“The Perfect Vagina” is a BBC documentary program hosted by Lisa Rogers exploring the question of why British women consider reduction labiaplasty, reduction of the Labia minorae or the “vaginal lips.” It is natural as a surgeon who performs reduction labiaplasty to compare the impressions left with those of my experience. After watching this program, I was left with a few thoughts:
(1) The show made the legitimate point that there is an enormous variation in what is normal in the size of the Labia minora.
(2) The program also made it sound like some women were having the surgery because of the perceptions of men. I have been doing this procedure for almost ten years and not a single woman said she was doing it because of a man. In my experience, most men do not care about the size or shape of the Labia minorae. The women considering it do of course.
(3) The show did not mention and certainly did not emphasize that many women explore the option of surgery for issues of discomfort and pain. Many women are unable to feel comfortable in tight clothing or their choice of undergarments because of pain and seek reduction to take this discomfort away. The operation almost always works for this too.
(4) The show did not explore the technical aspects of the actual surgery very well. The only operation shown on the program was simple trim technique under straight local, the technique associated with the most discomfort leaving the patient with the least normal-looking result. I do not offer the surgery under straight local for exactly the reason shown; it hurts. I perform a different technique that leaves the patient with less discomfort and a more functional and yes, “pretty” result. In my practice, the patients are operated in a surgical facility with anesthesia, again for comfort.
(5) The very premise of the show, that women were seeking to “perfect” their Labiae was a bit over the top. While there is, of course, a cosmetic aspect to this operation, many women also have functional concerns. The bit where women were showing each other their genitals as a therapy session of sorts was silly. I had not even heard of this before. The show also did not show any of the really large Labiae that I have seen.
(6) Despite the fact that the program included the story of a sixteen year old young lady having the surgery, this is not the norm. I have not performed the operation is anyone under the age of twenty. Just like in other areas of plastic surgery, labiaplasty surgeons all have their own philosophies. One even close to mine was just not presented on the show.