Surgical Procedures - Female Genital Surgery

FEMALE GENITAL SURGERY

With age and childbirth, the labia and surrounding vaginal tissue, both external and internal, can change in shape, size and tone. This can be bothersome or even greatly disturbing to some individuals. Some women, despite minimal changes to these areas over time, have never been happy with the appearance or function of their genitalia. The following are some common genital surgery procedures to correct these problems:

Labial reduction (labiaplasty) - Female genitalia are more or less hidden but larger than average labia may protrude well beyond the outer lips of the vagina causing discomfort when they rub against clothing, or during sport or sex. Women with exceptionally long or unequal lengths of the inner lips (labia minora) can have them aesthetically reshaped.

Vaginal tightening (perineoraphy) - The most common cause of an enlarged vagina is childbirth. However post-menopausal women and those who have been treated for cervical cancer can find their vaginas have enlarged, and may seek vaginal reconstruction. In this procedure, which is normally performed under TVA or general anaesthesia as a day case.

Other procedures - Various other operations to improve the appearance, tone and sensation of the vagina can be performed, such as liposuction of the pubic mound, surgical correction of the clitoral hood (to give better exposure of the clitoris and enhance sexual gratification) and alteration of the position of the clitoris (clitoropexy). The outer lips (labia majora) can also be reduced by liposuction or enlarged by fat transfer.

Right For you?

Many of these modern procedures are based on techniques developed in the US and in the UK. Hurlingham Clinic Consultant Plastic Surgeon, Mr Erik Scholten, has established himself as a leader in this field, originally describing many of the surgical techniques himself. Female Genital Surgery is the fastest-growing area of plastic surgery. Women claim that the aesthetic improvements that these procedures give, boost their confidence and improve their self esteem. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The most suitable patients are physically healthy, emotionally stable women who are realistic about what the surgery can accomplish.

Some Risk

In general, female genital surgery is very safe and complications are rare. But, as with any operation, there are risks. These may include: prolonged bleeding (which usually stops spontaneously within 24 hours), accumulations of clotted blood (haematoma) in the tissue (which may need to be removed surgically but will not affect the final result) and infection, which usually can be treated with antibiotics. Another complication is an opening of part of the wound (dehiscence), which is usually left to heal on its own, but may require further correction. Because of the risk of postoperative bleeding, albeit small, day surgery patients who need to travel a long distance from the hospital to their homes are advised to stay overnight near the Clinic. Those considering this or any surgery should be aware of the risks. Your surgeon will discuss these with you during your consultation. Feel free to ask questions.

Planning

Your surgeon will initially evaluate your health and recommend which surgical techniques are best for you based on your age and condition of the area to be treated. Discuss your expectations fully and frankly with him. He will be equally frank with you, describing your choices and the risks and limitations of each. Be sure to tell your surgeon if you smoke and if you are taking any medications, vitamins or other drugs. Your surgeon will also explain the type of anaesthesia to be used, the facility where the surgery will be performed and the costs involved.

Preparation

Your surgeon and his staff will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Where?

Our surgeons perform genital surgery in the operating theatre in the Hurlingham Clinic or in one of the London private hospitals where they serve as a Consultant. The surgery usually takes from one to two hours. Many patients are able to go home on the day of the surgery; some remain in the hospital overnight.

Anasthesia

The Hurlingham Clinic and Spa offers a modern, patient-friendly approach to anaesthesia TIVA - Total Intravenous Anaesthesia. TIVA, is a newer anaesthetic technique which has risen in profile within the last 5-8 years. It has been made possible with the advent of a new generation of intravenous medications with unique properties. TIVA patients sleep soundly during the entire operation, feeling no pain and experiencing no anxiousness. They wake up quickly and comfortably with no memory of their procedure. Many patients prefer this type of anaesthetic to traditional general anaesthetics since they feel comfortable, wake quickly, have less nausea, experience none of the 'hang-over' effect of a full general anaesthetic, and therefore can be discharged earlier. TIVA is safe, effective, extremely well tolerated and is the anaesthetic of choice of Hurlingham Clinic surgeons and most of their patients.

Alternatively, for some patients, they and their surgeons may decide that a full general anaesthetic is still the best choice. Discuss your options for anaesthesia during your consultation with your cosmetic surgeon.

What Happens?

Labial reduction (labiaplasty) during the procedure the surgeon removes a wedge-shaped piece of tissue and re-attaches the labium in a new position so that the inner lips no longer protrude beyond the outer lips.

Vaginal tightening (perineoraphy) a section of vaginal lining is removed and the underlying muscles are repositioned in such a way that the outer third of the vagina is noticeably tighter. The surgeon will remove a diamond shaped section inner lining of the vaginal wall where the elastic tissue is stretched and sometimes cut or torn during childbirth. Muscle and skin are then tightened.

A dressing may be applied immediately after surgery, and all wounds are sutured with soluble stitches

After Surgery

You will feel tired and sore for a few days and we recommend that patients observe as much bed rest as possible during the first week after surgery. Most of your discomfort can be controlled by prescription medication. In the first week after surgery the area is likely to be swollen, and bruised, and urinating may be uncomfortable. This burning and stinging sensation can be eased, either by urinating whilst showering, or pouring lukewarm water from a jug over the area whilst urinating. An ice pack (or bag of frozen peas) can be used to alleviate the discomfort and reduce the swelling. Personal hygiene is extremely important for rapid healing and twice-daily showering is essential. Loose underwear should be worn for the first two weeks. Tampons should not be used during the first six weeks, and penetrative sex should also be avoided during this period.

Recovery

Most patients can return to work within a week to ten days. Follow your surgeon's advice on when to begin exercises and other normal activities. By six weeks after surgery they should no longer be sore. In this particular area the scars are always very inconspicuous.

Happy?

Many women find that the aesthetic improvements that the procedures give boost their confidence and improve self esteem. Your decision to have female genital surgery is a highly personal one. Not everyone will understand. The important thing is how you personally feel about it. If you have met your goals, then your surgery is a success.