operation. A most important additional requirement is that burning desire - that great emotional strength to stay the course and proceed toward the final goal in spite of the many negative expressions another people. Without this deep motivation, a difficult and frustrating journey can easily become an impossible one. It is well known that there are various methods of doing the transformation procedure as well as a variety of techniques involved with each one depending on the operating surgeon’s preferences and capabilities. Personally, I have always felt that, no matter what I am doing, the simplest method of doing things is usually the most beneficial and productive. I have never been’ impressed with complicated and unnecessarily involved operations. The less one does to accomplish the task, the better the final result, and so I have worked hard to make the SRS procedure as simple as possible. The inversion technique, which is essentially what I do, is an excellent operation and the final result is hard to surpass. In terms of ease of performance, lack of complications and patient satisfaction, penile inversion is the method of choice for most Male to Female transsexuals. Use of the Sigmoid Colon has been advocated and performed successfully by capable men, however, in my opinion the results do not justify the extensive surgery which involves another organ system and can result in such voluminous mucous flow that Kotex pads must be used almost continuously. I have three objectives: First to bring to bear every Plastic Surgical technique which will result in a vulva which rivals the appearance of the genetic female. Unfortunately, this cannot be done with one operation since the blood supply to the area would be severely compromised. Thus, a Labiaplasty to enhance the femininity of the Perineum is done no sooner than three months after SRS in patients who desire it. On the other hand many individuals find the shape and form of the area is so pleasing that they accept it without having more surgery. During the Labiaplasty, the superior portions of the Labia Majora are brought together over the previously created clitoris utilizing a double Z-Plasty with an attempt being made to form a hood over the clitoris. If the patient feels her clitoris is too large, it can easily be revised smaller at this time. Because the clitoris is made from the same tissue as the urethra, there is an opening “connection” if you will - between the top of the urethral opening and the bottom of the neo-clitoral opening. It is this fistula that I open as part of the Labiaplasty which results in an area of very feminine looking mucous membrane rather than skin between the urethra and clitoris. Lastly, any other revision of the vulva such as reshaping the labia can be done along with ancillary operations of the face and breast. Second, and most importantly, I want my patients to experience comfortable, effortless, trouble-free sexual intercourse. This can be accomplished only if the dimensions of the neo-vagina are adequate. If the neo-vagina is short or has strictures and stenosis making penetration uncomfortable, the operation was not successful. A number of surgical principles must be carefully adhered to if we wish the final result of the neo-vaginal construction to be one of adequate depth and accommodating size with no contractures. Obviously, the operating surgeon must make the neo-vagina sufficiently deep to satisfy the requirements for normal intercourse. The dissection is carried out within the very narrow confines between the Rectum and Prostate gland as far posteriorly as Denonvilliers’ Fascia which is virtually as far back as the intra-abdominal cavity. If this dissection is inadequate, the depth of the neo-vagina will be compromised; also, enough Levator Ani muscle must be divided for ample diameter. Assuming that all dimensions of the neo-vagina are satisfactory, the opening must now be lined with epithelium - but remember that a seven inch deep neo-vagina cannot be lined with a three inch penis and also keep in mind that it takes two inches of penile skin just to reach the opening of the neo-vagina. Obviously, if the penis is short with little skin to contribute to the job of lining the entire shaft, additional epithelium must be obtained utilizing a skin graft which is best obtained from the lower abdomen between the umbilicus and the pubic hair. Experience tells us that this is a better donor site area than the buttocks or thighs because from here the best quality grafts arc obtained, it is easier to hide the donor site scar and the grafts can be removed with greater facility than from anywhere else. Obviously, if a patient is not at all interested in future intimate relations, no graft is necessary and we simply accept whatever depth we can get which in some cases is virtually nothing. If all this great effort is expended to create a functioning vagina but the patient does not experience warmth, excitement and orgasmic feeling in the operated area, I do not believe that we have achieved all that we could from the procedure; it is this sense of sexual fulfillment that is my third objective. The mind is truly the most important sexual organ but without proper nerve and blood supply to the reconstructed site, no amount of stimulation will arouse an area devoid of nerve supply. For this reason I make every effort to preserve all possible nerve tissue. The nerve of sex is the External Pudendal Nerve which caves the lower spinal cord and eventually passes through Alcock’s Canal where it branches out to supply the entire genital and peri-anal areas. By making sure that this nerve’s integrity is maintained and as many branches of the nerve are kept intact as possible, we can feel quite certain that the equipment necessary for orgasm is present and will function to the patient’s satisfaction. This brings us to the basic surgical principle which dictates that as much tissue as possible be preserved. The longer I do surgery - surgery of any kind - the less tissue I am inclined to sacrifice. At one time I removed most all of the Corpora cavernosa; this I no longer do because I have found that by saving enough Corpora to construct the neo-clitoris, we produce yet another source of pleasurable sensations. During sexual arousal, all erectile tissue in the genital area becomes engorged with blood, and it is this engorgement which causes some of the intense excitement experienced during intercourse. For this reason I construct the clitoris from the Corpora cavernosa rather than utilizing - as some surgeons have proposed - a small part of the glans penis, either as a skin graft or as an island Rap, preserved on a long neuro-vascular pedicle which usually does not survive anyway. I believe that the entire intact head of the penis serves a better function inside of the neo-vagina. At the conclusion of the operation, if all has gone technically well, we should have two - possibly three - potential sources of orgasmic sensation: the intravaginally positioned head of the penis, the Crus of the Corpora cavernosa on either side of the urethra and the clitoris constructed from the penile Corpora cavernosa and Corpus spongiosum. So, to excel in the areas of aesthetics, function and pleasure is my surgical goal for the Transsexual patient. As the operation has developed in my hands, I have observed with great satisfaction the ability to routinely reproduce these objectives. Of course it is impossible to attain the same degree of success in everyone but only in those individuals who have anatomical, physiological (such as Diabetes) or psychological problems do we fail to realize the full potential of the procedure. Also to be considered are the expectations of the patient - in those whose expectations arc so high that they are unattainable, the outcome, as far as the patient is concerned, will be disappointing. My suggestion to anyone contemplating surgery of any kind would be to keep your expectations within reason - only then will you most likely find that your surgeon could do more for you than you ever thought possible. Do things always go well? No, this world is too imperfect for that. Problems and complications do occur from time to time but fortunately not very often. Genetic males who take female hormones do run the risk of forming thrombotic emboli which could be fatal. By discontinuing the use of hormones three weeks prior to surgery and by assisting blood flow in the lower extremities with intermittent pressure stockings during the bed rest period after surgery, the likelihood of this dreaded eventuality is greatly reduced. The most feared intra-operative complication is, of course, the inadvertent entry into the Rectum while dissecting the neo-vagina. This could result in a Recto-vaginal fistula necessitating a colostomy with an eventual attempt made to repair the damage that was done. Should this happen, the neo-vagina is invariably lost to scar. Severe postoperative bleeding requiring blood transfusions or Gastro-intestinal ileus calling for the use of a naso-gastric tube to remove air from the stomach may occasionally be seen which requires our immediate attention. And certainly, less significant problems can arise to bedevil us. As healing progresses, contractures of the neo-vagina can occur and are usually due to lack of diligent neo-vaginal dilation the part of the patient. It is difficult to understand why anyone would neglect to dilate on a regular basis when it is so vital to the outcome of their surgery, especially after they have come so far, but it does happen. Substandard craftsmanship can result in a less than ideal cosmetic and functional outcome. I have examined and re-operated patients done elsewhere who have had objectionable swelling in the neo-urethral area from retained Bulbospongiosus and Ischiocavernosus muscles which should have been removed. Once this excessive muscle is excised, the area becomes comfortable with improvement in appearance as well. This retained muscle can also affect the urethra’s normal function. Patients will complain of the “sprinkling can’t effect which, incidentally, can also be caused by scar that is present around the neo-urethral orifice; scar and urethral deformity occur because the opening was not sutured properly to begin with. Great care must be utilized when suturing the urethral mucosa to the neourethral opening because it must be sutured internally - not externally. Attention to detail can make the difference between a superb result or one which will make a patient unhappy for the rest of her life. The future for SRS is exciting. I see on the horizon a great deal of evolution and development - improvements in technique and the way the operations are done; for example, a great step forward will be a method to line the neo-vagina without the necessity for a skin graft. Clever and talented surgeons will come upon the scene and they will make sensational things happen. The sources for genuine human happiness are many and diverse - it is my sincere hope that SRS in my hands has been, and will continue to be, a source of happiness for all who come to me as patients; and as far as l am concerned personally, the development of the SRS procedure is a never ending search for excellence which has been both an adventure and a great source of satisfaction.

Why do people have labiaplasty?

2008-01-19T06:09:00.000-08:00

While there are some medical conditions that require labiaplasty, the majority of advertisements for labiaplasty are based on cosmetic and aesthetic considerations; with surgeons encouraging people to consider the procedure just to “look and feel better”.
Unfortunately there are no reliable studies that have examined what, if any, impact labia size actually has on sexual functioning and pleasure (some surveys have been done, but always funded by for profit companies with a financial interest in the topic). There is also no agreement on what “normal” size labia are.

What this means is that most of what we know about labiaplasty comes from the people who are making a lot of money offering the procedure. These people report that women elect to have labiaplasty due to reasons which include: self-consciousness about the way ones labia look (to long, too thick); inability to enjoy sex because of self-consciousness; belief that ones genitalia are ugly or wrong; complaints that labia cause physical discomfort.
How many people have labiaplasty?The American Society of Plastic Surgeons, which maintains statistics of plastic surgery procedures performed by their members has only recently started collecting data about cosmetic vaginal surgeries. They don’t break the figures down but in 2005 they reported 793 procedures listed as “vaginal rejuvenation” and in 2006 the number rose to 1030. Those numbers are relatively small (0.08% of all cosmetic procedures), but the surgery is the third fastest growing procedure from 2005 to 2006, showing a 30% increase in that time.
Will labiaplasty improve my sex life?There is absolutely no evidence that labiaplasty will have a positive impact on your sex life, and there are some reasons to suspect that it could have a negative impact. Despite glowing testimonials printed on the websites of plastic surgeons, there are practically no long or short term studies on this question. While surgeons claim that labiaplasty will improve self-confidence and self-assurance there is no proof of this, and no proof that this will result in “better” sex.
But it is completely possible that you will be as unhappy with your surgically altered labia as you are with your current labia. It’s also possible that any complaints you have about your sex life are related to something more complicated than the size of your labia. There are lots of reasons to avoid unnecessary genital surgery (I mean the phrase along should be enough to do it), and despite the claims to the contrary, there is no proof that such surgery will improve your sex life.
Are there dangers associated with labiaplasty?Aside from some discomfort immediately following surgery reports suggest that most women do not experience pain or swelling two to four weeks following the surgery, indicating that the procedure itself doesn’t seem to carry serious dangers.
Of the few peer-reviewed articles that report on outcome of labiaplasty the largest one (with one hundred and sixty three patients) reported “no significant complications”, but twenty percent of patients felt the doctor did not adequately explain the procedure and the results, and seventeen percent were not satisfied with the result. Another smaller study found that twenty three percent of patients had complications following surgery. In another article exploring the ethical implications of labiaplasty a gynecologist who has performed the procedure reported seeing a patient who had persistent vulvar pain as a direct result of labiaplasty that took almost a year to treat successfully.
Of additional concern are the possible effects on sexual functioning in the long term. Research in the past ten years has completely changed the way we understand female genital anatomy, specifically the clitoris, which we now know is not just a surface organ but one that extends deep into the body. Any cutting therefore raises the possibility of scar tissue and the reality of nerves killed in the process. There is no research on the long term impact of labiaplasty so claims that these procedures have no negative impact beyond six weeks after your surgery are premature.
How much does labiaplasty cost?Quotes for labiaplasty on line range from $3000-$5,500. Unless you are having the procedure for a diagnosable medical condition its unlikely that it would be covered by any insurance. This is probably why so many of the websites advertising labiaplasty have financing and payment plan options available.

MAKING SURGERY MORE INTIMATE WITH VAGINAL RECONSTRUCTION

2008-01-17T12:32:00.000-08:00

You’ve heard of people requesting Sharon Stone’s nose and Pam Anderson’s breasts? Well, now many women are now taking copies of Playboy to their plastic surgeons, saying: ‘I want one like that.’ Why the recent demand, you may ask, for perfection in the most intimate of areas? The reasons are as varied as the women who ask for the procedures. Desiring higher levels of sexual gratification, a more aesthetically pleasing look, the ability to exercise without discomfort and the ability to wear all kinds of clothing are the most common reasons.

The most common procedures, the vaginoplasty (large vagina surgery) and labiaplasty, have been around for decades, but have more recently come into prominence as elective surgeries. Dr. Ronald Blatt, Medical Director of The Center for Vaginal Surgery in Manhattan, is a Board Certified OB/GYN who reconstructs the "optimum structural architecture" of the vagina for the most aesthetically pleasing and comfortable result.

Vaginoplasty is a surgical procedure that involves the tightening of vaginal muscles and support tissues as well as the reduction of redundant vaginal mucosa (relaxed vaginal lining). Childbirth, trauma and even simply aging may cause the vagina to become stretched and the surrounding muscles lose their strength and tone. This loose feeling that many women feel is often noticed not only by them, but by their partners during sexual intercourse. “Vaginoplasty decreases the diameter of the vagina, which results in increased friction during intercourse. After surgeries, women and their partners often report increased levels of sexual gratification,” says Dr. Blatt.

The surgery is a standard gynecologic vaginal procedure where the vaginal vault and pelvic floor are made tighter and the foundation muscles of the vagina are made stronger. The G-spot which lies in the anterior proximal vagina is not affected by this procedure Labiaplasty refers to the trimming of labia minora, more commonly known as the lips of the vagina. Having enlarged, or irregular labia minora may adversely affect the quality of life for patients, resulting in lowered self-confidence, discomfort with wearing clothing, exercising, or having sex.

The enlarged labia can have a protuberant and abnormal appearance that can be bothersome and distressful. More specifically the unsightly appearance of excessive skin can cause psychological damage and may decrease the sexual desire in both partners. Women who have this excessive skin are often so embarrassed by it that it may take years before they discuss it with a friend and even longer before they seek correction of the problem.

If you have these problems, they can be remedied! Each procedure takes approximately 60-90 minutes to perform. An additional hour is spent in Dr. Blatt’s recovery room under the supervision of a Registered Nurse. Dr. Blatt recommends general anesthesia for his patients so they will not feel any pain during the surgery. Patients can, however, expect to have discomfort at the surgical site for the first few days after the procedure.

This discomfort is greatly reduced by pain medication and antibiotics that Dr. Blatt prescribes. Full healing and a return to normal sexual activity takes approximately six weeks. All sutures used are absorbable and therefore do not need to be removed. Insurance usually does not cover these surgeries because they are considered elective. The end result of these procedures may not only be a more youthful appearance, improved sensation and a more comfortable and confident sex life, but an overall improvement in the quality of life.

PART TWO: GENITAL LANDSCAPING, LABIA REMODELLING AND VESTAL

2008-01-14T00:57:00.000-08:00

Vaginal relaxation can indeed be a medical problem, says Dr. Linda Brubaker, chief of uro gynecology and reconstructive pelvic surgery at Rush Medical College in Chicago.''I see a number of women with pelvic- oor problems who have satisfying sex lives," she says. ''Prolapse (the bladder and or uterus dropping into the vaginal canal) may need to be treated surgically, but to claim that sexual enhancement occurs is scienti cally unproven." She feels that peer review and scienti c documentation are necessary to validate Matlock's claims, and that if this is
such a major breakthrough for women, he should be sharing it with his fellow gynecologists in published articles. Designer vaginoplasty, and another of Matlock's services-hymen reconstruction- are considered elective surgeries. Only if there is a functional problem like prolapse or stress urinary incontinence will a patient be covered by insurance for the surgery, which costs between $4,000 and $8,000. In Matlock's office on a recent day is a 56-year-old Filipina whose English is not strong. She is here because of the eye-catching ads she has seen. Matlock's ads-featuring a luscious young thing in a bikini who looks like she's in the throes of orgasm- appear frequently in local papers. The older woman has checked o on Matlock's brochure problems she wants corrected-stress urinary incontinence and labia minora she feels are too big. ''I have no problem with sexual grati cation," she laughs shyly. Matlock explains
the surgical procedures, pointing to a plastic diagram of the female organs. He repeatedly rolls out his catch phrases, like ''laser vaginal rejuvenation for the enhancement of sexual grati cation" and ''designer laser vaginoplasty."
After a brief exam by the doctor, the woman returns to the consulting room. ''Your labia aren't too bad," he says. ''We can reduce those if you like." He recommends an operation called an anterior colporrhaphy to restore the bladder to its normal position and ease her incontinence. ''This procedure is 94, 95, 96 percent e ective in correcting the problem of stress urinary incontinence," he says. The surgery, done on an outpatient basis in the doctor's office, will take no more than an hour, but the patient must wear a catheter for four days afterward. Colporrhaphy is indeed standard for treating stress urinary incontinence, according to Brubaker. But she warns: ''Making the vagina tighter doesn't necessarily improve female sexual response. This surgery can produce scarring and painful intercourse"{an opinion shared by a prominent Westside urogynecological surgeon who prefers not be named in order to avoid a ''pissing contest" with Matlock.
Dr. Malcolm Lesavoy, a professor of plastic surgery at UCLA and chief of plastic surgery at Harbor-UCLA Medical Center, says adamantly, ''Vaginoplasty is for reconstruction, not for aesthetics." He cautions that there also can be a loss of sensation in the labia after such surgery, an opinion echoed by other plastic and reconstructive surgeons. Matlock minimizes the possibilities of scarring and pain. ''Scarring- you can't look at it as scarring per se," he says. -The body heals by scarring. If you look at this procedure, you can't see anything, there's a thin line. The vagina, the mucous membranes, heal so well. It heals by scars, it heals by retraction."
He insists that any scarring that occurs would in no way interfere with sexual enhancement or grati cation. Matlock claims to have performed 1,000 of these surgeries over the past decade
and says the proof of his work is in the happiness of his patients. Moreover, he claims, his surgeries (half of which were to enhance sexual grati cation) produced no complications from scarring or pain. -Everybody enjoys what has been done," he says.
Dr. Brubaker is incredulous. -If that's the case, he should de nitely present this for peer review. That's an amazing statistic for any surgeon." Her sentiments are echoed by others who are stunned at such assertions. -That's beating the odds," said one L.A. plastic surgeon.
Though his peers may not be reading about him in scienti c journals, Matlock is enjoying a lot of media attention. He cites an appearance on Howard Stern's radio show, an upcoming article in Marie Claire, and a mention in the L.A. Times business section. Later this year, women also will have a book from Dr. Matlock entitled ''What The Gynecologist Didn't Tell You." He's excited about the book's potential. ''Hopefully I can bring a lot of attention to these issues," he says. ''My colleagues are interested." Of course, the book won't be aimed at his colleagues in the American College of Obstetricians and Gynecologists, but at women who worry whether their labia are symmetrical{and if an hour in Matlock's hands could really enhance their sex lives.
And what do men think about the concept of tightening? To quote one 37-yearold single male publicist, ''I never met a pussy I didn't like." Though now, thanks to Dr. Matlock, he may be meeting more than a few that look alike.

PART ONE:GENITAL LANDSCAPING, LABIA REMODELLING AND VESTAL VAGINA: FEMALE GENITAL MUTILATION OR FEMALE GENITAL COSMETIC SURGERY?

2008-01-13T04:59:00.000-08:00

Dr. Tight
Hey, girls! A Beverly Hills gynecologist says he can juice up your sex life with some quick, below-the-belt surgery.But some medical experts have reservations.
Lisa Derrick
New Times Los Angeles Online \Dr. Tight".
04/30/1998
First it was hair color, with women being told that blondes have more fun. Then came breast implants, liposuction, collagen, and Gortex. But now women are informed that they should make some internal modi cations as well. And though they may not be what kind of changes Deepak Chopra has in mind, a Beverly Hills gynecologist says his one- hour laser procedure to resculpt and tighten the vagina will result in better sex. Dr. David Matlock is selling an operation normally used to relieve stress urinary incontinence{leakage of urine from the bladder during coughing, exercise, or sexual intercourse. But he's marketing the surgery as a way to enhance sexual gratification, a claim that has yet to be proven in clinical studies.
According to Matlock, ''sexual grati cation" doesn't necessarily equal orgasm.''Sexual grati cation is sexual pleasure," he says. Orgasm is just a part of that; it's the pinnacle of that." To the doctor, who cites Masters and Johnson repeatedly, sexual grati cation means an increase in ''frictional forces." That is achieved, he explains smoothly, by decreasing the diameter of the rst third of the vagina. To accomplish this, he makes incisions in the top and bottom of the vaginal canal using a laser, overlaps the muscle, stitches it in place with absorbable sutures, and removes excess surface tissue. ''I get patients that say they are not satis ed sexually, that they desire to have a more aesthetic appearance. They want to be tighter," he explains. Some patients, the husband and wife, come in together and say, We're not sexually satis ed."The woman has to come in here initially without anorgasmia (the inability to achieve orgasm)," Matlock continues. ''We don't want to deal with that; that's in the realm of dysfunction." Instead, he wants to enhance the sex lives of ''normal functioning women" who have no serious problems sexually. Traditionally, gynecology{even gynecological plastic surgery{has concerned itself with issues of physical function such as incontinence rather than sexual pleasure. But Matlock feels this needs to change.''You're not here to make an ethical judgment; you're here to help people," he says. ''And if [women] feel this will help their sex life, okay, we can go ahead and enhance these things." Among the enhancements Matlock is betting women want is ''designer laser vaginoplasty," a cosmetic remodeling of the labia. ''It's called `designer' vaginoplasty because the woman is the designer," says Matlock. ''The doctor is just the instrument." He cites the airbrushed women of Playboy as examples of what is aesthetically pleasing in labia. ''Honestly, if you look at Playboy, those women, on the outer vagina area, the vulva is very aesthetically appealing, the vulva is rounded," he says. ''It's full, it's not at...Women are coming in saying, `I want something dierent, I want to change things.' Then look at Playboy, the ideal woman per se, for the body and the shape and so on. You don't see women in there with excessively long labia minora." The glossy brochures that share space with Vogue, Cosmopolitan, Allure, and a bouquet of arti cial owers in Matlock's beige-marble offices on Sunset Boulevard contend that 30 million American women ''suer" from symptoms of vaginal relaxation, primarily stress urinary incontinence, a gure other gynecologists interviewed for this article supported. But Matlock claims that, after surgically treating women for this problem, his
patients reported an astounding side eect. ''They would call me and say, `my sex life is greatly enhanced.' I had husbands calling. Patients would tell their friends who may not have had functional problems, saying, `well, Suzy had this done.' I thought, if the patient wants this and we can oer it, let's do it. I changed my concepts and oered it to patients who wanted it. Laser vaginal rejuvenation for the enhancement of sexual grati cation is a laser surgical procedure designed to enhance sexual grati cation."
Another Beverly Hills gynecologist who declined to be named says that he has performed this surgery on women with stress urinary incontinence and they, too, said it improved their sex lives. But would he recommend the operation to a woman purely for sexual enhancement? \Not at this stage, no," the physician says. ''What Dr. Matlock is doing is very avant garde and on the cutting edge. I prefer to be in the middle of the pack."

Plastic Surgery and the Materialization of Gender Norms ByKaren McNamara

2008-01-13T02:51:00.000-08:00

While the discourses of medicine and the media function to disseminate and reinforce “regulatory norms of sex,” plastic surgery procedures give those norms a material reality by reshaping the flesh of the body. Most labiaplasty procedures eliminate the “excess” tissue that hangs below the labia majora in many women. The removal of this dangling flesh, which hangs between a woman’s legs like a phallus, serves to further distinguish the female genitalia from the male. The female body must be distinguished from the male body because it is in contrast to the female that the male has meaning. The system of gender is relational, operating through binaries: a “man” is “not woman,” just as “masculine” is “not feminine.” The two concepts are locked in an interdependent relationship. If the binary begins to break down, the salience of each of these categories breaks down as well. Therefore, to prevent such a degradation, the rigidity of the categories “man” and “woman” and the strict boundary that exists between them is fiercely protected. Because of this, in contemporary Western culture, ambiguity of the genitalia is culturally unacceptable. If a baby emerges from the womb with anything less than a body clearly marked as either male or female, medical technology and expertise rush in to give precision to the anatomy. Suzanne Kessler, who has done extensive research on gender reinforcement surgery on intersexed individuals, says, “Genital ambiguity is corrected not because it is threatening to the infant’s life, but because it is threatening to the infant’s culture” (25). The “in-between-ness” demonstrated by fleshy or hanging labia is threatening because it complicates the strict gender binary that underpins the Western social fabric. Consequently, society marshals its forces—economic, cultural, and political—to bring those aberrant bodies in line. In this case, the female body must be appropriately feminized. Thus, the female genitals, generally thought to be the marker of womanhood, are in many cases “not female enough.”
This removal of labial tissue does more than simply sharpen the distinction between the female body and the male body, however. The excision of tissue deemed “excessive” functions on a symbolic level as well, for it reflects broader societal norms that forbid a variety of excesses among women, particularly inordinate sexual appetites. Simone Weil Davis historicizes the association between large labia and heightened sexuality, noting, “at least since the sixteenth century they have indicated to doctors the alleged presence of hypersexuality, onanism, and possible ‘tribandism’ or lesbian tendencies” (37). Through labiaplasty, both her body and behavior are “civilized,” metaphorically reigned in to meet society’s insistence on female restraint and discretion. Saartjie Baartman, or the “Hottentot Venus,” perhaps best illustrates this type of phrenology by illustrating society’s attempt to draw a link between the physical appearance of the woman’s genitals and her character. Baartman was an African woman whose body was put on display through a touring exhibition across Europe for five years in the early part of the nineteenth century (Gilman 232). Her labia were of particular interest to the Europeans, who were eager to seize upon physical characteristics that could be used to make classificatory distinctions between the races. European travelers of the eighteenth century had returned from Africa with reports of the “Hottentot Apron,” a “hypertrophy” of the labia found among some tribes (232). Western colonialists used the “primitive” nature of the black woman’s sexual organs as evidence of a corresponding “primitive” sexuality, generally defined by “excesses,” including lesbianism (237). The Hottentot Venus provided a contrasting image for bourgeois European women’s genitals and sexuality. Unlike the untamed excess of the Hottentot, white women demonstrated a properly modest, civilized sex. Those highly gendered notions of the proper female body can still be detected in the modern practice of genital plastic surgery, which aims to reduce women’s sex—and sexuality—to more acceptable proportions.
Other surgical procedures besides labiaplasty are also tasked with sexing female bodies. For example, physicians’ promotional materials hail vaginal rejuvenation surgery (or vaginoplasty) as an “essential service” for women to enhance their physical sensation during sex, with advertisements touting “You won’t believe how good sex can be!” (Gorov C1). However, many doctors have voiced skepticism about such claims. A New York Times piece from 2004 quotes Dr. Thomas G. Stovall, president of the Society of Gynecologic Surgeons, as saying that no scientific evidence exists to support the claim that women experience enhanced sensation during intercourse after the procedure (Navarro 9.1). In fact, he claims the opposite, as some women actually experience pain after the surgery as a result of the muscles being too tight. Other risks include nerve damage leading to loss of sensation, a buildup of scar tissue, or infection. Despite some plastic surgeons’ repeated insistence that the women they treat seek the procedure to enhance their own sexual satisfaction, others concede that many women have a consultation at the urging of their husbands, boyfriends, or partners who want increased sensation for themselves. Thus, by surgically altering the vagina toward the goal of enhancing male sexual pleasure, vaginoplasty reinforces the instrumental function of the vagina in normative heterosexuality. Being a site of pleasure for the male sexual organ is a primary function of the vagina under the heterosexual matrix of gender. If the vagina fails in this capacity and is no longer able to deliver adequate stimulation to the phallus, a cultural intervention is required. Underscoring Butler’s theory, the vagina itself does not qualify one as a woman. Being a woman, a condition that under the normative heterosexual culture of contemporary society includes accommodating the phallus, requires medical assistance. As Simone de Beauvoir famously said, “One is not born a woman, but becomes one.” In this case, one is not born a woman, but is made one: Her sex is brought in line with her gender.
In addition to the function of the vagina being important under the heterosexual imperative, the appearance of the vagina is important as well. A desire for youthfulness stands as a key motivation for genital surgeries, as it does for plastic surgery in general. In her article “Vulva Goldmine: How Plastic Surgeons Snatch Your Money,” Julia Scheeres quotes UCLA psychology professor Paul Okami, who says, “These procedures are designed to approximate that of a pubertal vulva or vagina.” And, as other feminist critics have done, Scheeres points to the infinite number of Web sites promoting images of “teenage sluts” or “barely legal babes” as additional evidence of patriarchy’s sexual obsession with young, barely pubescent girls (75). Aside from having vaginoplasty to “rejuvenate” the genitals, some women have fat injected into their labia to give them a plumper shape. Feminist health expert Judy Norsigian, as quoted in the Los Angeles Times, situates this trend in the context of men’s obsession with barely pubescent young girls. She attributes the popularity of Brazilian waxing—in which nearly all of the pubic hair is removed—as further evidence of this. In the context of the heterosexual imperative, the female must be ever vigilant to keep herself alluring and hold the male’s sexual interest. Physicians point out that older women may be in a losing battle against gravity as they begin to notice their nether regions increasingly “on the move.” As Davis says, “It is woman’s work to make sure her genitalia are snug, not wayward” (15). Sustaining a youthful, feminine body, as necessitated under the heterosexual matrix of gender, requires constant attention and maintenance.
Hymenoplasty, in which the hymen is surgically reconstructed to mimic the virginal state, is yet another example of how the female genitals are produced to support heterosexual normativity. The procedure is not new. However, it has historically been performed on women from Middle Eastern or Latin American cultures that would themselves or their families suffer physical harm or shame if they were discovered not to be virgins upon marriage (Masterson 7). The small operation would erase physical evidence of prior sexual activity or rape. Although the number of women seeking these procedures is considerably less than those pursuing labiaplasty or vaginoplasty, its popularity has begun to take hold in the U.S., primarily among white, affluent, urban women. To distinguish it from the aforementioned cultural context, those in the industry have dubbed the procedure “recreational” hymenoplasty. A Philadelphia Daily News article quotes one woman who is having the $5,000 surgery as a “gift” for her husband who, she says, “deserves everything” (Armstrong 1). Other women undergo the procedure to mark anniversaries or other special occasions. Unlike vaginoplasty, though, in which some doctors still make the case for enhanced female pleasure (despite evidence to the contrary), hymenoplasty guarantees women’s discomfort. Again, if the vagina no longer meets a key requirement of womanhood under heterosexual society—keeping the phallus endlessly stimulated and entertained—then action must be taken to create proper bodies.
These various practices—vaginoplasty, labiaplasty, hymenoplasty—and a range of others, highlight the constructedness of the sexed female subject because her body requires constant maintenance to adhere to gender requirements. Dominant gender ideology enlists her to become a sentinel, watchful for aberrations or abnormalities that cause her body to slip beyond the boundaries of acceptable womanhood. Thus, responsibility for the enforcement of norms rests within the individual subject herself. Just like the docile bodies of Foucault’s Panopticon, bodily surveillance has been internalized: “We are neither in the amphitheatre, nor on the stage, but in the panoptic machine, invested by its effects of power, which we bring to ourselves since we are part of its mechanism” (217). With gender, there is no center of power that enacts rules and then punishes transgressors. Rather, the gender binary is so strong and so pervasive that no external policing is necessary. On our own, as sexed subjects, we accomplish the disciplining of our bodies to fulfill the requirements of gender categories.
However, because the very definitions of these categories are cultural creations, they are subject to change over time and space. As the gender norms shift, so must our disciplining practices. The variance that exists among norms becomes apparent when examining the practice of labiaplasty in the West alongside the practice of female genital operations (or FGO) in Africa. According to Davis, both cultural practices are underpinned by the idea that “the genitalia are cultural terrain that must conform to identificatory norms” (17). Nonetheless, most American women who seek labiaplasty would no doubt be horrified at the comparison between their own procedure and the practice of FGO in Africa. However, Davis asserts that the distinction between the two is not so great. Since the mid-1990s, ten U.S. states have passed anti-FGO laws. Although the nature of the operations criminalized in these laws would easily apply to the kinds of procedures being performed in the offices of Beverly Hills plastic surgeons, the laws include language to address specifically “the custom and belief-based cutting of African immigrants” (21). Consequently, the parents of intersexed American infants are free to have the genitals of their children cut or excised, as are women who have made the determination that their labia stand in need of some corrective measures, without concern for legal ramifications. Yet, the distinction between Western practices of plastic surgery and African practices of FGO is one figured along cultural, racial, and national lines. In practice, the difference is not so pronounced: “Among the key motivating factors raised by African women who favor female genital surgeries are beautification, transcendence of shame, and the desire to conform; these clearly matter to American women seeking cosmetic surgery on their labia, as well” (Davis 23). Davis goes on to quote Soraya Mire, a Somali filmmaker, who says “In America, women pay money that is theirs and no one else’s to go to a doctor who cuts them up...Western women cut themselves up voluntarily” (21). In this way, one could see Western female consumers who consent to the procedures (and even finance them) to be even more oppressed and bound by normative gender than their African counterparts.
The comparison between practices in the U.S. and Africa shows that although the specific methods may vary across space and time, normative gender imprints itself upon the body. In the U.S. context, the discourses of Western medicine and the media work together to reinforce messages about normative gender and the female body. Plastic surgery then functions as the means by which those gender norms are translated into flesh, transforming women’s bodies into “properly sexed” female subjects that are better able to fulfill their duties in the service of imperative heterosexuality. The process of “sexing” the female body, however, does not end when the anesthesia wears off. Rather, under the matrix of gender relations, women exist in a constant state of monitoring and correcting, forever striving to hit the moving target that is “woman.”

Discourse and the Dissemination of Gender Norms By Karen McNamara

2008-01-13T02:48:00.000-08:00

One of the key ways in which these “regulatory norms” operate is by using institutions and discourses of power to produce messages about how gender is properly expressed through the body. Perhaps most obviously, the institution of Western medicine uses a discourse of disease to pathologize the female body and encourage adherence to gendered notions of normalcy.

The plastic surgery industry in particular has developed a new lexicon to classify even healthy bodies as abnormal. For example, in the early 1980s, the American Society of Plastic and Reconstructive Surgeons launched a media and educational campaign claiming that women with very small breasts were suffering from the disease “micromastia.”

The society submitted petitions to the Food and Drug Administration (FDA) in which they asserted that breast implants were essential to “correct physical deformities.” The physicians also targeted female consumers directly, promoting implants as a solution for flat-chested women to look “more normal.” The literature touted the implants as feeling both “real” and “natural,” underscoring the possibility for “realness” and “naturalness” to be qualities that one can achieve or even purchase (Bloom 95).

Doctors have used similar strategies in advertising genital plastic surgery procedures. Dr. David Matlock, a Beverly Hills-based plastic surgeon, is one of the most outspoken proponents of vaginoplasty, a surgical technique in which incisions are made in the vaginal muscles before resuturing them to achieve a tighter opening.

Generally, the procedure is marketed to women who have experienced a relaxation of the vaginal muscles after childbirth. His office’s publicity materials claim that his “laser vaginal rejuvenation surgery” (an $8,000 procedure which he has trademarked) is an “essential service for women with a certain physical dysfunction” (Gorov C1, Healy F1). Here, the typical and nonpathological condition of a woman’s genitals after childbirth has been elevated to the status “dysfunctional” and requiring surgical intervention.

Rhetoric of “the normal” figures prominently in the power of medical discourse. In interviews with women who have sought out these surgeries, the women emphasize that they are not pursuing some idealized version of bodily perfection. Rather, they simply want to look and feel “normal.” In a New York Times article, journalist Mireya Navarro interviews a 39-year-old woman from Boston who underwent labiaplasty, cosmetic surgery to reduce or reshape the labia. She says, “Now I feel free. I just feel normal.” Similarly, a 34-year-old woman from Long Island, who underwent the procedure to reduce her inner labia, says, “I look down and I say, that’s the way it should be” (9.1). Julia Scheeres’s research on the marketing strategies used by this niche of the plastic surgery industry reveals the prevalence of this discourse of normalcy as well. She cites an advertisement from a Los Angeles newspaper that addresses itself to women who “suffer from low self-esteem due to abnormal vaginal appearance.”

Appropriating second-wave feminists’ messaging about empowerment through bodily self-discovery, a press release urges women to “take out [their] hand mirrors” and inspect themselves for defects (71). The message is clear: Simply having female primary sex characteristics in no way ensures that one is a normal woman. Yet, when surgery is promoted as the path to achieve normalcy, the constructedness of the very idea of “normal” is revealed. Although many women may understand “normal” to mean the way their bodies should have been, the notion might more accurately be understood as the way in which culture dictates their bodies must conform.

Alongside the rhetoric of “the normal” is that of “the natural.” The aptly named Dr. Gary Alter is a pioneer in labiaplasty, a procedure sought by many women whose labia minora hang below their labia majora or are asymmetrical in size or shape. He has developed his surgical technique around this very notion of naturalness. In his interview with Fabula, a feminist magazine, he says that in the past doctors would simply “cut off” the offending tissue. However, Dr. Alter found the resulting suture line to be “very unnatural.”

Thus, in an attempt to achieve the all-important quality of “naturalness,” Alter developed a new procedure by which the labia are reduced, but their original edges are left intact (Loy 26). Likewise, some women claim to have sought surgery in the first place because they found their large or asymmetrical labia to be “unnatural.”

Again, this example effectively highlights how this idea of naturalness, although conventionally thought to be a pure condition that exists before any type of cultural intervention, in fact denotes the mark of culture itself. In practice, a body regarded as “natural” is a body that has successfully modified itself to earn such a classification.

Similarly, rhetoric of “hygiene” is often called upon as justification for labiaplasty, as well. Nearly every report of this trend that has appeared in mainstream media publications has quoted doctors and patients alike describing the new beauty standard for the vulva as one of looking “neat” and “clean.” For example, in a Boston Globe article, a 25-year-old student from California, a patient of Dr. Matlock’s, describes her post-surgery genitalia as “cleaner” and “more hygienic” (Gorov C1). Women’s eNews quotes Crystal, who says, “I had labiaplasty and now I love the way I look; nice and neat and new” (Kobrin).

Dr. Matlock offers a similar vision for what he considers the definition of vulvar beauty—specifically, a “nice, clean look” (Healy F1). These descriptions of the ideal of feminine cleanliness recall the shame with which the female “dark continent,” the site of Freud’s castration horror, has long been associated. As Davis writes,

The same social world that generated the mythos of the delicate, proper lady has also continually spawned and recycled dirty jokes about ‘vaginal dentata,’ fatal odors, and other horror-story imagery about female genitalia. The off-color disgust has always been tied in a complex way to a vast, off-color desire, and these both have been concomitant with the prescription to stay dainty (8).

The ideal of the clean, delicate, discreet vaginal slit so widely used in industry discourse functions to cast those bodies that have not undergone these procedures as necessarily dirty and unsightly. Thus, plastic surgery of the vagina becomes a kind of ritual of purification by which the dark, dirty, shameful female body can finally achieve a sense of decorum.

Other discourses are also hard at work to encourage women to bring their bodies in line with gender norms. In the case of genital plastic surgery, the media/entertainment industry factors heavily into how gender norms are perpetuated. Media representations of women with extremely thin bodies and large breasts promote ideals that women want to emulate. However, these images often cannot be achieved without plastic surgery.

A similar phenomenon operates with representations of the female genitals as well. Scholars have noted that in years past, women rarely had the opportunity to see other women’s vaginas and thus had no sense of how a typical vagina might look. However, with the mainstreaming of the adult entertainment industry, that situation has changed. Now, a beauty standard has emerged, one established primarily through porn actresses, nude models, and strippers. According to surgeons, women are bringing in pictures from magazines and adult Web sites, pointing out whose vaginas they want to recreate.

However, the irony of this situation is that in pornographic films and photographs, everything from eye color, to stretch marks, to genitalia can be digitally modified. Gary Rohr, who does image retouching for Flynt Publications says, “The easiest thing to do is to replace genital shots. You take one you prefer and paste it over the one you don’t” (as quoted in Scheeres 73). Similarly, Sharon Mitchell, of the Adult Industry Medical Healthcare Foundation, claims that asymmetrical or wrinkled labia are routinely airbrushed (Healy F1). Thus, the pictures that women bring in to their doctors’ offices and point to as the “ideal” female genitals often depict bodies that never actually existed. In a process that suggests Baudrillard’s simulacra, women are remaking their bodies to become copies of copies that in fact reference no original.

Genital Plastic Surgery and the Production of the Sexed Female Subject By Karen McNamara

2008-01-12T12:42:00.000-08:00

For decades, American women have turned to plastic surgery to make their breasts larger, their stomachs flatter, and their thighs smoother. Recently, more and more of them also want their vaginal openings tighter and their labia smaller. Although no official data are available on how many of these procedures are performed annually, industry experts estimate that plastic surgery of the female genitals is the fastest-growing area of plastic surgery in the United States. How should cultural critics interpret this phenomenon? One useful approach to examining this trend is to consider it as evidence of Judith Butler’s theory that gender actually produces sexed bodies. From this perspective, how might genital plastic surgery serve to transform the bodies of women into “properly sexed” female subjects that are better suited to meet the criteria of the label “woman” under the heterosexual imperative?
In Gender Trouble, first published in 1990, Butler radically challenges the long-held idea that gender is a social construct that imprints itself upon stable, “natural,” sexed bodies. Conventional thinking presumes that gender, particularly the myriad of ways in which people “perform” their role as a man or a woman, is an effect of having one of two kinds of sexed bodies. Butler’s work inverts this assumption, demonstrating how sex is actually a gendered category. As such, gender is therefore a cause rather than an effect, and the mark of gender brings the sexed body “into being” . Butler emphasizes how sexed bodies are created toward a particular end: normative heterosexuality. In Bodies That Matter, published three years after Gender Trouble, Butler continues her investigation of this topic:
The regulatory norms of ‘sex’ work in a performative fashion to constitute the materiality of bodies and, more specifically, to materialize the body’s sex, to materialize sexual difference in the service of the consolidation of the heterosexual imperative. Recognizing Butler’s understanding of the body as a discursive construct, one can begin to consider how even those born with the sexual organs of a female might determine that, nonetheless, they do not “measure up.” Simply having a vagina, it seems, may not be sufficient qualification for membership in the category “woman.”

Sigmoid Vaginoplasty Is Effective In Treating Females With Vaginal Atresia

2008-01-12T11:23:00.000-08:00

BERKELEY, CA (UroToday.com) - The creation of a neovagina is challenging. Although not a common procedure, this may be necessary in those who have vaginal agenesis, vaginal loss, or undergo genital reassignment.
A number of different techniques have been described in the creation of a neovagina; however some methods suffer from technical difficulty or poor postoperative outcomes. Kapoor and colleagues from Uttar Pradesh, India describe their use of sigmoid vaginoplasty in those with vaginal agenesis secondary to Mayer-Rokitansky-Kuster-Hauser syndrome.
They reviewed the charts of 14 patients with Mayer-Rokitansky-Kuster-Hauser syndrome. The average age at the time of surgery was 16.8 years (range 13-22). 13 of the cases were diagnosed at menarche, while one occurred later. The procedure is performed in an extended lithotomy position to allow access to the perineum and abdomen. A simultaneous abdominoperineal approach is used. A 10-15 cm segment of sigmoid colon is isolated on its vascular pedicle to be used as the neovagina. An H shaped incision is made in the perineum and dissection is performed between the urethra and rectum. An abdominoperineal tunnel is created that is large enough to pass at least 2 fingers and the bowel segment is then pulled through the tunnel. The distal bowel segment is attached to the vulvar mucosa using absorbable sutures. The proximal portion of the neovagina is secured to the sacral promontory to prevent future prolapse. The neovagina is packed with petroleum gauze for 48 hours. Patients are taught self dilation and irrigation of the neovagina for mucus. This is performed daily for 8 weeks and then weekly.
The mean follow up of these 14 patients was 4.1 years (range 6 months- 7 years). Perioperative morbidity included one ileus and one superficial wound infection. . All the patients were compliant with dilation and there were no cases of stenosis. At the most recent follow-up, there were no complaints of irritation, dryness, excessive mucus production, or dyspareunia. The subjective satisfaction rates were 8.01 on scale of 0 (very disappointed) to 10 (satisfied).
The authors conclude that sigmoid vaginoplasty is an ideal treatment for vaginal atresia. It can be done safely with minimal morbidity. The sigmoid neovagina is functional, with low rates of dyspareunia, and patients have high satisfaction rates.

Irish doc critical of genital surgery By Irishhealth.com

2008-01-12T11:22:00.000-08:00

While female genital mutilation has been condemned by many developed countries, the issue of 'aesthetic' genital surgery in rich countries garners no such criticism, an Irish doctor has said.
Genital mutilation, sometimes referred to as female circumcision, is a traditional practice in some developing countries. It is generally condemned by the western world.
However writing in the British Medical Journal, Dr Ronán Conroy of the Royal College of Surgeons in Ireland (RCSI), insisted that genital surgery in the developed world should be tackled before other traditional practices are criticised.
"The practice of female genital mutilation is on the increase nowhere in the world except our so called developed societies. 'Designer laser vaginoplasty' and 'laser vaginal rejuvenation' are growth areas in plastic surgery, representing the latest chapter in the surgical victimisation of women in our culture", he wrote.
Furthermore, this burgeoning industry is able to operate without the slightest attention being paid to it by medical researchers, he said.
He pointed out that the literature on female genital mutilation is 'long on polemic and short on data'.
"European and American writers often assume that it is forced on unwilling young girls, but this is at odds with the high social value placed on it in societies that practise it", he said.
He suggested that 'our own sexually repressive use of female genital mutilation may be at the root of our misunderstanding of its role in other countries'.
Dr Conroy believes that the 'high moral tone' with which those in richer countries criticise female genital mutilation would be more credible 'if we in the rich countries had not practised it and did not continue to practise it'.
"It is western medicine which, by a process of disease mongering, is driving the advance of female genital mutilation by promoting the fear in women that what is a natural biological variation is a defect, a problem requiring a knife", he added.

The Most Private of Makeovers By MIREYA NAVARRO

2008-01-12T11:16:00.000-08:00

HE 39-year-old yoga instructor was like a lot of women these days: she was unhappy with her body and thought that a little sculpturing by a plastic surgeon would help. But her goal was not the usual smoothing out of facial wrinkles or expanding her bust.
Instead she wanted to achieve her beauty ideal in the most private part of her anatomy — her genitals.
"I was very, very self-conscious about the way I looked," said the woman, who lives in Boston and spoke on the condition that her name not be used, to protect her privacy. "Now I feel free. I just feel normal."
As millions of women inject Botox, reshape noses, augment breasts, lift buttocks and suck away unwanted fat, a growing number are now exploring a new frontier, genital plastic surgery. They are tightening vaginal muscles, plumping up or shortening labia, liposuctioning the pubic area and even restoring the hymen, sometimes despite their doctors' skepticism about the need for such cosmetic measures.
Procedures that once were reserved for problems like incontinence, congenital malformations or injuries related to childbirth are now being marketed by some gynecologists and plastic surgeons as "vaginal rejuvenation," surgical techniques to enhance sexual satisfaction and improve the looks of the genitals.
Even doctors who do not advertise say they get inquiries from patients every month.
"There's remarkably amazing patient interest in this," said Dr. V. Leroy Young, chairman of the emerging trends task force for the American Society of Plastic Surgeons. "This is at that early stage where there's a lot of enthusiasm for it." Dr. Young said his group, the largest organization of plastic surgeons, has not yet started tracking how many doctors are making "gynecologic cosmetic care" or "vaginal rejuvenation" their specialty, but he said that anecdotal evidence suggests that while the numbers may be relatively small compared with other surgeries, demand for genital procedures is growing rapidly.
The most popular of those are tightening of the vaginal muscles, or vaginoplasty, and reduction of the labia minora, called labiaplasty. Doctors who perform the surgeries, which are usually done on an outpatient basis in less than two hours and can cost from $3,500 to $8,000, say that the reasons for the procedures are not always purely cosmetic; some women with large labia, the surgeons said, suffer discomfort wearing tight pants or during activities like bicycle riding.
But primarily, doctors say, aggressive marketing and fashion influences like flimsier swimsuits, the Brazilian bikini wax and more exposure to nudity in magazines, movies and on the Internet are driving attention to a physical zone still so private that some women do not dare, or care, to look at themselves closely.
"Now women shave," said Dr. Gary J. Alter, a plastic surgeon and urologist with offices in Beverly Hills, Calif., and Manhattan who has come up with his own "labia contouring" technique. "Now they see porn. Now they're more aware of appearance."
Dr. Bernard H. Stern, a gynecologist in Fort Lauderdale, Fla., began to focus exclusively on genital cosmetic surgery four years ago and said he had seen his business quadruple this year, to four to five surgeries a day on patients who come from all over the United States and abroad.
"It is lucrative and it has patient appreciation," said Dr. Stern, who has a Web site and runs ads in strip club magazines.
Other doctors who perform genital surgeries as part of broader medical practices say they are seeing at least a handful of patients a month concerned with the aesthetics of the vagina.
Some procedures, like hymen reconstruction, are relatively rare and confined to a minority of women who need to conform to religious or ethnic rules on virginity, doctors said. A greater number of patients complain of stretched vaginal muscles because of childbirth and aging, or inner labia that are too big, too uneven or unsightly.
"The women feel undesirable or unpretty," Dr. Stern said. "Even if nobody sees it, they see it."

The yoga instructor from Boston, who flew to Dr. Alter in Beverly Hills for a labiaplasty four years ago, said she was "asymmetrical": part of her inner vaginal lips extended about half an inch beyond the outer labia.
"The only women I could compare myself to was women in pornographic movies," she said. "They were tiny and dainty and symmetrical. Nobody looked like me."
A 34-year-old housewife from Long Island said a similar problem nagged her through adolescence, marriage and three children. Like other women interviewed for this article, she would speak only on the condition of anonymity because of the private nature of the subject and fear of ridicule.
"It never bothered my husband," she said, "but it was always like `Yuck!' All I know is that what I had I didn't like."
Just two years ago, she said, she could not find a doctor in her area with experience in labiaplasty or who would not play down the problem and try to keep her from seeking a surgical solution.
Last year she went online and found Dr. Edward Jacobson, a gynecologist in Greenwich, Conn., who performed a labiaplasty using a laser technique.
Now, she said, "I look down and I say, that's the way it should be."
But, some doctors warn, buyer beware. Vaginoplasties are often touted as a way to improve sexual satisfaction for women, but Dr. Thomas G. Stovall, president of the Society of Gynecologic Surgeons, the principal group for gynecologic surgeons with academic appointments, said there is no scientific data to back up the claim.
The opposite is true, he said; painful intercourse can result if the vaginal muscles are too snug.
Other possible risks from genital procedures are painful scarring or nerve damage that could result in loss of sensation or hypersensitivity, according to some doctors. But they added that the procedures have a low rate of complications and that their happy customers reject those qualms.
A 41-year-old police officer in Fort Lauderdale who saw Dr. Stern for vaginal surgery last June said that after having four children she thought her vaginal muscles needed improvement, both for her and for her partner.
Like many other genital surgery patients, the officer has had other plastic surgeries, including breast augmentation and liposuction.
"I just felt that I keep myself in shape everywhere else, and this would make me feel better," she said, adding that the surgery has given her more intense sexual enjoyment.
One patient, a 22-year-old college student from Toronto, said she had never had intercourse until after her labiaplasty because she felt "insecure and ugly" about excess labia tissue.
"It's just that when you feel bad about your body, especially this part of your body, it's kind of impossible to let your true feelings and passions show," she said.
Now, after the surgery last May, she said, "I have nothing to hide."
Some sex therapists are troubled that the emphasis on a youthful look in the doctors' ads are creating demand. And some pointed out that there are dissatisfied customers as well.
Dr. Laura Berman, director of a treatment clinic for female sexual dysfunction in Chicago, the Berman Center, said some of her patients complained that they ended up with pain or could no longer be sexually aroused after undergoing some of the procedures. Unlike most other cosmetic procedures, she said, genital plastic surgery has the potential to harm function.
"Any time you're having surgery that involves any kind of intervention in the genitals you're asking for trouble in regard with your sexual function," she said.
Dr. Berman, who this year completed a national survey on the effect of women's "genital self-image" on sexual function, said most women "walk around with a feeling of anxiety about their genitals" because women are not usually brought up feeling confident about that part of the body. "These surgeries kind of play into that," she added. She said her research showed that a woman's comfort level with her genitals affects her sexual enjoyment.
But she and other sex therapists say they recommend less drastic measures, like Kegel exercises to strengthen pelvic muscles, as a way to deal with any insecurities.
Some plastic surgeons, who note that there is no such thing as "normal" female genitals, are scratching their heads.
"It doesn't make a lot of sense to me, to be honest," said Dr. Young, of the American Society of Plastic Surgeons, who said he does a small number of labiaplasties in his practice in St. Louis. "I try to discourage most patients."
Even people in the pornographic film industry say there is no universal standard of beauty for genitals and that, in any event, men fantasize about the woman, not any one body part.
Mark Kernes, a senior editor with the trade magazine Adult Video News, said, "I really don't think most men care."
Some doctors said men would be flocking to their offices for their own genital surgery if such procedures as penile enlargement were not fraught with complications and unintended outcomes.
Dr. Alter, the plastic surgeon and urologist, who performs genital surgery on both women and men, said, "With female genital surgery it's predictable, and women are extremely happy."
The housewife on Long Island agreed. "I'm not saying you should do it on a whim," she said. "But if you think it'd make you feel better, why wouldn't you do it?"

Intimate perfection By By Daphna Berman

2008-01-12T11:07:00.000-08:00

When women come to Dr. Bernard Stern's office for plastic surgery, they aren't seeking larger breasts, fewer wrinkles or even a flatter stomach. Instead, they've come to him for help in reshaping their most intimate body part, an area hardly anyone - including themselves - ever even sees: their vaginas. Stern, an American physician visiting Israel this week, is at the forefront of this new, lucrative and controversial trend in genital cosmetic surgery, often marketed as "vaginal rejuvenation." The trend, still relatively new in the United States, has yet to make serious forays in Israel. But American women, it seems, are no longer just injecting Botox, getting liposuction or turning to silicon to carve out a more perfect body. New surgeries now also allow them to tighten vaginal muscles, trim or plump their labia and make cosmetic changes to their most intimate body parts in what some pundits have referred to as the making of "designer vaginas." Stern, an obstetrician/gynecologist by training, has performed about 750 of these surgeries from his office in Ft. Lauderdale, Florida. He specializes in labiaplasty, reshaping the labia (the lips surrounding the vagina); as well as vaginoplasty, a procedure that tightens the vagina. He also performs hymenoplasty, which restores the hymen to its "pre-sexual state." The prodecure is done mostly for Muslim women who want to appear like virgins on their wedding night, even if they've already had sex.

"The demand is definitely growing," Stern, here on vacation, said of the surgeries. "I make it very clear to my patients that they don't need this, that it is an elective cosmetic procedure. But this isn't about vanity. My patients aren't strippers and dancers. These are educated women." The trend in vaginal plastic surgery, blasted by feminists, also has received a tepid response from the established medical community. The American College of Obstetricians and Gynecologists advises women against the procedures, citing a lack of "documentation of their safety and effectiveness." In a statement issued by the organization in September, the doctors also warned, "It is deceptive to give the impression that any of these procedures are accepted and routine surgical practices." In Israel, Prof. Rami Neuman, the head of plastic surgery at Hadassah University Hospital in Jerusalem, says he refuses to perform the surgery. "If there is a growth there, we will operate," Neuman said. "Anything else is stupid." But that hasn't stopped women from flocking to Stern and the hundreds of doctors in the U.S. who now advertise the procedures. Indeed, this newest rage is considered the fastest-growing sector of American cosmetic surgery. Stern says he performs about five surgeries a day on busy Fridays, and that most of his patients come from out of state. He's been featured in The New York Times, the Chicago Tribune and Bloomberg news, as well as Hustler, the pornographic magazine. "Just like women have larger than average ears, they can have labia sizes," Stern explained. "They can have labias that are four times as large or as thick. Even though nobody else sees it, they know it's there and it bothers them." Stern, 61, spent most of his career delivering babies, specializing in high-risk cases. He worked closely with the Chabad community in South Florida and was its unofficial chief obstetrician for many years. But in 2001, Stern shifted gears, to put it mildly, and began performing the vaginal plastic surgery procedures. In his first year, he worked with 17 patients; now, he'll see that many patients in a week. "It's a matter of exposure," he said of the explosion in interest. "Women are just now finding out that these kinds of operations exist." He also points to television programs like Nip/Tuck and the reality show Dr. 90210, as well as women's more "heightened knowledge of their anatomy" as additional influences. "It's a very private surgery and many women seek this but won't tell anyone about it," he said. "Vaginal plastic surgery is still taboo, the way that breast augmentation was 20 years ago. Women are now open about getting face lifts, but 25 years ago, they'd just disappear for six weeks." Some 11.5 million cosmetic surgical and nonsurgical procedures were performed last year in the United States, according to the American Society for Aesthetic Plastic Surgery (ASAPS). Although the trend in Israel is obviously on a smaller scale, it, too, is growing. More than 11,600 cosmetic procedures were carried out this year, according to the Israel Society of Plastic Surgeons, compared with 10,000 in 2005, an increase of 16 percent. In the U.S., the cosmetic procedures are advertised mostly online and come with promises of increased sexual fulfillment. Vaginoplasty, for example, which costs some $6,500 and is popular with women in their late 30s who have had children, is designed to restore vaginal tightness. The surgery, according to Stern's Web site, "can usually correct the problem of stretched vaginal muscles resulting from childbirth(s), and is a direct means of enhancing one's sexual life once again. The procedure typically tones vaginal muscle, resulting in greater contraction strength and control, thereby permitting greater sensation during sexual experiences." "Women ask, 'Will I have an orgasm if I never had one before?' and I tell them no," Stern says. "This operation will restore the vagina to the way it was when you were 18 or 20 years old, before you had children." Equally popular is labiaplasty, which costs some $5,500. Stern says women come to him distressed by large or disproportionate labias and though he admits there's no real need for "pretty labia," he says that the operation can also have a functional aspect. Some women, he says, wish to rid themselves of the discomfort from wearing tight pants or horseback riding. His Web site, www.cosmeticsurgery2.com, includes before and after pictures of patients who have undergone the procedure. Stern also specializes in hymenoplasty, performed mostly for ethnic and religious reasons, on patients who wish to re-rupture their hymen on their wedding night as a sign of virginity. Some married women have reportedly sought the procedure as a kind of "ultimate gift" to their husbands - an intimate and painful take on the traditional watch or necktie wedding anniversary present - though Stern says he refuses to conduct the procedure in those cases. Critics, meanwhile, are disturbed by the surge in demand for these unnecessary and costly surgeries. Increasingly exposed to pornography that is often digitally altered, they say people don't realize that female genitalia can vary significantly from woman to woman. And in a culture where beauty is becoming increasingly standardized, it is unclear where this latest craze will lead. Stern, for example, says he's been approached by three Israeli physicians who have expressed interest in studying with him in order to import the procedure. But he nevertheless rejects claims of fueling the craze, insisting that he is simply boosting women's self-confidence in intimate areas. "You won't see me on late-night television or on billboards," he says. "People don't know I exist until they come looking for me." "I delivered babies for many years as an OB/GYN and I brought so much joy and happiness to my patients. I have the same joy now doing what I do. For those who want the surgery, it is crucial. I restore a sense of normalcy and am changing lives, one woman at a time." Still, he admits that he won't casually discuss his specialty with strangers he meets at dinner parties. "People don't feel comfortable talking about it," he explains. "I'll just say I'm a cosmetic surgeon, without going into the specifics."

Designer Vagina Chat Transcript

2008-01-11T08:51:00.000-08:00

O.k. this topic popped into my head this morning. I am having an uncomfortable day today (almost a feeling like everything is swollen) and after weeks of not checking I couldn’t help myself and after my bath had a feel around! My cervix to my surprise was sitting a good inch higher than normal but where it has moved up it has revealed more than ever my saggy front wall which I am terrified is going to continue to sag and eventually my bladder will fall with it (if it hasn’t already to some extent). I kept thinking to myself that although we can reposition our organs and pin them in a better place keeping everything tucked up inside there is absolutely nothing we can do to re-tone this sagginess. I don’t expect to be like I was when I was 18 after having had a traumatic birth experience and I can put up with some sagging but you are lead to believe this just is not the norm and that makes me feel freakish
I had no reason to examine myself prior to prolapse so have no idea what was going on up there before so have nothing to compare it with.
Anyway (sorry I am waffling on here) I starting thinking about the latest trend of designer vaginas. Having googled it and read a little bit about it, it says and I quote “surgeons are offering a growing range of operations to change the size and shape of the vagina and/or labia. Some use scalpels, others lasers, to tighten the vaginal muscles and support tissues and reduce flaccid or floppy vaginal linings (vaginoplasty). They can also build up the area between the vagina and the anus and repair any internal damage following childbirth which may have resulted in urinary or faecal leakage.”
Now surely this can lead to POP?
It is frightening that there are loads of young and not so young women out there undergoing this surgery who do not have POP but are now putting themselves at an increased risk.
Am I wrong?

You are not wrong. Unfortunately I believe you are right on target. It is bad enough women (younger and younger!) are falling for the pressure to get nose jobs, boob jobs, and other purely cosmetic procedures to try to achieve "perfection" (WHY???) but in most cases these other procedures do not by mere construction wreck the underlying natural support system. The youngest generation today has NO concept of being able to survive without over-technologizing everything. It is absolutely terrifying if you stop and think about it; they're being programmed from birth to look to the massive industrialized medicine machine for now, not only treatment for disease, but for unnecessary crap like this. Excuse my language, but I find it disgusting the way young women more and more submit themselves to risky major surgery for pure vanity. Nothing against modern medicine per se! Thank god we have these procedures for mastectomy patients, accident victims and so forth. And I certainly believe in individual liberty; you want to drop several grand on bigger boobs go for it. But personally, I am making damn sure my two girls get a motherlode of information from me about the risks of going down this idiotic, self-absorbed pathway. Beautify your inner self a little more ftw and I don't mean the vagina.
I don't mean to offend anyone if you have had a cosmetic procedure. If it made you happy and you paid for it yourself (not my tax money) then more power to you. My beef is with how society is pushing very young women into this sort of thing. Even teenagers. It is dangerous and misleading to allow them to go under the knife under the illusion that bigger boobs will fix their social life or god-forbid, enhance their (unmarried) sex life.

Designer vaginas grown in lab By Stephen Brown (Reuters)

2008-01-11T08:45:00.000-08:00

An Italian doctor has reconstructed vaginas for two women born with a rare congenital deformation, using their own cells to build vaginal tissue in the lab for the first time. Professor Cinzia Marchese of University Sapienza in Rome says a 28-year-old woman who underwent the first such operation a year ago now has a healthy vagina. "She has got married and is living a normal life," says Marchese, a professor of clinical pathology and biotechnology whose study is published in the journal Human Reproduction. The second operation was on a 17-year-old girl. The researchers took cells by biopsy from where her vagina should be and say the cells should grow in the lab to provide mucosal tissue, from which to 'build' a new vagina.Mucosal tissue is found inside the vagina, the mouth and elsewhere in the body and has important attributes distinct from ordinary skin. The two women have a condition called Mayer-von Rokitansky-Küster-Hauser syndrome, or MRKHS for short, which affects an estimated one in 4000 to 5000 female infants. Girls with the syndrome are born with no vagina. They often have a normal uterus, ovaries and external secondary sexual organs such as breasts, but cannot have sexual intercourse or give birth. "Usually the syndrome is diagnosed when they are young and they try to have sexual intercourse for the first time and it hurts," says Marchese. Women with MRKHS are often embarrassed to talk about it with their parents when they are young and often "live the rest of their lives with no normal sexual life, even though they are normal women with normal feelings", she says. Alternative to surgerySo far, surgeons have been able to correct the condition by reconstructing a vagina out of grafted skin or from intestinal tissue. But the surgery is highly invasive, lengthy and painful. And it takes a long time to grow a normal mucosal wall. Such women, if they have healthy ovaries, have been able to achieve pregnancy by artificial insemination but would then need a surrogate mother to carry the fertilised eggs and give birth.But the Italian researchers take a different approach. "What we do is to take a little biopsy of 0.5 centimetres from the place the vagina should be," Marchese says.The researchers then used an enzyme to break down the tissue and let the immature cells, called stem cells, generate new, mucosal tissue on their own. It takes about 15 days to get a thick enough layer to transplant into the patients, Marchese says. Marchese studied using stem cells to build sheets of skin in vitro to provide skin grafts for burn victims at Harvard Medical School with the technique's pioneer Professor Howard Green."When I came back to Italy I modified this technique for mucosal vagina tissue," she says, adding that its success could be good news for women with cancer and other vaginal complaints.

Designer Vagina By Jamye Waxman

2008-01-11T08:43:00.000-08:00

RELATIONSHIFTS:When I first read the phrase “to be feminine is to have a tight, well-toned vagina” I wanted to tighten my fingers around someone else’s tight, well-toned neck, preferably the someone who wrote the stupid fucking phrase in the first place. In a country where thin is always in and self esteem is, for a lot of women, lower than the “you must be this tall to ride” sign, it’s never a good time for some half wit to start spewing his stupid beliefs about what is and isn’t beautiful or feminine, when feminine is not for any one person, or website, to decide.I hate that there are websites called the Vagina Institute and another for vagina enhancement, both subscription based services that provide women with what they describe as “the best insight” into their own vaginas, that tout mottos like small is beautiful, and encourage women to reclaim the vagina of their virginal youth. I can’t tell you what’s going on in the Vagina Institute because I will not chalk up the $17.95/month ($18.95 for the vagina enhancement site that will provide me with the secrets to non-surgical size reduction) so they can tell me how to fix my possibly imperfect vagina, even if I believe my birth canal is just fine, thank you very much. Perhaps whoever created the Vagina Institute has a really small penis and that’s why this “gender neutral” site is around in the first place. Oh, and I’ll let you in on what may be the vagina enhancement secret, it’s called kegel exercises, so there go spend you $18.95 on a new vibe for your vulva.
Of course you can still take the “how does my vagina measure up” quiz, and ask yourself does your vagina look “good and appealing,” or “ugly and unsightly.” Or you can just ask yourself, who thought up this question, and what is their problem? Okay I know that some women really do have problems with overly loose vaginas, especially after lots of childbirth, and that some women really do need to find a way to make their vagina’s tighter, but most women do not need to hear any of this trash talk from a site that has a self help book whose cover portrays a woman with an obviously warped boob job. Yes, a woman’s vagina does loosen up over time. It is after all a muscle and muscle’s need exercise in order to stay strong and in shape. That means it’s mui importante for women to do kegel exercises, just as it’s important for each and every woman to love the curves, folds and crevices that are our cunts. Now, once the love fest is over (and you better have spent at least a minute or two looking at and loving the vulva in your life even if it doesn’t belong to you) start your kegels, and do the exercises at least four times a week for the rest of your life.
To do your kegel exercises, sit on the toilet and pee, then stop the flow and start again, and do this until you know the muscles you’re using to make it all happen. And then, don’t do that again because it’s not good for you to stop your stream of urine all the time, but use those muscles, those pelvic floor muscles and hold in and release at least 100 times a day. If you can hold for three seconds each time, great, if not it’s still great that you’re doing the exercises. To make sure you’re working the right muscles, put a finger inside your vagina and squeeze. If you can feel the sensation of your finger getting sucked on, then you’re probably doing it right.
Kegels are great because the strengthen your pelvic floor muscles. They help you to not pee when you laugh or sneeze (it’s technically called incontinence). They can help a woman through childbirth and they definitely help you improve your orgasmic potential and therefore sex life. And yes men can do them too, although they won’t help him with through childbirth.
Again, some vaginas are larger than others, just like some penises are smaller than my middle finger, but that doesn’t mean I think he should find a way to plump his pinky dick up just so he can be more masculine. A penis does not make the man, so why should a vagina define the woman?

VAGINOPLASTY

2008-01-10T07:59:00.000-08:00

An enlarged vagina is frequently a problem after childbirth, especially after multiple children, vaginal delivery of a large baby or a difficult delivery. Birth-giving, aging, and genetic factors often cause the vaginal muscles to loosen and weaken, sometimes even tear. The result can often be loose, weak, vaginal muscles.

The diameter of the vagina gets bigger and there is a loss of feeling. Sexual gratification is directly related to the amount of frictional forces generated. The loose and unsatisfying feeling that many women feel can also be felt by their male partner during intercourse. It is not, however, a solution for sexual dysfunction, lack of interest or arousal, or orgasmic inadequacy. Many women find that while the experience of childbirth may be the most rewarding of their lives, sometimes the after effects for both their sexual partner and themselves is not as satisfying as it once was.

A woman’s feel, in her vagina has a significant importance in a woman’s life. It is closely related to her self-esteem, and to the actual and expected excitement involved with her sexual life and desire. Discomfort in a woman’s vagina can severely affects both her and her partner’s psychological state. Many women with grown children are now seeking renewal of vaginal tissues, both to increase their feeling, sexual satisfaction, and to enhance the sexual experience they have with their loving mate.

Vaginoplasty, is a surgical technique that strengthens the vaginal walls. Generally, anyone in average physical condition or good health can be a candidate for vaginoplasty surgery. Vaginoplasty tightens vaginal muscles and surrounding soft tissues, by reducing excess vaginal lining. It will also effectively decrease the internal and external vaginal diameters (tighten the vagina) as well as build up and strengthen the perineal body.The result is an immediate decrease in the size of vaginal muscles, resulting in more friction during sexual experiences. Surgery is done in a hospital under general anesthesia. It usually takes 40 minutes. You may leave hospital the same or the next day after surgery.

Surgery may cause slight pain which can easily be controlled by medication. After surgery, the patient is usually able to walk comfortably within a day, most people can return to their jobs within a few days and may return to sexual activities within 3 weeks.
Vaginoplasty can increase friction during intercourse and can enhance intimacy. Most patients are very happy after vaginal tightening surgery. Their regained vaginal muscle tone significantly improves their quality of life in general, and the quality of their intimate sex life in particular.

INNER LIP SURGERY

Many women dislike the large protuberant appearance of their labia minora. Labioplasty is a procedure performed on women who dislike the large size of their labia minora, which may cause embarrassment with a sexual partner or discomfort in tight pants, with sports, or during sexual intercourse. Some women are born with enlarged labia and therefore opt to have labiaplasty; whereas others develop the enlargement with age or from child-birth. Occasionally, a woman is self-conscious of her labia since childhood. A labia reduction procedure can be performed to reduce the labia minora.

Women who are self-conscious and unhappy with the length or shape of their labia minora - the inner lips around the vaginal opening - may feel as if they have no one to talk to because the subject is so personal and private. They may keep their thoughts about their bodies to themselves, even while it makes them self-conscious in the bedroom and uncomfortable during many different physical activities such as bike riding or horseback riding. In some instances, women with large labia can experience pain during intercourse, or feel discomfort during everyday activities or when wearing tight-fitting clothing. Others may feel unattractive or wish to enhance their sexual experiences by removing some of the skin that covers the clitoris. The overly large labia minora can also result in constant irritation in tight pants. Medical reasons for labioplasty include discomfort or irritation with tight pants, sports, cycling or other physical activities. In many instances, women are born with large labia; others may develop the condition with childbirth or age.

Aesthetic (beautification) reasons include self consciousness and self-esteem issues and a desire for sculpting to achieve a better look for ones self. Candidates for labioplasty who are either experiencing sexual dysfunction, embarrassment, or pain because their labia are over-sized or asymmetrical. Also, women who dislike their large labia or shape of their labia, which may cause inelegance or awkwardness with a sexual partner. Although the procedure is usually aesthetic, in order to improve vaginal self-image, it may also be indicated because of pain during intercourse.
The surgery is usually performed on an out-patient basis using local anesthesia.

Surgery takes 30 minutes. Neither the clitoris nor the urethra is affected when the labia is made smaller. The labia will either be shortened or a small triangular-shaped wedge will be removed with the sides sutured together to form smaller skin folds. During this procedure the urethral opening can be redefined and if necessary improvements to the vagina may be made. Retaining a natural shape along with all normal sensation is paramount. Most patients feel fine immediately after surgery. After the procedure you wear a panty liner. A daily bath or gentle shower ensures quick healing.

The sutures dissolve spontaneously so there is no need for physical removal. You can resume sexual relations in about 10-14 days after a labia reduction.Long labia can make a woman self-conscious about her body and can make some physical activities uncomfortable or even painful. By shortening the labia, discomfort and irritation can be greatly reduced if not completely eliminated. Women who before were self-conscious in the bedroom (some women avoid sex all together before the surgery because they are so self conscious) often feel relieved and have more sexual self-confidence.

Labioplasty can also make personal hygiene easier to maintain, as well as helping to simplify such activities as urinating and sexual intercourse. Most patients are very happy after labia reduction. They often wish to have had surgery much earlier. Their regained comfort and self esteem significantly improves their quality of life.

OUTER LIP SURGERY

The vulva encompasses the external female genitalia. The labia are the visible parts of a woman's genitals, commonly called lips. The labia majora are folds of skin, or fatty tissue, covering a thin layer of smooth muscle lying along each side of the vaginal opening. These are two rounded folds of fatty tissue that are covered with skin and extend downward and backward from the mons pubis. After repeated childbearing, the labia majora become less prominent, and in older women begin to shrivel. The labia area is a sensitive issue for women. Shape of the outer lips of the vagina may cause discomfort, embarrassment, or adversely affect sexual intimacy.

The labia majora may be enlarged from birth, secondary to childbirth, or due to aging. The outer lips of the vagina can be enlarged with excess skin and tissue. This enlargement causes an embarrassing bulge in pants or swimsuits. Meanwhile, there are some women than develop very full and large outer lips as a result of weight gain.

This becomes a noticeable nuisance when wearing tight pants, shorts, or bathing suits. It also traps moisture and causes skin irritation, rash, or even promotes yeast infection. Overgrowth of the outer lips may be due to a congenital condition, aggravated by pregnancy, or generalized aging. Early or less severe degrees of labia majora hypertrophy without skin laxity can be managed with liposuction if the primary problem is fatty or puffy labia. Vulvar liposuction can completely remove the unsightly fatty bulges of the pubic area and labia majora.

The fatty accumulations in these structures produce clothing, undergarment, and bathing suit irregularities and bulges. In some cases it can prevent women from wearing clothing of their choice. More advanced hypertrophy can be treated with labia majora reduction which is accomplished by excising an elliptically shaped section from the inner or hidden surface of each labia majora.

The incision is concealed in the valley between the labia minora and majora. Fully developed young women and adult women who are in good health are the best candidates. Labia majora remodeling is a female genital surgery to reduce the size of enlarged outer lips of the vagina. This is a relatively minor procedure and is not painful. General anesthesia is usually used, but sedation with local anesthesia is possible if you choose. A portion of each inner labium is removed.

The scar is hidden in the concavity between the inner and outer labia. This surgery is minor and takes about one hour. Sexual intercourse is restricted for about 2-3 weeks. The incidence of complications is low and manageable. You can resume light duty work in 1-2 days. None of the patients have complained of any loss of sensation or any decline in the ability to have orgasms.Atrophic (sunken, empty, deflated) appearing labia majora may be a consequence of genetic factors, weight loss, or aging.

This results in a loss of the youthful fullness of the labia majora. Augmentation of the labia majora can be achieved by lipoinjection (fat grafting from the abdomen or thighs). This is easily corrected by injecting fat taken from another area of the body. This is collected using liposuction techniques. The surgery is relatively minor and is not very uncomfortable. This surgery is typically is scheduled for 1 hour and performed under sedation with local anesthesia or general anesthesia. It is commonly combined with other female genitalia cosmetic surgery procedures. If performed as an isolated procedure, you should be able to resume sexual activities in about two weeks. None of the patients have complained of any loss of sensation or any decline in the ability to have orgasms.

PUBIC LIFT

A woman may have unsightly fat deposits in her pubic region, which causes a bulge in clothes. This deposit may have been present since birth or acquired with weight gain or puberty. Aging or weight gain may cause the pubic and vaginal regions to descend, resulting in an aged appearance. Following massive weight gain and subsequent loss or a prolonged pregnancy, it is not uncommon for a woman to report dissatisfaction with her loose, sagging, or prominent mons pubis. Occasionally there is an associated skin laxity which creates the illusion of an aged or collapsed appearance due to loss of support. This excess skin and fat may obscure or put excess weight on vaginal area.

These areas can be rejuvenated and lifted by excising excess skin above the pubic hair and removing excess fat in the pubic region. There are many aspects to genital rejuvenation and one of these is mons pubis rejuvenation. The mons pubis is the hair-bearing area of the pubis. Pubic sag may be associated with weight gain and weight loss, pregnancy and aging. A lift or suspension of these tissues is accomplished by excising an elliptical shaped piece of skin immediately above the pubic hairline and removing excess fat in the pubic region. This elevates and rejuvenates the genitalia in combination with liposuction.

These procedures are most commonly performed under general anesthesia in our fully accredited surgical center. In individuals concerned about postoperative discomfort, a pain pump can be inserted but is not typically requested.

The incidence of complications is low and manageable. You can resume light duty work in few days. Sexual intercourse is restricted for about 2-3 weeks. When a pure pubic lift is done, a caesarian type scar just above the pubic hair is used as the approach for lifting the pubis. This scar heals well as a horizontal scar just above the pubis. Surgery is done under general anesthesia and takes about 1 hour. Little pain is present after the surgery. Bruising and swelling may persist for 7 to 10 days. The pubic liposuction and pubic lift procedure may be combined with a tummy tuck or requested after having a tummy tuck. A pubic lift results in a more attractive, streamlined pubic area. Eliminating the sagging skin results in rejuvenation of this area.

Vaginoplasty surgeon lists

2008-01-10T07:55:00.000-08:00

Finding the right plastic surgeon by Over The Rainbow [via archive.org]
European surgeon list by Kate Kira has the most up-to-date info on European surgeons, including dozens not listed elsewhere.
Transgender in Thailand: Links by Andrew Matzner is a great overview of the Thai surgical resources. [via archive.org]
Lynn Conway has a selective list of vaginoplasty surgeons with commentary and photographs of results.
Anne Lawrence has a partial list of vaginoplasty surgeons with commentary and photographs of results.
Trasek.net has an annotated list of vaginoplasty surgeons.
GenderCare has a partial list of vaginoplasty surgeons.
Pamela Sexton has a list of vaginoplasty surgeons, with a focus on Europe.
Susan's Place Transgender Resources has a list of surgeons with reader ratings and comments.

* Asian surnames (last names) are the first word in their names unless westernized.
See also list of surgeons by location.

Travel advisory: Those planning to travel outside their country of residence for vaginoplasty should make preparations with your government's agency in charge of documentation well in advance of their expected travel date. See my legal issues page for details.
• Alter, Gary (Los Angeles, California, USA)
• Bellringer, James (London, UK)
• Bhumsak Saksri (Bangkok, Thailand)
• Biber, Stanley (Trinidad, Colorado, USA) [retired]
• Bowers, Marci (Trinidad, Colorado, USA)
• Brassard, Pierre (Montreal, Quebec, Canada)
• Brownstein, Michael (San Francisco, California, USA)
• Chen CF (Taipei, Taiwan)
• Chettawut Tulayaphanich (Bangkok, Thailand)
• Cholon, Annette (Menlo Park, California, USA)
• Choomchoke Janwimaluang (Bangkok, Thailand)
• Corman, Marvin (Los Angeles, California, USA)
• Dalrymple, James (London, UK)
• Daverio, Paul (Potsdam, Germany)
• Edgerton, Milton (Charlottesville, Virginia, USA)
• Falces, Edward (San Francisco, California, USA)
• Fang RH (Taipei, Taiwan)
• Futrell, J. William (Pittsburgh, Pennsylvania, USA)
• Granato, Roberto C. Sr. (Elmhurst, New York, USA) [retired]
• Greenwald, Daniel (Tampa, Florida, USA)
• Greechart Pornsinsirirak (Bangkok, Thailand)
• Haertsch, Peter (Epping, NSW, Australia)
• Hashmat, Azid (Manhasset, New York, USA)
• Huang, Ted (Galveston, Texas, USA)
• Jirapong Poony (Chonburi, Thailand)
• Kamol Pansritum (Bangkok, Thailand)
• Kenney, John (Charlottesville, Virginia, USA)
• Kirk, Sheila (Pittsburgh, Pennsylvania, USA) [retired]
• Krueger, Michael (Potsdam, Germany)
• Laub, Donald Jr. (Williston, Vermont, USA)
• Laub, Donald Sr. (Palo Alto, California, USA) [semi-retired]
• Lee, Sun-Kyu (Seoul, South Korea)
• Leis, Sherman (Bala Cynwyd, Pennsylvania, USA))
• Mac Millan, Guillermo (Valparaiso, Chile)
• Maldonado, Pablo (Buenos Aires, Argentina)
• Manders, Ernest K. (Pittsburgh, Pennsylvania, USA)
• Meltzer, Toby (Scottsdale, Arizona, USA)
• Menard, Yvon (Montreal, Quebec, Canada)
• Myung, Soon-Chul (Seoul, South Korea)
• Narongdet Jiarapipan (Bangkok, Thailand)
• Nguyen, Tuan A. (Portland, Oregon, USA)
• Paiboon Chitprapai (Bangkok, Thailand)
• Paisarn Asavapakuna (Bangkok, Thailand)
• Pichet Rodchareon (Bangkok, Thailand)
• Preecha Tiewtranon (Bangkok, Thailand)
• Reed, Harold (Miami, Florida, USA)
• Rohatgi, Sheila (Calcutta, India)
• Royle, Michael (Brighton, UK)
• Ruch Wongtrungkapon (Bangkok, Thailand)
• Sáenz de Cabezón y Chico, Jesús (Barcelona, Spain)
• Sáenz de Cabezón y Martí, Jorge (Barcelona, Spain)
• Sanguan Kunaporn (Phuket, Thailand)
• Schrang, Eugene (Neenah, Wisconsin, USA) [retired]
• Seghers, Michel (Brussels, Belgium) [retired]
• Sharma, Manohar Lal (New Delhi, India)
• Somsak Kunachakr (Bangkok, Thailand)
• Suporn Watanyusakul (Chonburi, Thailand)
• Terry, Timothy (University Hospital, Leicester
• Thep Vechavisit (Bangkok, Thailand)
• Thomas, Philip (Hove/Brighton, UK)
• Vesely, Jiri (Brno, Czechoslovakia)
• Vichai Surawongsin (Bangkok, Thailand)
• Walker, E. Peter (Christchurch, NZ)
• Witoon Wisuthseriwong (Bangkok, Thailand)
• Surgeons no longer performing vaginoplasty via IndigoWiki (2005)

Vaginoplasty “Designer vagina”

2008-01-09T05:59:00.000-08:00

The term ‘female genital mutilation’ is usually used to highlight the seriousness of the gynaecological surgery carried out on girls or young women who do not choose to undergo such procedures. It is against UK law and also illegal for any UK resident to take young women out of the UK for FGM. However, it is not illegal for surgeons in this country to carry out labiaplasty and vaginal and vulvar cosmetic augmentation or reduction procedures on adult women choosing to have such surgery, prompting critics to say that “female genital surgery” is the fastest-growing area of plastic surgery.

Private clinics advertise such procedures in the context of “alleviating pelvic floor disorders”; however, much of the promotional material offers women vaginal rejuvenation for the “enhancement of sexual gratification”. Some even offer hoodectomy (removal of the prepuce or vaginal hood), which constitutes Type I FGM, and illegal – even with consent – although they get around this by framing it as “corrective” surgery. While clinics claim that women desire aesthetically enhanced and “youthful” labia, and are concerned about whether the inner or outer lips project sufficiently or too much, it is clear that they are offering medically unnecessary procedures, based on perceived norms of female genitalia dictated by the increasing availability of pornography. It is surely time to question whose desires are being catered for by this surgery.

The clinics sometimes acknowledge that women seeking such procedures may below in confidence about their image or appearance, and that decisions should not be hurried. However, clinics clearly have no reason to acknowledge the pressures and expectations on women’s sexuality and appearance which might lead them to seek such drastic “solutions”, and have no reason to offer any alternative support or advice. They simply claim that the surgery will lead to better sex – i.e. better and longer orgasm – as if a positive sex life is only related to “the amount of frictional forces generated”.

Laser Vaginoplasty, Questions and Answers (Repeat Text)

2008-01-08T05:00:00.000-08:00

Dr. David Matlock is the undisputed leading surgeon for vaginoplasties and laser rejuvenations, having pioneered these procedures over a decade ago. While few women openly discuss vagina-related cosmetic issues, many women wonder about how they can enhance the aesthetic look of their vaginas and increase sexual gratification. In this interview, Dr. Matlock discusses a wide variety of vaginal cosmetic procedures that treat all common imperfections (see full description of procedure options at end of interview)…giving women hopes everywhere.
MMH: What is vaginoplasty and what problems and imperfections does it address?Dr. Matlock: At the Laser Vaginal Rejuvenation Institute we perform two categories of procedures, laser vaginal rejuvenation (LVR) for the enhancement of sexual gratification and designer laser vaginoplasty (DLV) for the aesthetic enhancement of the vulva structures. LVR is primarily for women who have had children and as a result of childbirth they are experiencing vaginal relaxation. This vaginal relaxation results in decreased sexual gratification for the female. LVR enhances vaginal muscle tone, strength and control. It also decreases the internal and external vaginal diameters and builds up the perineal body (the area outsets the vagina and above the anus). DLV consist of numerous aesthetic procedures of the vulvar structures. The most requested is laser reduction labioplasty of the labia minora. The laser procedure sculptures down the labia minora. Women state that they don’t want the labia minora to project beyond the labia majora (large outer lips). We can perform most anything one desires of the vulvar structures (reduction of the labia majora, liposculpturing of the fatty mons pubis and labia majora, autologous fat transplant to the labia majora to enhance them, correct deformities, combination procedures (LVR plus DLV).
MMH: Please discuss the different types of vaginoplasty procedures and what problems and imperfections each treats (i.e. laser reduction labioplasty, augmentation labioplasty, reduction of prepuce).Dr. Matlock: Women want the skin of the clitoris to hug it like a piece of paper is draped over a pencil; this can be done via reduction of the prepuce [excess skin along the sides of the clitoris]. The majority of women have this done with the laser reduction labioplasty of the labia minora., vulvar labioplasty, etc.).
MMH: Which of these procedures is the most common?Dr. Matlock: The most common DLV procedure is laser reduction labioplasty of the labia minora.
MMH: Please describe how the procedure is performed as far as incisions, anesthesia, and other technical details. How long does a vaginoplasty take to perform?Dr. Matlock: LVR is a one hour outpatient laser surgical procedure. One can have their choice of anesthesia from local to general anesthesia. Everyone gets a special block which results in an 18 to 24 hours pain free period after surgery. You can return to work in 7 days and get back to the gym in 2 to 3 weeks. Sex can be resumed in 6 weeks. The laser is used to perform all the cutting and dissecting. The muscles are tightened with sutures. I have treated patients from all 50 states and over 30 countries. Most patients say that they want to be like 16 or 18 years old again. With LVR we can accomplish this. In our DLV procedures the laser is used to perform all the cutting. The same above info also applies to DLV.
MMH: How is the future of vaginoplasty looking and are there any innovations on the horizon that can improve the aesthetic outcome of the procedure?Dr. Matlock: I pioneered and developed LVR and DLV eleven years ago. To date I have treated Patients from all 50 states and over 30 countries. I have 140 surgeons (gynecologist, plastic surgeons, and urologist) trained in my trademarked techniques in over 21 countries. The future of this field is bright. I have just developed a new procedure called a lip/tuck where I lift the sagging vulvar structures. I am also just launching my G-Shot procedure (G-Spot Amplification). This procedure amplifies the G-Spot and enhances sexual gratification.
MMH: When did vaginoplasties start to become popular?Dr. Matlock: The procedure became really popular 11 years ago.MMH: Is there a specific age range for a woman seeking a vaginoplasty, or can a woman of any age have a vaginoplasty? Please specify if there are any ages of patients beyond which or before which one should not have a vaginoplasty?
Dr. Matlock: My patient population is 20s to 40s.
MMH: Are there any special considerations for women who intend to be pregnant as far as when a vaginoplasty is safe to have?Dr. Matlock: With DLV there is no problem if one wants to become pregnant. With LVR the pregnancy can damage the LVR. These patients can have a C/S. This is rare and most patients for LVR have completed their family.
MMH: What types of doctors (i.e. gynecologists, urologists, or plastic surgeons) typically perform vaginoplasties?Dr. Matlock: All the ones you mentioned are good choices.
MMH: Who do you think are the best qualified to perform vaginoplasties?Dr. Matlock: LVR-gynecologist; DLV gyn and plastics.
MMH: What should a patient desiring a labioplasty look for in a physician?Dr. Matlock: Training in the techniques and experience.
MMH: How long do the results of a vaginoplasty last? What can a patient expect 4-5 years and then 10 years after a vaginoplasty?Dr. Matlock: For LVR as long as they don’t have children they should be fine. The cause of the problem in the first place was children.
MMH: How is the recovery like from the various types of vaginoplasties?Dr. Matlock: The patients can return to work in one week. They can resume sex in 6 weeks. The main post operative symptoms are mild swelling and pain which is controlled by pain meds.
MMH: What symptoms can a patient expect to have (i.e. bruising, swelling, numbness) and for how long do they persist?Dr. Matlock: The majority of the discomfort is gone in 7 days.
MMH: Can a patient walk, sit, or use the bathroom easily following a vaginoplasty?Dr.Matlock: The patient will walk into surgery and after the recovery period in the recovery room she will walk out. These are outpatient procedures and the patients can ambulate immediately.
MMH: Can a patient experience permanent loss of sensation following a vaginoplasty?Dr. Matlock: No.
MMH: What are the risks associated with a vaginoplasty?Dr. Matlock: The risks are bleeding, infection (these are the main risk and they are less than 1%); hyposensation, hypersensation, scarring, uncomfortable sex. These are safe, bloodless outpatient procedures with very low risk and high satisfaction.MMH: Are there any scars following a vaginoplasty?Dr. Matlock: No.
MMH: Are there physical exercises, personal care products and routines for the vagina that can help reduce its aging process?Dr. Matlock: Not really. It is a good idea to maintain a normal weight (ideal weight).
MMH: What level of improvement in sexual gratification can a woman expect from vaginal rejuvenation? Does the partner of the woman also benefit from this procedure?Dr. Matlock: Our primary concern is to enhance sexual gratification for the woman but it also enhances sexual gratification for the male.

What is Vaginal Rejuvenation? By Red M. Alinsod, M.D., FACOG, FACS, ACGE

2008-01-08T04:51:00.000-08:00

One of the fastest growing segments of cosmetic surgery is female genital surgery. Many phrases are used to describe what is surgically done and the catch-all phrase lay people have seen with increasing regularity is “vaginal rejuvenation.” The branded name “Laser Vaginal Rejuvenation” has even gained national attention in print and television. In reality, vaginal rejuvenation is a marketing term referring to vaginoplasty, or the surgical tightening of the vaginal canal. Birth trauma, tissue stretching, and improper surgical healing are the usual reasons for requesting vaginoplasty. Vaginoplasty usually entails a modification of a standard gynecologic procedure called “posterior repair” along with rebuilding of the perineum (the space between the vagina and rectum). This procedure was traditionally performed for a fallen or prolapsed rectum, or rectocele. A rectocele is a bulge of rectum going into the vagina. A similar appearing vaginal bulge is an enterocele. It is a bulge of small bowel going into the vagina. Gynecologists and urogynecologists have the most training performing these types of surgery. Lasers, scissors, cautery units, knives are used in surgery. Excellent results have been achieved by all these methods.

Another surgery rapidly gaining social acceptance and widespread growth is labiaplasty. This is when the labia minora (the “minor lips”) are sculpted to look more pleasing and less prominent. The usual reasons for having this surgery done are complaints of large and unappealing labia minora. Many complain of pain and irritation from pulling and rubbing caused by wearing tight clothing, horseback riding, and sexual intercourse. Teens and young women complain of the inability of wearing swimsuits for fear of their labias protruding out and causing severe embarrassment. At times, the labia majora can also be altered by excision of excess tissue, resurfaced and shrunk with CO2 lasers, or injected with fat to make it look more plump and appealing. Others want liposuction done in this area and also above it in the Mons Pubis to make the region less prominent. Labiaplasty and vaginoplasty have been referred to as a “vaginal face-lift.” Gynecologists have performed these procedures for years. Plastic surgeons have recently showed interest in this rapidly growing ultra-sub-specialty surgery.

Modern pelvic and vaginal surgery often requires the use of strong new materials to replace loose and damaged tissues. Urogynecologist are usually the specialists with the most advanced training in these types of advanced repairs. Vaginoplasty typically takes about 60 minutes to complete depending whether or not a rectocele or enterocele has to be repaired and if mesh or tissues are used to repair the vaginal hernias. Labiaplasty takes about 60 minutes to perform. A combination of both surgeries will take two hours to finish. A full pelvic reconstruction involving mesh or tissues will take three hours.

In recent years reconstructive pelvic surgeons and urogynecologist, with specific training in pelvic and vaginal surgery, have popularized these aesthetic genital procedures and have helped provide it legitimacy. It was only several years ago when cosmetic vaginal surgery was attacked vigorously by many medical practitioners as barbaric, unnecessary, and frivolous. However, baby boomers drove the acceptance of these procedures and fueled the growth of this subspecialty. Women did not want to live with unflattering, sagging, and large labias, nor did they want to live with gaping open vaginas and lack of sensation when having sexual relations. Both young women wanting a sleeker appearance of their genitals and older women wanting to repair the ravages of childbirth and time are in the forefront of demand to look and feel young again. Southern California became the birthplace of this movement.

There is great controversy whether or not vaginal rejuvenation can improve the pleasure of intercourse or increase sexual desire. There are no randomized controlled studies showing that narrowing the vaginal canal improves orgasms or dramatically alters a woman’s sex life. Reports of improved sexual sensation from increased friction are by anecdotal experience and less scientific surveys. However, many couples do report more satisfying lovemaking, more tightness, and a belief that surgery has helped their sex lives.
There are only a handful of surgeons who perform these surgeries in adequate volumes to be proficient and adept. Technical skill is of paramount importance but having an artist’s eye is of equal value. The cost of a vaginoplasty is approximately $6,000 with labiaplasty commanding a $5,000 price tag. Combining the surgeries will average $10,000. Insurance companies do not typically cover labiaplasty and vaginoplasty. However, repair of cystocele, rectocele, enterocele, fallen uterus, and slings for incontinence are usually covered by medical insurance. Cosmetic labiaplasty and vaginoplasty can be combined with pelvic prolapse repair at the same time. Some women even have their tummy tucks and breast augmentations done concomitantly as part of their “extreme makeover.”

Medical Study Case:Colpectomy After Vaginoplasty inTranssexuals

2008-01-03T11:03:00.000-08:00

From the Departments of Plastic and Reconstructive Surgery and Pathology, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.
Address reprint requests to: J. Joris Hage, MD, PhD Antoni van Leeuwenhoek Hospital Department of Plastic and Reconstructive Surgery Plesmanlaan 121 NL-1066 CX Amsterdam The Netherlands E-mail: j.jorishage@inter.nl.net
Background: Penile amputation, vaginoplasty, and clitoroplasty help male-to-female transsexuals accept their bodies and increase psychosocial function. Subsequent colpectomy is unusual.
Cases: We report three patients in whom complicated, long-term problems subsequent to vaginoplasty led to total colpectomy in one case of neovaginal overgrowth of condylomata acuminata, and in two cases of colitis in rectosigmoid transplants used for neovaginoplasties.
Conclusion: Before inversion of penile skin, in cases in which the genital skin has condylomata, the risk of condylomata overgrowth might be anticipated. Rectosigmoid vaginoplasty might result in therapy-resistent colitis, which also could lead to colpectomy.

Genital Surgery

2008-01-03T10:05:00.000-08:00

Women and even men may want to have their genitals changed. In women it is usually vaginal surgery, surgery of labia minora and majora and the hymen reconstruction surgery.

Genital Surgery
Vaginoplasty
Labiaplasty
Labia minora
Labia majora
Hymenoplasty – Hymen reconstruction surgery
Vaginoplasty
In general it represents modification of female vagina. Most frequent procedure is the narrowing of vaginal opening, eventually specific narrowing of the vagina, which can lead to its partial firmness.
The aim of the surgical procedure is to return, eventually enable better sexual life to the patient.
This surgery is usually performed in women of middle age that gave birth already and when it came to loosening of vagina and vaginal opening caused by deliveries and increasing age.
The procedure is performed under general anesthesia, it lasts usually 45 minutes. It is performed with following technique: In the area of vaginal opening, on its back side, an excision of a tissue in various extents (according to the wish of the patient, anatomical finding and so on) is made. Then the wound is sutured. It is better to make the extent of the excision bigger and therefore narrow the opening more because consequently during the life it is usual that the vaginal opening widens again slightly.
If the incision is expanded even to the back vaginal wall and into different distances, we can contract the whole vagina like this. This surgery is also performed under general anesthesia, it lasts around 1, 5 hours.
The surgery does not involve only the mucosa, but it intervenes even into the muscle layer of vaginal wall. At first the vaginal mucosa is excided in needed (chosen) extent, next the muscle layer of vagina is firmed and shortened and the last phase of the surgery is to suture the vaginal mucosa. The same is valid about the extent of the excision as it is mentioned in correction of vaginal opening. During this surgery a big prudence and experience of the surgeon is necessary because of the near vicinity of vagina and terminal part of colon to prevent the creation of so-called rectovaginal pouch.
Both methods of the surgeries use absorbable suturing material, we do not recommend sexual intercourse, sometimes even for 6 weeks.

Labiaplasty
Labia minora
This term means surgical modification of inner and outer lips in women.
The labia minora in women often protrude between the labia majora and many times reach unbelievable size. The aim of the surgery is to reduce such protruding inner lips, sometimes even almost completely remove. According to their function we do not recommend their total removal.
The surgery is not usually difficult, it can be performed even under local anesthesia, analgosedation, or eventually under general anesthesia. We use absorbable material and we do not recommend a sexual intercourse for about one month.

Labia majora
Atrophic labia majora, when the fat tissue and elasticity reduce in time and therefore the labia loose their fullness.
There are several ways of solution:

Filling of labia with own fat. The procedure is usually often repeated because own fat can be very soon absorbed according to the frequency of sexual activities.
Another method is the skin reduction of labia majora, when the incision is usually made in the inner side to labia minora.
The combination of both methods.
It is possible to perform all the surgeries even under local anesthesia, although it is better under analgosedation or general anesthesia.
Hypertrophic (excessively large) labia majora
Most often in young women, there are also several ways of solution:

D Magazine Story on Laser Vaginal Rejuvenation, Laser Reduction Labioplasty and Hymenoplasty

2008-01-03T09:35:00.000-08:00

Dallas women are—ahem—opening up to a plastic surgery procedure that some doctors are calling the new boob job.
It’s gotta be a joke. That’s what Shay Gibson thought. Her husband called from the road one night last spring, saying he’d heard a comedian on the radio talking about a plastic surgery that tightens vaginal walls. “I thought there’s no way the procedure can be real,” Gibson says. But, with her interest piqued, she turned to the Internet. That’s where she learned it wasn’t a joke—and that this wasn’t the only operation, either.

Gibson, a 28-year-old mother of three who lives in Dallas, could also have her labia trimmed or even her hymen reattached. Doctors across the country regularly perform the surgeries. And the more web sites she visited, the more FAQ pages and testimonials she read, the more, actually, Gibson thought an operation could be right for her.

Truth was, sex for her had become less enjoyable after the kids were born. She couldn’t feel her husband as much. “I thought, ‘Why not do it?’” Gibson says. Her husband agreed.

She flew to San Antonio last July, where she met Dr. Troy Robbin Hailparn at the Laser Vaginal Rejuvenation Institute. Hailparn is one of two doctors in Texas performing the surgeries—the other’s in Pharr—and the only woman using the laser for these procedures anywhere in the country. Gibson had her vaginal walls tightened and, for appearance’s sake, her labia trimmed. The procedure took a little over an hour. She flew home the next day.

The healing process took two months, but it was worth it. Gibson won’t soon forget the first night back with her husband.

He screamed, “This was so worth the $10,000!”

CALL IT, AS ONE PLASTIC SURGEON DOES, THE SEARCH FOR “designer vaginas.” Call it, as many people do, vanity run amok. The truth is, there’s a growing number of women who want to look like a porn star or feel like a virgin, or who want their sex lives restored or childbirth-induced incontinence cured. There are about a dozen doctors across the nation who perform these laser vaginal rejuvenations. And, no surprise, some of their clients come from Dallas. The laser vaginal rejuvenation, some doctors say, is the new Botox. Heck, the new boob job.

But there are no nationwide statistics kept on the number of such surgeries. The LVRs are too new for that. Dr. V. Leroy Young, head of the American Society of Plastic Surgeons Emerging Trends Task Force, first heard about the surgeries three years ago. He thought then they were a fad. He doesn’t now. He’s noticed the proliferation of ads in magazines and on billboards, and the web sites that have popped up, even the discussion of laser vaginal rejuvenation on Dr. 90210, a reality show on E!. Young says that he hopes to have relevant stats by the end of the year.

It’s about time, Hailparn says. The labia surgeries she performs at her clinic have tripled from two years ago, and the vaginal tightenings have doubled. “I’ve done hundreds of these in the past two and a half years,” she says.

Naturally, not everyone’s pleased business is booming. Some feminist bloggers and authors say LVR is female objectification; at worst, they liken it to genital mutilation. More locally, Charles Curran, a professor of human values at SMU’s Perkins School of Theology, calls the surgeries “just as rank” as anything else society faces today. And the American College of Obstetricians and Gynecologists, while withholding a formal opinion of the surgeries, aired several “concerns” about them in a 2004 letter, namely how the surgeries are marketed to the public, labeled within the medical community, and taught to other surgeons.

Indeed, business booms for people like Hailparn because so few doctors are willing to perform the surgeries. The controversy surrounding them is too great. “I think it’s seen as kind of a vain thing,” Young says. Too vain for plastic surgeons? “The sexual aspect of it is what makes it a little more taboo.”

And we still have yet to talk about what’s most taboo, the hymen repair. Yes, you, too, can have your hymen reattached (well, if you’re a woman). Shay Gibson opted out of that procedure. But Jeannette Yarborough didn’t. She’s a medical assistant from San Antonio and she went to Hailparn to have her vaginal walls tightened and her “virginity restored” as a gift to her husband on their 17th anniversary. “It was the ultimate gift that I could give him,” Yarborough says.

Though Hailparn doesn’t do too many hymen repairs, Dr. Marco Pelosi does. He’s a gynecologist in New Jersey who’s performed hymenoplasties for 30 years. Until recently, the women requesting them came from Middle Eastern cultures in which punishment for an impure bride was, in some cases, stoning. Today, though, most women requesting the surgery are upper-middle class, largely white, coming from all over the world (and, yes, Dallas, too, Pelosi says, though D could not reach any former clients), and they are having the procedure for reasons similar to Yarborough’s. Pelosi now does 10 hymen repairs a month, up from two a decade ago.

“I say it will be a one-night deal,” Pelosi says. “But the women say, ‘I don’t mind.’”

Thomas G. Stovall thinks it’s all bunk. A past president of the Society of Gynecologic Surgeons, he told the Wall Street Journal surgeries to improve one’s sex life rarely work and “hymen repair is a totally bogus procedure.” Jeannette Yarborough disagrees. She says Stovall should ask her husband if he thought the hymen repair was bogus. And as far as the sex goes, both she and Gibson say it is “incredible” now.

In any case, none of this comes cheaply. A hymen repair costs about $5,000, roughly the same price as a vaginal tightening and a labia trim. To have two surgeries performed, as both Gibson and Yarborough did, can cost as much as $12,000. Financing in some cases is provided through the clinic. But, still, $5,000 for a surgery that will be undone by morning? Twelve thousand dollars for surgeries that insurance won’t cover?

“This can be a relationship saver,” Hailparn says. She says the surgeries are borne, more times than not, out of marital unrest. After childbirth, “no one is talking to women about the sexual intercourse,” she says. “Ninety-nine percent of my patients say their OB-GYN isn’t asking about it.” Women have been taught to accept a frustrated sex life, Hailparn says. Or a mid-life filled with pain (because some pants chafe too much) or embarrassment (because some pants reveal too much). “It doesn’t have to be that way,” Hailparn says.

Shay Gibson agrees. “I think every woman should have it,” she says.

Dr. David Matlock, the pioneer of vaginal rejuvenations, who now does 500 a year in Los Angeles and teaches other surgeons how to perform them, offered the procedures 10 years ago “as a result of listening to women,” he says. And he’s kept listening. If a woman is pressured into a surgery, he won’t do it. (Hailparn and Pelosi say they won’t, either.) But now women want more than the perfect vagina, Matlock says. So he’s had to work harder. He’s already patented one idea, even tested it on eager women who enjoyed the results in their yoga and spin classes, or driving over cobblestone streets. Matlock says the product will hit the market this summer.

It is a collagen-based g-spot enhancement.