If you’re like 99.9 percent of women, you were taught to stay mum about all things related to your vagina. The result? No one knows what’s “normal,” but we’re all pretty sure we’re the odd vagina out.
Fortunately, the days of silent wondering are in the past. Conversations about labiaplasty (a surgery that trims the lips of the vagina) and the host of other surgical procedures collectively grouped under the “vaginal rejuvenation” umbrella are way out in the open. In 2016, for example, the American Society of Plastic Surgeons said its members performed more than 12,000 labiaplasty procedures (a 39 percent jump from 2015).
“It’s a good thing that women are more comfortable talking about their vaginal health, especially if they get the message that there is no one normal when it comes to vaginas,” says Cheryl Iglesia, M.D., director of female pelvic medicine and reconstructive surgery at MedStar Washington Hospital Center in Washington, D.C. “What’s normal is that we’re all different.” (Need proof? Check out The Great Wall of Vagina art installation.)
So, if we’re all normal, what are we all thinking when we begin to mull the idea of physically changing our vaginas? Dr. Iglesia has some answers, but first the basics.
What is vaginal rejuvenation? As noted above, it’s an umbrella term that covers a number of procedures meant to correct vaginal problems that can occur naturally as we get older, including an over-stretched vagina, stress urinary incontinence (the kind where you might leak when you sneeze or laugh hard), and vaginal dryness.
So, surgery? Not necessarily. A vaginoplasty to tighten the vagina is just one option—and it likely won’t be the first treatment your doctor recommends, says Dr. Iglesia. (Hello, Kegels and pelvic floor exercises.) Labiaplasty can help women experiencing pain from the tugging of labia that hang low and make it difficult to go about your day, exercise, or enjoy sex.
Noninvasive heat-based treatments are newer—and increasingly more common—options to address the loss of vaginal tightness, a leaky bladder, and dryness: Chances are you’ve seen ads or brochures for radiofrequency devices Viveve or ThermiVa, which use electromagnetic waves, or for laser treatments like FemTouch, MonaLisa Touch, and FemiLift, all of which stimulate new collagen production. Both devices damage the top tissue layers, so the underlying layers make new, firmer tissue.
That doesn’t sound so bad, what’s the catch? All of these options are worth considering, but Dr. Iglesia’s advice is to share your concerns with your gynecologist or a urologist. “If your vaginal health is disrupting your life, you have a medical issue, not a cosmetic issue, and these are the doctors who are going to help you walk through your issues and weigh the risks and benefits of all the treatment options,” she says.
She notes that while the non-surgical options have impressive stats and FDA approval, there’s actually been “very little follow-up” in the form of long-term studies, or trials that compare heat-based treatments to estrogen therapy or other treatments. In many cases, women who’ve undergone a non-invasive treatments wind up needing surgery.
“Urinary incontinence is a great example,” she says, “lots of practices promote laser treatments to help with incontinence, but there’s an extremely low level of evidence showing the efficacy of lasers for this issue. Meanwhile, there are high levels of evidence and efficacy showing the benefit of sling surgery.” Her point? It’s fine to look at the new treatments, but don’t discount the tried-and-true.
“It’s important to talk to a doctor who understands the hormonal milieu and the biome of the female body,” she continues. “You don’t want to land in the office of someone who can offer you only one or two options.” In her practice, for example, she’s had instances where women have benefitted from laser treatments that augment estrogen therapy.
Anything else? Yes! Let’s talk money. Many of these treatments are pricey. In 2017, the average price of a labiaplasty was just shy of $3,000. In some areas, the heat-based treatments may cost in the neighborhood of $5,000. However, depending on your diagnosis*, Dr. Iglesia notes that your health insurance may cover the treatment, leaving you on the hook for your standard co-pays.
(*The American College of Obstetricians and Gynecologists considers any vaginal surgery or procedure intended to enhance sexual gratification, vs. sexual dysfunction, as medically unnecessary.)
Bottom line: “Look at every option with an open mind, and get several opinions,” says Dr. Iglesia.