Mr McCulley was featured on Radio Nottingham’s Mark Dennison Show on 3rd April discussing the somewhat taboo subject of labiaplasty.
Mark Dennison: When it comes to plastic surgery a nip and tuck here and there is becoming more acceptable, from breast enlargements to breast reductions, liposuction, facelifts; the stigma around going under the knife is somewhat disappearing. But while attitudes are changing, the fastest growing form of plastic surgery for women still remains a bit of a taboo. Would you believe that since 2001, the number of ‘designer vaginas’ or labiaplasties, to use their technical term, performed by the NHS has actually risen fivefold leaving some people asking the question, why?
Stephen McCulley is a cosmetic surgeon from Mapperley Park and he’s here to discuss this a little bit more.
Just talk us through what this actually is.
Stephen McCulley: I think there is a lot of confusion as to what a labiaplasty is and the term ‘designer vagina’, because there are a lot of different types of operations, some of them probably more useful and more commonly performed.
I’m sure most of your listeners are fairly aware of the female external genitalia anatomy, but around the edge of the vagina you get the labia majora which is the main bulk of the external groin area and the labia minora which are the folds or the lips just on the edge of the vagina. A labiaplasty, let’s be very clear, is literally just surgery to those labia minora, it is nearly always performed for either cosmetic or for functional purposes, in terms of discomfort.
I must emphasise that although it is performed in the NHS for some reasons, cosmetic labiaplasty is not available on the NHS, so it’s not supported by the NHS. (The procedure’s popularity) has grown and it has become a lot more acceptable and really it’s very important to understand that a labiaplasty is an operation on the labia minora specifically. It’s usually because they’re too long and them being too long can either cause some discomfort. For example, women describe literally sitting on them when they’re cycling and so forth, and this can actually give them functional problems. Also there are potentially functional problems through intercourse but that’s uncommon in reality.
For many women it’s just a cosmetic concern, but understand this is not all about women post childbirth, this is predominantly younger women who have always had this and it’s just the way their labia has developed. Now that’s completely different to the whole range of these other, if you like, although it’s a slightly unfortunate term, ‘designer vaginas’, where there’s a whole range of other operations about trying to do vagina tightening. This is in post childbirth where the vagina is too lax, or repairing of old episiotomy, the cuts that you make during childbirth, which makes the vagina entrance look too wide. Some of these (procedures) are useful but this is far more debateable.
So you can actually almost separate them all from a whole group of vagina functional beautification operations, where the vast majority have a lot more debate. Labiaplasties are very distinct and it’s a very specific operation involving the labia minora, which is actually a very simple procedure provided it’s done by someone who knows what they’re doing.
Mark Dennison: Now I mentioned some of the stats and around the country there seems to be more of this happening. Are you seeing more of this happening in Nottinghamshire?
Stephen McCulley: Yes, I don’t think the rise is massive, I looked at my own figures and compared to the figures that have been seen, I haven’t seen (a rise that big) but it definitely is rising. I think it is also just a question of, as you in your introduction said, as there’s more awareness and availability it’s maybe less taboo. I think that not surprisingly, when you start talking about surgery to this area, people would find it probably more of a taboo in many circumstances, and also recognition that there are things you can do about it. For some women labiaplasty can actually be a fantastic operation, it’s a simple operation which can alleviate all sorts of concerns and anxieties. It’s obviously not a common operation amongst the female population and it shouldn’t be. But for the right patient, to discover there is something that can be done about it, it’s a good thing.
Mark Dennison: In terms of body confidence you mean?
Stephen McCulley: Well you can split it into two groups. This fits very much into this whole cohort of conditions, which I often call the formative years. As a teenager you might recognise that there’s something different about your body, whether it be your ears, your nose, your breasts or the fact you feel you have huge hips – whatever it might be, now for many teenagers they’re not bothered by this, which is fantastic and is what we’d all like. But, if you are bothered by something and if you do recognise that it’s different and you develop some anxiety at that age, then that anxiety will stay with you forever.
Labiaplasty is a classic one for younger women that fit into that group, they recognise that it’s different, for those that it becomes an issue for, they may or may not have some physical symptoms with it and actually that translates into a problem with confidence as they get older and become sexually active.
This isn’t the case for everybody and if it’s not an issue to you then great, that’s fantastic but if it is an issue, telling someone it’s not an issue is not going to make any difference and it can be quite debilitating from an anxiety point of view for some women. So if you’re going to start doing a complicated operation to cure that then there is a real debate, but if you’re going to do an operation that is actually very safe, (there are problems with this operation don’t get me wrong, if it’s performed badly it can be a disaster) but done carefully it’s a very simple operation and can actually be a great release to these women. So yes I do think for the right patient it is very worthwhile.
Mark Dennison: Some people might say, and doctors have raised concerns, that this kind of operation could change our idea and our perception of what women’s bodies should look like.
Stephen McCulley: Well I think that’s a very valid discussion and that discussion transcends all of cosmetic surgery doesn’t it, right through from the size of breasts to what a figure should be, to what a face should look like as we get older.
I don’t have a problem engaging in that discussion but I think also we sometimes jump on this modern bandwagon and it’s no doubt it’s one that society does create, maybe if you like a different norm. But actually, I think also we forget that as human beings we’ve always been worried about being different, probably from the beginning of time to be honest. I think that these anxieties about being different, if you look back to Victorian times and before, those anxieties have always been there. Therefore I concentrate more from looking at it from the anxiety it’s created as opposed to trying to create a social norm as to what a vagina or a labia should look like.
I don’t view it like that at all because that’s not what the patients are presenting with. They’re not coming in saying ‘I look abnormal’, they’re coming in and saying ‘I feel anxious about this, I don’t like this, it affects me’. You can talk through that and sometimes, just saying that it looks normal and showing them some pictures helps them and that’s enough, which is great.
Mark Dennison: I know at the start of this conversation you were drawing a distinction between labiaplasties and also these so called ‘designer vaginas’, are you seeing a slight increase in the number of people asking for these as well?
Stephen McCulley: Yes, although, if you look at the other procedures some women have, the main one on this point of discussion is really the vagina tightening operations and this is definitely for women who have had children.
If you have had many vagina deliveries, the vagina muscle does stretch and the vagina is not as tight and that is potentially, and I have to emphasise potentially, an issue for some women and their partners. The problem here is that these operations, which I’m happy to discuss with patients but I don’t personally perform them, are much bigger operations in terms of potential side effects and potential problems.
It’s not that they don’t work, but the science behind them is not fantastic, in terms of, there’ll be lots of publications and therefore we have a good follow up of the complication rates. I have more reservations about that operation and personally, because of that, it’s not one that I would perform.
Saying that, again, you get some women who’ve had an episiotomy, the cut from a vaginal birth, which although was repaired, wasn’t repaired very well and that’s not always necessarily an incredibly difficult thing to make a bit better. Some women who really, really have a very full mons pubis, the area at the front of the pubis area, could do with a little bit of liposuction there for example. These are very low risk or low risk operations.
The one thing you do not want to do is obviously do an operation which causes a problem with function, because if you create scarring or wound problems that then makes sitting down or intercourse painful, then you’ve just created a disaster. Although that is cited for labiaplasty, and there is a small risk for labiaplasty, done carefully, that risk is very, very, very small indeed. Whereas these bigger operations the risks are slightly higher and therefore I think the balance and the justification is more difficult.
This interview appeared on the Mark Dennison Show on BBC Radio Nottingham on Thursday 3rd April at 9am.