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Cosmetic Gynecology

Physicians have neglected aesthetic surgery of the female external genitalia. However, awareness of female genital aesthetics has increased owing to increased media attention, both from magazines and video. Sometimes the way a woman feels about the look and sensation in her vagina and pubic areas can mean devastating effects on her life. Women may feel self-conscious about the appearance of their labia majora (outer lips) or, more commonly, labia minora (inner lips), particularly as age sets in and the labia become stretched and saggy. The vaginal cavity can also be stretched due to the effects of childbirth and aging, resulting in decreased sensation during sexual intercourse. The aging female may dislike the descent of her pubic hair and labia. A large pubic fat deposit may be unsightly. It can threaten her self-esteem, reduce her sexual desire, and ruin her intimate relationship and love life. . Women may feel self-conscious about the appearance of their labia majora (outer lips) or, more commonly, labia minora (inner lips). Plastic surgeons are in a unique position to do something about that.

Aesthetic female genital surgery is designed to improve the appearance subjectively, and potentially provide psychological and functional improvement in sexual stimulation and satisfaction. That’s why more and more number of women is now seeking cosmetic vaginal surgery to recreate sexual excitement, restore self-esteem and rejuvenate their love lives.

 What is Female cosmetic genital surgery (FCGS)?

Female cosmetic genital surgery is the term given to a group of surgical procedures which are performed to improve the aesthetics of female genitals. Cosmetic Gynecology can be performed for any reason from tightening up the vagina to trimming to labia and increasing the sensitivity of the female g-spot. It is highly specialized branch of cosmetic surgery which enhances the vaginal area. In recent years, the most commonly performed female genital procedure is Hymen Repair or Hymenoplasty or revirgination; in which the thin membrane that covers vaginal opening is restored to its original shape to give you a virgin appearance. It is common for women to want to have the inner labia reduced, especially if they protrude farther out than the outer labia.

Although not much talked about, these procedures are very popular and lead to very satisfying results.

We know that having cosmetic genital surgery is a very private decision. We maintain a strict non-disclosure policy for your privacy and protection.

There are several procedures that come under the term FCGS. They include:

Hymenoplasty or Revirgination

"I didn't care about it but I come from a conservative family. I couldn't tell my parents that I am not a virgin. My parents have arranged my marriage. So I chose to get this surgery done," a 23-year-old, who has recently got the surgery done, told us.

Once lost, virginity can never be replaced — but modern medicine now offers women a near-perfect physical simulation of their lost innocence. The hymen is a thin, delicate membrane (a membrane is like skin but much thinner). It partially covers the opening of the vagina in most girls. The hymen is named after, the god of marriage in classical Greek mythology, Hymenaeus. Hymenoplasty, the surgical reconstruction of the hymen broken during a women's first experience of intercourse, or, increasingly, during demanding exercise or as a result of a collision or fall by women who've never had sex, has prompted a growing number of young betrothed women  to make a last-ditch attempt to avoid the humiliation, repudiation, and possibly violence that could result from husbands and families discovering from blood-free bridal sheets that their wedding night had not been their first sexual experience.

Hymenoplasty or hymen reconstruction surgery is the surgical restoration of the hymen, which has been torn in tags after multiple intercourses. It is also known as hymenorrhaphy. Usually the aim of hymenoplasty get done aim is to cause bleeding during post-nuptial intercourse, which in some cultures is a considered proof of virginity. A woman would like to restore a more intact, tighter hymen ring and experience vaginal bleeding and pain with the first sexual intercourse. Using a special surgical technique Dr. Goyal performs hymen repair to tighten and restore the hymen to a more intact, virgin like state. In most cases the hymen repair is virtually undetectable after complete healing and our patients have been extremely pleased with Dr. Goyal’s very natural looking hymen repair surgery results. Dr Goyal customizes the surgery to the individual needs and expectation of the patients.

The Procedure

 This surgery is performed preferably 8-12 weeks before the intended marriage. Patients are advised to refrain from penetrative sex for up to three months following this procedure.  Typically, the procedure takes 1 to 2 hours and is performed under local anesthesia as a day care procedure. Some patients prefer the addition of IV sedation or even general anesthesia. Using a surgical technique, the torn edges of the hymen are put back together. Very fine invisible sutures are applied from the inside to repair torn hymen. These sutures are dissolvable and get absorbed within 2-3 weeks time. If done correctly, to the visible eye, there is no apparent scarring and the hymen appears intact. After this type of hymen surgery and without complication, subsequent intercourse will typically tear the membrane causing pain and bleeding.
You will go home after surgery; there is no need for an overnight stay in the hospital.

 The social function of the hymen, however, has been and still is a mythical symbol of virginity in
many cultures

Recovery

Once the Hymenoplasty procedure has been done, it is very important to take care of yourself. You need to make sure to keep the vagina extremely clean to help avoid any kind of dirt particles from settling in the stitch wounds. Avoid lifting heavy objects and housekeeping work for at least a week, as this will bring pressure on the entire vaginal area. Avoid heavy and strenuous work during your recovery.

Labiaplasty

Labiaplasty / 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 or during sports or during sexual intercourse. This involves surgery to the labia minora (inner lips) and less frequently, the labia majora (outer lips). It generally involves reducing the size of the inner lips so they do not protrude below the outer lips. It is also used to correct asymmetry of the lips. Functional indications include: discomfort in clothing or during sports, dyspareunia due to invagination of the labia on

penetration can be another functional reason but an increasing number of women seek this kind of surgery purely for aesthetic reasons.

The procedure is simple, performed under local anesthesia as a day care procedure.  An area of the labia minora is removed using a variety of incisions and takes 1 to 2 hours. You will go home after the surgery; there is no need for an overnight stay in the hospital. Careful placement of the scar is important, however, in order to prevent painful scar contracture along the rim of the labia. We have refined this technique over the years to safely reduce the size of the labia majora by excising a crescent shaped portion of the inner portion of the labia majora. The scar is hidden in the crease between the inner and outer labia.

             When there is a volume excess, the enlarged labia majora can be reduced by liposuction. However, this might create sagging and skin excess. In case of skin excess due to volume loss, a reduction of the labia majora can be performed using a longitudinal wedge excision of the excess tissue with the incision along the length of the labia minora.

Vaginoplasty

Vaginal tightening surgery has been around since the mid fifties, where gynecologists used to tighten the entrance of a woman's vagina with an extra stitch while repairing vaginal and perineum tears or episiotomies after giving birth. At that time it was notoriously known as the “husband's stitch,” the “husband's knot,” or the “vaginal tuck,” and doctors discreetly referred to this procedure as “improving a woman's well-being.”

Vaginoplasty also referred as vaginal tightening or vaginal rejuvenation, involves tightening the inside of the vagina and the vaginal opening by removing excess tissue from the vaginal lining. It effectively results in a vagina with a smaller diameter. Vaginoplasty is often promoted as a solution for women who have experienced a loss of vaginal tone due to childbirth.  The goal of these procedures is to reconstruct (or to narrow) the lower third of the vagina, which includes “the orgasmic platform, internal and external vaginal diameter (introitus) and the perineal body.”Vaginoplasty can enhance sexual gratification for women who for whatever reason lack an overall optimum architectural integrity of the vagina.

Vaginoplasty can also be performed as reconstructive procedure for correcting the defects and deformities of the vaginal canal or congenital absence of vagina (vaginal atresia) or because of an acquired cause (e.g. trauma, cancer).

The procedure usually performed under general anaesthesia, may be as simple as placing sutures at the introitus (vaginal opening), or may involve excising excess vaginal mucosa together with tightening the muscles of the posterior vaginal wall. Neovaginoplasty may involve taking skin from your thigh & creating a new vagina through it.

Labia majora augmentation

This procedure seeks to plump up the outer lips by injecting them with fatty tissue taken from another part of the woman's body. As women age, after childbirth or with weight loss, the labia majora may undergo a significant atrophy and the dermis under the skin thins out. As a result of these changes the labia majora becomes shrunken, flat, saggy, wrinkled, and darkened. The surgeon can drastically rejuvenate the labia majora with micro fat grafting. The fat injections add fat to the areas beneath the skin, creating fullness where needed that results in a lasting, youthful appearance of the labia majora.

Pubic liposuction and lift

A woman may have unsightly fat deposits in her pubic region, which causes a bulge in clothes. Usually the fat can be eliminated by liposuction - this is called pubic liposuction. Aging or weight gain may cause the pubic and vaginal regions to descend, resulting in an aged appearance. These areas can be rejuvenated and lifted by excising excess skin above the pubic hair and removing excess fat in the pubic region. The pubic liposuction and pubic lift procedure may be combined with a tummy tuck.

G-Spot Augmentation

The G-spot or Gräfenberg spot was first described in the 1950s as a highly erogenous zone inside the vagina that enlarges when directly stimulated. The erotic zone can be found on the anterior wall of the vagina along the course of the urethra. Although the location varies, the G spot is typically located about half way between the pubic bone and the cervix, ~2 to 5 cm into the vagina 

G spot augmentation is believed to enhance the sexual stimulation to the G spot through increased projection of the G-spot into the vagina (3–5 mm). In a nonaugmented state, the G-spot lays beneath the surface of the vaginal wall and needs to be stimulated indirectly, when projected into the vagina the G spot is more accessible for stimulation.

The augmentation is performed by collagen or hyaluronic acid injections under local anesthesia. It is an office procedure where the patient first indicates the right zone to be augmented by palpation. The effect of the current bulking agents is not permanent because of resorption; it usually lasts for 6 to 9 months.

Clitoral hood reduction

This simple procedure involves reducing the hood of skin which surrounds the clitoris, exposing the head of the clitoris that lies underneath. A clitoral hood reduction is aimed at providing more stimulation, therefore, heightening a woman's sexual pleasure. The procedure is also known as hoodectomy or female circumcision.

Your Recovery

After surgery, you will wear a menstrual-type pad to absorb any little drainage and to provide padding and protection to the area. You can expect some swelling and discomfort for 1 to 2 weeks. Most women return to work in 1 to 3 days, and sutures are dissolvable. Strenuous activity and exercise should be avoided for 3-6 weeks, and you should not use tampons, douches, or have intercourse for 6 weeks to allow the surgical area to heal properly.

Expected Result

The majority of women are thrilled with their new, more aesthetically desirable appearance after Vaginal Rejuvenation, and are more confident, comfortable, and sexually active.

Sex Reassignment Surgery

            As you were growing up, how did you know you were a girl or a boy? Was it because you had a female or male organ (vagina or a penis)? Or was it something other than what your body looked like? Some people feel that their minds and bodies don't match up. This feeling is commonly known as gender identity disorder or gender dysphoria. The medical community used to use the word "transsexuals" to describe this community. But today, "transgender" is used as a general, non-medical term to describe anyone whose gender identity is different from their physical sex at birth.

Transgender people often wish to live as a different gender than the one they were assigned when they were born. They may transform their bodies through Sex Reassignment Surgery, also known as gender reassignment surgery or gender confirmation surgery or sex change surgery- 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.

Gender identity struggles usually begin in early childhood but have been identified in people of all ages. A biologically born man who identifies as a woman is known as transwoman, or transgender woman. A biologically born woman who identifies as a man is known as transman, or transgender man. There are also people whose identity lies somewhere along a spectrum of gender that may refer to them as neither male nor female.

 Prospective candidates for gender reassignment surgery must work with a mental health professional for diagnosis. However, the mental health professional additionally provides counsel about treatment options and implications as well as therapy and education for the individual, his or her family and employers.

After a diagnosis, there are three phases left for patients undergoing surgery:

  1. Hormone therapy
  2. Real-Life Experience, also known as the Real-Life Test
  3. Surgery to change genitalia and other sex characteristics

In addition to diagnosing patients and providing counsel, mental health professionals also assess a person's eligibility and readiness for hormone therapy and surgery. Not all transgender people need all three phases of therapy; each path to gender reassignment is tailored to the person. And, as we've noted before, not all transgender people undergo surgery. After a patient meets these criteria and undergoes a basic physical examination, a physician will then prescribe hormones.

Androgens are given to biological females transitioning to male. Estrogen, progesterone, and testosterone-blocking agents are given to biological males transitioning to female. Hormones are taken orally, by injection or transdermally (a patch).

The Real-Life Experience immerses the individual into life as his or her preferred gender. The candidate is required to maintain full or part-time employment (or attend school full or part-time), legally change his or her first name to one that is gender appropriate and prove that people other than the therapist and doctor know his or her desired gender.

After 12 months of continuous and successful hormone therapy and Real-Life Experience, the individual is eligible for genital surgery. Two letters of recommendation, usually one from the mental health professional and one from the hormone-prescribing physician, are required for surgery.

Male to female (Trans female)

The procedures involved systematic excision of penis & testicles, Creation of neo-vagina using penis skin, creation of labia majora & labia minora by scrotal skin and creation of clitoris by de-bulked sensate flap of glans penis. Breast implant (Silicone cohesive gel or expander implant) completes the procedure. Though the surgery can be performed in single or two stages, but few further stages may be required to fine-tune the result or to perform procedures like reduction thyroid chondroplasty, suction-assisted lipoplasty of the waist, rhinoplasty, facial bone reconstruction, hairline correction, forehead recontouring, brow lift, cheek implants, lip lift, lip filling, chin recontouring, jaw recontouring and blepharoplasty. Some patients have laser hair removal, vocal cord surgery or voice training.

Female to male (Trans male)

F to M is more complex and complicated procedure than M to F. Genital surgery for female-to-male patients may include excision of breast, hysterectomy, salpingo-oophorectomy, vaginectomy, metoidioplasty, scrotoplasty, placement of testicular prostheses and phalloplasty (the creation of a neophallus or surgically constructed penis). A transman may also undergo elective surgeries like liposuction to reduce fat in hips, thighs and buttocks, placement of penile implants for penile erection.  

These all surgeries are performed in stages. A gap of 4-6 month is required in between each stage for proper healing of the areas.

It's generally reported that transgender people who have undergone these surgeries are, in almost all cases, happy they did so. And while there may be a few, who regret their decision.