What is the difference between
Labiaplasty and Vaginoplasty?
Many people ask me this very
question. It is probably one of the most common ones I answer on
a daily basis. Even established doctors have a hard time
differentiating between the two surgeries. It is actually quite
simple if you think of what you see and what you don’t see.
First, what you see in a woman’s
pelvic area is called the “vulva.” This includes the
clitoris, inner smaller lips (labia minora), larger outer lips (labia
majora), and the perineum (space between the vaginal opening and the
anus. Some even include the anal area, inner thighs, and the fat
pad above the pubic bone as part of the vulva since it is
visible. Remember, this is the stuff you can see with your own
eyes without the aid of retractors, microscopes, or other
devices. This is the area where labiaplasty surgery is
done. Specifically, labiaplasty usually involves the surgical
trimming, reduction, or re-sculpting of the inner smaller lips.
However, it can also refer to the surgical procedure to reduce the
saggy skin of the larger outer lips. Together, the inner and
outer lips are called the labia, hence labiaplasty. One more
thing, if you have a flap of excess skin on the sides of your clitoris
that is large and floppy, pulls, or is constantly irritated then a
clitoral hood reduction (also called prepuce reduction) is often done
as part of the labiaplasty surgery.
Next, what you don’t see is the
inside of the vagina. This is the canal where tampons are placed,
where babies pass through, where vibrators are placed internally.
This is the inside of the vagina that is stretched over ten times its
normal size when a child is born through the vagina. Even with a
C-Section this inside space of the vagina can be severely
stretched. When this happens, the walls of the vagina become
loose and saggy on the inside, the part you don’t see. This
is the area where vaginoplasty surgery is done. Specifically,
vaginoplasty usually involves the surgical tightening of the unseen
inside of the vagina to narrow its size by both suturing together inner
deeper tissues and trimming more inner superficial vaginal skin.
When you have to do surgery on the space in between the vagina and the
anus it is called a perineoplasty or perineorrhaphy. This is done
if there is a bulging structure in this space or if a prior delivery
messed up the appearance of this region. Prior tears or
episiotomies are the most common cause of looseness in this entry point
into the vagina.
One thing you should remember is the way
most plastic surgeons do their vaginoplasty surgeries. During a
plastic surgeon’s residency program, and even in their fellowship
programs, most will only get a couple of months of surgical time with
the gynecology department. During these two months the plastic
surgery resident typically assists the gynecology resident or fellow
doing the vaginal surgery. The only other time most plastic
surgeons get any vaginal surgery experience is during their two to
three month rotations as medical students in the obstetrics
wards. During this time, they may get a few deliveries in which
they repair superficial lacerations and tears in the perineum. It
is rare that the plastic surgeon will be given the responsibility of
repairing deep damage since the anatomy is difficult and rips into
rectum, bowel, or bladder may occur during the repairs. In their
gynecology rotations a medical student is never the primary surgeon
doing deep pelvic repairs. As a plastic surgery resident or
fellow it is rare that they do the primary deep pelvic repairs since
they have to battle with the gynecology resident or fellow for these
precious learning experiences. This usually means that a plastic
surgeon advertising that they do vaginoplasty is really doing a
perineoplasty and only tightening the opening into the vagina and doing
little to no tightening of the deeper inner canal. To be fair,
most gynecologists have absolutely no training in cosmetic surgeries
such as breast implants, tummy tucks, and Brazilian Butt Lifts.
In fact only a very few actually do these cosmetic procedures. In
almost all cases these skills were learned after graduating from their
formal residencies and fellowships and were learned in seminars or as
an “apprentice” to a plastic surgeon. Few
gynecologists are formally trained to do labiaplasty surgeries and even
fewer plastic surgeons have the training to do them safely.
Red M. Alinsod, M.D., FACOG, FACS, ACGE
South Coast Urogynecology, Inc.
Laguna Institute for Aesthetic Vaginal Surgery
Laguna Beach, CA