A problem about genital area might lead to sexually functional problems (sexual problems) with the person himself/herself and/or sexual partner of the person. After all, sexuality is something experienced by two individuals collectively.
Detailed medical history of the individuals who would like to have this type of procedures should be obtained. For instance; a woman with a wide vagina would lead to less pleasure in the male partner during coitus (coitus of vagina & penis). Woman would like to feel the fulness of the penis in her vagina, while the male partner seeks for the feeling of pressure on the penis (cosmetic penile surgeries/procedures).This might cause loss of self-confidence in woman in time. It might lead to sexual problems of both male and female individuals. For example; the condition of having bigger internal lips of vagina which is called labia could block the vaginal route and make the coitus more difficult. The reason why I’m giving these examples is to show that these surgeries are not only conducted for aesthetical reasons but also to resolve a functional problem and therefore the sexual problems occurring.
Although cystocele (bladder prolapse) and rectocele (rectum prolapse) are more mechanical disorders, I’ve included them within this subject since they can be combined with genital aesthetical surgeries.
What Are Genital Aesthetical Surgeries?
- Vaginoplasty (vaginal contraction)
- Labioplasty (labia minora aesthetics)
- Labia majora filling (labia majora aesthetic/filling)
- Genital bleaching (laser genital bleaching)
- Laser vaginal rejuvenation
- Laser urinary incontinence treatment
Vagina is an internal channel that is approximately 8-9 cm long, is the female area where the coitus occurs, that can stretch and is made of muscle tissue. The muscles surrounding the vagina loosen due to factors as age, congenital loose vaginal tissue, deliveries, gynaecological operations and frequent sexual coitus, and it might become less tight in time. The vagina can be structurally wider than usual in some female individuals despite any deliveries and young age. A wide vagina can’t wholly surround and feel the penis. The feeling of pressure on the penis of sexual partner becomes less. This might lead to problems such as not being able to have orgasm called anorgasmia in the later stages.
Therefore, the pleasure of the male and female partner during the coitus becomes less as well. This might cause serious problems between the partners (sexual partners) by getting a bigger one in time. Quite pleasant results can be obtained as a result of surgical vagina contraction, or in other words, the vaginoplasty operation. The surgery takes around 30-40 minutes. It can be applied through general, spinal or locally supported sedation. Wide parts of the vagina are removed, the muscular tissue underneath is repaired and the edges having been cut are repaired aesthetically. One month of sexual abstinence is prescribed after the surgery.
Labia minoras are gyrose and elastic structures which start in between bigger lips from the level of clitoris (sexual pleasure area) above the vagina and end below the vagina it. Its size varies from person to person. In some female individuals, it’s bigger than usual due to hormonal changes during puberty and effuses. They might grow in ptotic, symmetrical or asymmetrical ways. The reason of this growth is usually structural and it might also occur in later stages. These labia minoras that grew might block the vagina and the urinary canal called urethra.
They might cause infections both in vagina and in urinary canal by creating a moist area. Additionally, problems such as funny smell, hygienic problems due to sweating of labia minoras and problems such as dryness, scratchiness and wounds due to contact with underwear might occur.
Bigger labia minoras might make the entrance of the penis into vagina more difficult during coitus. When all these problems of a female individual not finding her genital area aesthetical, having hygienic and sexual problems considered, sexual problems (sexual disorders) such as less confidence and lack of sexual drive, not being able to have orgasm and difficulty in having orgasm might occur. These problems could also affect the sexual partner in the later stages. This condition can be fixed through a simple surgical procedure. Labia minoras which have grown, ptotic, long, asymmetrical, dark colored would be fixed to their usual appearance. This surgical reparation operation is called labioplasty. This operation which takes around half an hour could be applied combined with other genital aesthetical procedures. All the ripples and skin folds that don’t seem nice should also be fixed considering the genital area as a whole during the operation. If only the labioplasty is in question, local anaesthesia would be enough for the patient. A mild anaesthesia, or in other words sedation anaesthesia could be applied to ensure the patient’s comfort. It would be enough to be over puberty for this aesthetical operation. This operation can also be applied on virgin female individuals since it’s not related to hymen. 3-4 weeks of waiting would be required for active sexual life after the operation.
LABIA MAJORE FILLING (LABIA MAJORE FILLING/AESTHETICS)
Labia majore, or external lips in other words are the formations covered with slightly puffy normal skin that are out of the internal ones, start from mons pubis (hairy area above clitoris) and go down on the sides of vagina. Usually, women would like the labia majores to be round. I prefer autolog fat transplant for labia majore filling. This means that I prefer using the fats obtained from the person herself. According to the condition of the patient, usually the fats from abdomen or inner part of the leg which is called medial femur are used. Afterwards, the fats obtained are purified by centrifuging (pure fat tissue). As a consequence, round shaped labia majores would be possible by injecting this purified fat tissue into the labia majores (lipofilling). Since approximately 30-40% of the injected fat tissue will be lost in six months, more fat tissue filling might be applied during the operation.
Anomalies such as bigger, ptotic, overswollen, asymmetrical labia majores and skin folds are possible in fleshy female individuals or structurally. In these cases, aesthetical procedures such as reduction of labia majore size could be used.
External genital area is called vulva. Genital bleaching is also called ‘’labial whitening’’ or ‘’vulvar whitening’’.
Tarnishing, browning and darkening might occur in vulva with the effect of oestrogen and sun light. Oestrogen hormone mobilizes the cells that release color pigments on the external genital area (melanocyte) with the effect of sun light and the darkening of color occurs. The fact that the area is covered or hairless doesn’t change the effect of UV irridations of the sun. Other than these; advancing age, hormones used and the creams applied to this area, gynecological operations undergone in the past, polycystic over syndrome, genetic susceptibility might be mentioned among the reasons of external genital area darkening.
This condition might lead to loss of self confidence in the female individual and sexual problems in the later stages. This darkening doesn’t have any physical effects on the person.
Generally, fractional carbon dioxide (CO2) and fractional erbium yag-laser are used for genital area aesthetics.
How is the procedure conducted?
Laser bleaching procedure takes around 15-20 minutes. Darker parts of the genital area are detected and the laser is adjusted accordingly. Local anaesthetic creams are used before the procedure. Mild sedation treatment might be used for the comfort of the patient. During the procedure, melanocyte cells that are located in the dermis layer of the skin, that cause the darkening and produce melanine pigment are corroded through laser light. This way, the genital bleaching is achieved. The laser used effects an area of 3-4 mm depth. Desquamation occurs in this area after the use of laser, the skin is then peeled and a new, colorful skin comes out. After the procedure, the individual can immediately go back to her routine life and starts feeling the effects of this procedure in around 3-4 weeks. Rarely, blisters might occur. Coitus would be possible in 3-4 days following the procedure. The procedure might be repeated couple of times depending on the darkening level and area covered.
- G-point shot
- Clitoris Aesthetics (clitoral hudoplasty)
- Cystocele and Rectocele Repairment
CYSTOCELE (BLADDER-URINE BAG PROLAPSE)
Cystocele is bladder or urine bag prolapse into the vagina. When the prolapse is advanced, it can be visible from the vaginal orifice. Aging, menoposis, multiple deliveries, histerectomy (uterus removal) operation are the risk factors of cystocele. The complaints of a female patient with cystocele are frequent urinating, urinary incontinence, difficulty in urinating, urge to urinate after urination and the feeling of not being done with urinating, nocturia (urinating at night) and pain during coitus. Sometimes the patients complain about feeling of a swell and pressure in the vagina or something that prolapses. Cystocele is diagnosed through physical examination (genital area examination). In addition to that, ultrasound and uroflow and PVR (postvoiding residual) tests are also helpful for the diagnosis.
Mild, unproblematic cystocele might not require treatment (laser vaginoplasty might be tried and be helpful). Advanced and problemativ cystocele should be treated through surgery. Anterior colporrhaphy (pre-repairment) is applied during surgical treatment. Repairment of the bladder and removal of extra tissues are aimed with this operation. Synthetic material called mesh can also be used for the repairment of bladder. Since the treatment of urinary incontinence would continue after cystocele repairment in these patients, sling operations (female urology) in case of urethra prolapse, loosening should be combined with cystocele repairment.
RECTOCELE (ANUS PROLAPSE)
Rectocele is the condition where the rectum, or in other words, large intestines herniate into the vagina. In the cases of advanced rectoceles, it’s seen that the rectocele comes of the vagina with or without pushing. Rectocele is also caused by pressure increases on the pelvic area and anus due to deliveries, obesity, constipation, chronic cough, excessive pushing. Apart from these, rectocele complaints increase with aging and after menopause. Intestine movements become more difficult and constipation is seen when rectocele is the case. The patients with rectocele complaints have difficulty in defecation, pushing, the feeling of not being able to finish defecation, not being able to relax after defecation, urge to fedecate immediately, and gas and abdominal swelling due to initial reasons.
Actually, irritative complaints of the urine that can’t be evacuated are the case for cystocele, and the stool that can’t be discharged are the case for rectocele. Cystocele is the bladder prolapse, while rectocele is the anus prolapse. Rectocele causes the feeling of swelling in the vagina as well. The feeling of having a mess in the back wall of vagina and pain during coitus can also be seen. Diagnosis is easy thorough physical examination. Consumption of liquid and fibrous foods are recommended in the case of mild rectoceles. Vaginal contraction through laser can be tried in the case of mild rectocele. The only treatment option for the patients with too much complaints and advanced rectocele is surgery. Rectocele repairment procedure is called colporrhaphy posterior (post repairment).
Cystocele and rectocele forming and the complaints they cause are similar to each other. Eventually, cystocele is about the front wall prolapse, herniation of the vagina, while the rectocele is about the prolapse and herniation of posterior wall of vagina. They can be observed together rarely.
The important things here are physical examination and the level of problems due to herniation Pelvic floor exercises (kegel exercises) in order to prevent advanced herniation in the patients with mild level cystocele/rectocele and in order to prevent relapse in the patients who have undergone surgery are very significant. Sports strengthening pelvic floor muscles such as plates can be done in addition to those exercises.