The Rejuvenated Vagina

I was talking to one of my young patients the other day during an annual exam, and she asked me what she could do to strengthen her vagina.  I reviewed Kegel exercises and she said that she had already done those and that her vagina still didn’t feel “as tight as it used to be before I had my daughter”.  So we had the conversation about how childbirth can cause permanent changes to the pelvic floor and how her exam was actually completely normal.  She did not seem too pleased with this information, and said “Well, I can always get one of those vaginal rejuvenation surgeries done, right?”

So arises the topic of vaginal rejuvenation, which is something that patients are asking me more and more about these days.  What exactly is this?  You know it is a hot topic when there is a Wikipedia entry about it.  According to Wikipedia: “Sometimes referred to as "vaginal rejuvenation”, “aesthetic vaginal surgery” or “cosmetic vaginal surgery”, various results aim to strengthen the function of the vulvo-vaginal area, firm up and reshape tissue for youthful appearances. In regular terms, the procedure is essentially a “face lift” for the vulva and vagina.”1

A face lift for the vagina?!  Really???

It’s true- sort of.  Its basis is a surgical procedure most commonly used for patients who have some degree of pelvic organ prolapse (ie, the uterus has descended to the lower levels of the vagina or is “falling out”) or other genital malformations (cancer, reversal of female circumcision, etc.).  For these patients, vaginal reconstruction is a medical necessity.

In our day and age, however, a variety of vaginal reconstructive surgeries have become popular cosmetic procedures.  These range from labiaplasty (which is alteration of the “lips” of the vulva) to “G-spot” amplification to “revirgination”.  These surgeries are marketed to women with promises to enhance sexual pleasure or improve appearance.  What most women do not realize are that these procedures come with significant risks, including loss of sensation, scarring, bleeding, infection and future painful intercourse.

According to the American College of Ob/Gyn:  “It is deceptive to give the impression that vaginal rejuvenation, designer vaginoplasty, revirgination, G-spot amplification, or any such procedures are accepted and routine surgical practices. Absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable.”2

I had a young patient tell me recently that she is unhappy with her vulva.  Apparently, she thinks that the “lips are too long” and that they are ugly.  I reassured her that they are not too long and definitely not ugly.  “Trust me”, I said.  “I see a lot more vulva that you do.  Your anatomy is totally normal”.  She was unconvinced and went on to see a plastic surgeon about the problem.  I was baffled.  How could this young girl be so convinced that her anatomy was abnormal?

I am not sure what to make of this increased obsession with the appearance of the female genitalia.  Most of my patients who are concerned about this are in their 20’s.  Young women today face tremendous societal pressures regarding their body image, with the concept of “perfect beauty” (whatever that means) being blasted at them from every angle.  It saddens me that this image now includes such focus on the vulva and vagina.  It may be time that we as women realize that this is a growing problem in our ranks and begin to address this assault into our most private lives.

-Dr. Jahedi

Sources:
1. http://en.wikipedia.org/wiki/Vaginoplasty
2. ACOG Committee Opinion No. 378, September 2007.  Vaginal "Rejuvenation" and Cosmetic Vaginal Procedures
 

Abnormal Bleeding and What It Means

Periods can be weird.

Some women are regular as clockwork and can tell me the exact date and time of day that their periods will arrive.  Others have a range of normal, somewhere between 28 and 30 days, for example, that they mark the calendar by.  Then there are periods that don't follow the rules.  These are periods that set in with a vengeance, causing heavy bleeding never experienced before, or an "extra" period in the month, or bleeding after intercourse, or spotting with wiping.  Women end up in my office for all kinds of unusual bleeding patterns.  For women who are regular- and even those who aren't- a bout of unexpected bleeding usually causes great concern.

The reasons behind what we in gynecology call "Abnormal Uterine Bleeding" are diverse.  Whole chapters are written on how to address these issues and come to a diagnosis.  For all intents and purposes, abnormal bleeding can be broken down into three main categories:
1.  Hormonal:  The first thing we check in abnormal vaginal bleeders is a pregnancy test!  Assuming that that is negative, there can be a myriad of other hormonal causes.  Thyroid disorders cause irregular bleeding.  Hormonal imbalances such as those seen in polycystic ovarian syndrome can lead to irregular bleeding.
2.  Anatomic:  These are actual structural problems found in the pelvis.  Fibroids or polyps of the uterus and/or cervix can contribute to abnormal bleeding.  Ovarian cysts also can be a cause of abnormal bleeding.  The best way of diagnosing structural problems is with a physical exam as well as imaging via ultrasound.  To better visualize the lining of the uterus, a procedure called an SIS (saline infused sonohystogram) may be done in the office setting.  The results from ultrasound generally aid significantly in making the diagnosis.
3.  Cancer: This is the least likely category, but is a consideration based on age and risk factors.  Cervical cancer and uterine cancer can both present with abnormal bleeding.  The diagnosis is made here with a tissue biopsy, where tissue is removed from the uterus (endometrial biopsy) or cervix and sent to be examined under the microscope.  Any kind of vaginal bleeding in a postmenopausal woman warrants immediate evaluation.

There are other reasons that don't fit neatly into the categories mentioned above: sexually transmitted infections (especially Chlamydia!) or genetic bleeding disorders can lead to prolonged or unexplained bleeding.  Then there is the "we don't really know why" category.  Really- it is its own category in the medical literature!  This diagnosis should only be used when everything else has been thoroughly evaluated and come up negative.

The causes of abnormal bleeding can usually be determined with a good history and physical exam, as well as with the aid of laboratory testing and the occasional pelvic ultrasound.  So if your period goes wacky on you- get it checked out.  Actually, first take a pregnancy test and then get it checked out.  It is always good to know if there is something more going on that you should be aware of.

-Dr. Jahedi