Increase in 'vaginal tightening' surgeries worries doctors

It was shortly after “Linda” had her fourth child that she decided she wanted to see a plastic surgeon. After marrying at 19 and spending her 20s caring for others, the 34-year-old felt she finally wanted to do something just for herself. So six weeks ago, she had her vagina tightened.

After talking to a close friend who had undergone vaginal tightening surgery, Linda felt assured the procedure could be a simple way to give a boost to her sex life.

“My friend said it had made a big difference and that she could feel more, sexually. So she really convinced me,” she told CTVNews.ca.

Like Linda (not her real name), a growing number of women are undergoing “vaginal rejuvenation” surgeries, not to repair injuries or treat conditions, but to enhance their sex lives.

Comedienne Ai Ai de las Alas recently made a splash in her native Philippines by announcing she had undergone a vaginal tightening. While offering her endorsement to the chain of plastic surgery clinics where she had the surgery done, the 49-year-old boasted that the procedure left her feeling “like a virgin… very, very tight.”

Dr. Jamil Ahmad at the Plastic Surgery Clinic in Mississauga, Ont. says his clinic has seen a huge spike in demand for genital surgeries over the last five years. Most of the requests are for labiaplasties, but Ahmad says his clinic also does one to two vaginal tightening procedures every month.

“Requests for both continue to grow. And I think that is due mostly to awareness by women that there is a procedure for this,” he said from his clinic. “And I anticipate this will grow, just like the evolution of breast enhancement surgery.”

While women with serious vaginal problems, such as uterine prolapse or urinary incontinence typically turn to gynecologists for help, Ahmad says women come to plastic surgeons like him for more personal reasons.

“They feel that they are loose ‘down there,’ they feel that their intimate life isn’t the same as it what it was before childbirth, that’s typically when they come to see us,” he says.

The procedures will be a topic of discussion in a scientific session entitled “The Ideal of Perfect - Genital Cosmetic Surgery” next month, when the Society of Obstetricians and Gynaecologists of Canada meets for its annual conference.

The SOGC has already outlined clear reservations about vaginal tightening in clinical practice guidelines released last December. In those guidelines, the group noted a lack of evidence that vaginoplasties are safe, either in the short or long term, or that they can improve sexual satisfaction or self-image.

They also expressed worries that many women were being coerced into genital surgeries, and noted the risks of the procedures, including infection, scarring, decrease in sexual pleasure and increase in pain during intercourse.

But with hundreds of “vaginal enhancements” being performed every month, Dr. Ahmad feels assured about safety. He agrees there aren’t many long-term studies on vaginal tightening and other procedures, and he wishes more of his colleagues would publish. But he says many areas of medicine proceed without a wealth of good studies to back them up.

“Really, for a lot of things we do commonly in medicine and surgery… we accept a standard of care where there’s actually not much good, comparative data,” he says.

When doctors are asked ask about these procedures, the SOGC wants them to remind patients that there are many normal variations among female genitals and that changes to the vagina with age and after childbirth are normal.

But Dr. Ahmad takes issue with the notion that women should essentially be told to accept their bodies the way they are.

“That’s the same kind of thing they said decades ago when women started having breast augmentation,” he says.

“From our perspective, this is about women making a conscious decision to improve something that’s bothering them. It’s about women having the right to choose what they do with their bodies,” he says.

“I think we should be advocates of women’s health, to educate them about their options and not shame women who are unhappy with something about themselves.”

While the SOGC advises doctors not to promote the surgeries as a way to enhance sexual function, Ahmad says that’s precisely what many of his patients report the procedures do for them.

“Patients frequently come back saying they feel great, they’re so happy, they’re happier with that part of their life (their sex lives),” he says.

“Now whether that’s to do with the operation, or their improvement in self-confidence and body image, I think it’s all a combination… When they look better, they feel better. It improves their self-confidence and their quality of life.”

As for Linda, she’s still waiting for the all-clear from her doctor to return to sex with her husband. But she says she never really worried too much about the risks. In fact, within a week of her first consult with Dr. Ahmad, she decided to go ahead with the procedure, in the hopes of giving her sex life a boost.

“I just thought if things could be better sexually, well then, ‘Why not?’”