The Quest for the Perfect Vagina: What You Should Know About Cosmetic Genital Procedures

The Quest for the Perfect Vagina: What You Should Know About Cosmetic Genital Procedures

By Pam Harrison


‘You’re Normal, Just Live With It’

With probably more procedures under his belt than just about anybody else in the United States (800 labiaplasties alone and counting), gynecologist and genital plastic/cosmetic surgeon Michael Goodman, MD, clinical assistant professor of obstetrics and gynecology at California Northstate University School of Medicine, Elk Grove, California, and the author of You Want to Do What? Where? Everything You Ever Wanted to Know About Women’s Genital Plastic & Cosmetic Surgery knows a thing or two about the use—and misuse—of cosmetic vaginal procedures and has strong opinions on who should be offering them and why.

“One of my responsibilities is doing the right things for the right reasons on the right patients,” Goodman said. “And if a woman comes in and says, ‘I’ve got to have a vaginal tightening operation for my boyfriend,’ that is a person I need to counsel and not necessarily just operate on,” he added. On the other hand, Goodman and like-thinking cosmetic genital surgeons feel that if a woman wants a cosmetic vaginal procedure to enhance her self-esteem and possibly her sexual enjoyment, who are they to tell her that she is “normal” and she should just live with a part of her body she doesn’t like, as ACOG recommends its members do? “If a woman goes to see her ob/gyn and says, ‘I’ve always been small and I don’t have a good self-image and would like a breast augmentation,’ or if she says, ‘I’ve always been large and I’d like a breast reduction,’ the ob/gyn will refer her to a plastic surgeon. The same holds true for abdominoplasty and rhinoplasty,” Goodman maintained.

But if a woman says, ‘My labia have always been large and I’m self-conscious about it,’ her ob/gyn might say, ‘You are normal and you should just accept it,” Goodman added. “It’s a combination of paternalism (I don’t think you should do this’) and dismissiveness,” he believes. Goodman also maintains that too few surgeons are trained specifically in these procedures. He often trains other clinicians at his high-volume practice focusing on cosmetic genital procedures and menopausal medicine in Davis, California, and is very involved in the academic worlds of both sexual medicine and plastic surgery. As a leader in this field, Goodman is highly critical of ACOG’s stance to not provide training in the area of cosmetic genital procedures, even though he has offered to hold courses at their annual meetings to teach ob/gyns the right techniques to minimize the risk for unintentional—but avoidable—mistakes. (The same is not true for plastic surgeons, who do offer courses in cosmetic vaginal techniques at many of their meetings, and at least some residents in plastic surgery are now being exposed to these procedures during their training.)

However, as Goodman also observed, “The basics are not just techniques; the basics are understanding what women are saying and understanding their sexuality, and then deciding what procedure would be best for them, in light of their goals,” he emphasized. At the same time, he continued, “Many of my patients say that they know they are normal, but they are still embarrassed and don’t want to make love with the lights on.”

He added, “Female genital plastic surgery is improving their self-image and self-esteem; it can offer functional improvement in terms of being more comfortable in exercise clothes and during certain activities, and can greatly improve sexual enjoyment. All I can say is, what’s wrong with that?”