Vaginal rejuvenation surgeries are far more dangerous than doctors think: Study
After Jessica Pin got a labiaplasty -- commonly referred to as vaginal rejuvenation or female genital cosmetic surgery -- she realized she could no longer feel sexual pleasure.
According to experts, lack of training standards among surgeons, and lack of knowledge of anatomy and female sexual function in general, are the primary reasons behind such botched surgeries. What is worse, says Jessica, a volunteer researcher at the Baylor University Medical Center, Dallas, is that women are often told there are no risks to sexual function from these surgeries.
Jessica along with her father Dr. Paul Pin conducted a research where they found that crucial nerves of the clitoris -- the female sex organ that corresponds to the penis in men and is responsible for sensation and orgasm -- are at a huge risk of injury from such surgeries as doctors do not know the female anatomy well.
Surgeons and laypeople alike tend to conceptualize the clitoral hood as just a flap of skin covering the glans. However, in reality, most of the clitoral hood, operated on by many obstetrician-gynecologists (OB/GYNs) and plastic surgeons, is actually the skin of the clitoris itself. While surgeons often believe the dorsal nerves of the clitoris (two main nerves responsible for its sensation) are out of harm's way, Pin’s study revealed that they are located a few millimeters below the surface of the clitoral hood.
The primary implication of the study, says Dr. Pin -- chief of the Division of Plastic Surgery at Baylor University Medical Center, Dallas -- is that the dorsal nerves to the clitoris are the same size as the nerves of the penis and potentially just as susceptible to devastating injury during female genital surgery. The findings have been published in the Aesthetic Surgery Journal.
A labiaplasty is a vulvar surgery done to reduce the size of the labia minora – the flaps of skin either side of the vaginal opening. Often, clitoral hood reductions are performed along with labiaplasty. In Pin’s case, a clitoral hood reduction was performed without her consent, and the nerves of the clitoris were cut. Her labia minora were also completely removed. Experts have told her complete, accidental amputations of the labia minora “happen all the time.”
According to the American Society of Plastic Surgeons, labiaplasty is the most commonly performed vaginal rejuvenation procedure and it can relieve symptoms women experience from twisting and tugging of the labia. However, it is primarily performed for cosmetic reasons, under the guise of a simple, safe procedure with the potential to even improve sexual function.
Additionally, says Jessica, labiaplasties and clitoral hood reductions are also commonly performed by OB/GYNs. Though there are no numbers for how many are done, advertisements for labiaplasty can be found on many board-certified OB/GYN websites. In one survey, 77% of OB/GYNs said they would perform labiaplasty. But how many they do is not tracked, says Jessica. While the focus is usually on the plastic surgeons performing these procedures, anecdotally, most surgeons with bad results have been operated by OB/GYNs, she adds.
For the current study, the researchers dissected the dorsal nerve of the clitoris by studying the vulvas of 10 women who had died. The study found that the dorsal nerves, clitoral glans, and the clitoral body were larger than expected. The dorsal nerves were 2.0-3.2 mm inside the clitoris itself. The researchers were surprised as doctors assume that the dorsal nerves in the clitoris are very small and difficult to dissect.
“When we started our study, many standard texts completely ignored or poorly represented the sensory nerves to the clitoris once they enter the clitoris. Many anatomy diagrams, including virtually all OB/GYN textbook diagrams, showed the nerves approaching the clitoris, then the drawings just stopped. Adequate surgical anatomy has furthermore been missing from literature on female genital cosmetic surgery techniques. This does not happen with other surgeries plastic surgeons perform. Some doctors assumed the nerves to be too small to define, which our study proves they are not,” Dr. Pin tells MEA WorldWide (MEAWW).
“When you compare the detail of the anatomy of the penis versus that of the clitoris, you have to conclude that anatomists just didn’t see female genital anatomy as important enough to justify equal representation,” he says.
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Lack of training standards
Jessica says while the study was published to help surgeons perform these surgeries safely, what she wants is for people to realize how careless surgeons have been in the past and continue to be by not pushing for this anatomy to be covered more. “As is, this never would have happened without a mutilated patient (me) insisting. And there is something seriously wrong with that,” she says. The innervation of the clitoris was also published in a major OB/GYN journal and OB/GYN textbooks for the first time this year, in response to her insistence.
Errors during such surgeries go undiagnosed and unreported due to the same ignorance of anatomy that causes them to happen in the first place, says the research team.
“In the wake of my surgery, I was told it couldn’t have affected my sexual function. This is despite visible scars in my clitoral hood (equivalent to penile shaft skin) and completely amputated labia minora. I was told I just needed to relax, just needed to fall in love, etc., Jessica tells MEAWW.
The removal of labia minora, as seen in Jessica’s case, is not an uncommon result and again happens due to a lack of training standards, say experts. “The labia minora are also sensitive tissue involved in sexual response. The fact that I was so young made it much harder to understand what had happened to me and why I had lost sensation. Given the age group most likely to seek surgery is 18-24, and that it is very common for women to lack knowledge of their genital anatomy, I believe there may be a huge problem with defining harm when it occurs,” says Jessica.
The researchers say the knowledge of clitoral anatomy is important beyond cosmetic surgeries, and there should be training standards like there are for all other major cosmetic surgeries. “Female genital anatomy is important and should be incorporated into all general anatomy textbooks and surgical specialty training. Some doctors have communicated that anatomy is already too demanding, however, a reasonable medical student could assimilate this additional material in a matter of minutes. Surgeons should reasonably be expected to learn this anatomy before performing female genital surgery,” Dr. Pin tells MEAWW.
According to Jessica, when she consulted with one of the biggest female cosmetic genital surgery experts in the country, he had no explanation for how she could have lost sensation. “For me to know I suffered from a dorsal nerve injury, I had to do my own research, teach myself the anatomy, diagnose myself, and then find a doctor qualified to confirm it. How many patients diagnose themselves?” she writes in a blog.
Experts say professional organizations also neglect to get involved in this field due to the taboo.
“Female genital cosmetic surgery has been controversial. For that reason, regulatory bodies, especially in OB/GYN, have not wanted to be involved in ensuring high standards of care. For example, while the American College of OB/GYNs approves these surgeries for medical reasons, they refuse to cooperate in the establishment of training standards,” writes Jessica in the blog.
Victim blaming is common
While such botched surgeries are not uncommon, very few women come forward as they fear being blamed. “We do not have any idea how rampant botched surgeries are. Anecdotally, they are very common. Surgeons I’ve spoken to have said things like ‘I see this all the time. Most surgeons don’t know what they are doing’,” says Jessica.
According to her, in almost every account she has seen of botched labiaplasties, the women have blamed themselves. “When surgeons doing these procedures are, for the most part, doing surgeries they have not been trained to do on anatomy they don’t know, it is not the victims’ fault,” Jessica tells MEAWW. Jessica believes that most patients who have been harmed are in the dark like she was for so many years. “I believe they don’t even have the words to explain what happened to them. They are told they are crazy or that it is their fault. Or was told it was her hormones. And this silences them,” she says.
She emphasizes what people need to understand is that all this amounts to systemic negligence. “As long as women keep blaming themselves instead of directing blame at those actually responsible, this will not change,” says Jessica.