What’s ‘designer vagina’ that’s being talked about in Netfilx’s The Fabulous Lives of Bollywood Wives?

Yesterday, I got a phone call from one of my many acquaintances. ‘Doctor, have you seen the web series currently streaming on Netflix?’
‘Which one?’
‘The Fabulous Lives of Bollywood Wives, Season 2.’
This was not the sort of a conversation a doctor usually has with a patient, but I was intrigued.
‘What of it?’ I asked.
‘They are recommending vaginal surgery to enhance sexual pleasure at menopause and something called a designer vagina.”
She was in the perimenopausal age group and was having gynaecological issues that were giving her a lot of stress. I calmed her down as much as I could and watched the episode she was referring to; incidentally, the doctor in the show did mention “designer vagina” but did not recommend it. After mulling over it, I decided to elaborate on the fastest growing, relatively new sub speciality of gynaecology – cosmetic gynaecology.

As a gynaecolog with special interest in urogynaecology, I realised that for years we had been repairing vaginas that had been damaged childbirth, operating on women with prolapse and always ended the procedure narrowing its width; in short creating designer vaginas without giving it the fancy name of “cosmetic gynaecology.”
What is cosmetic gynaecology? 
As with plastic surgery elsewhere, plastic surgery on the female genitalia could be either reconstructive or cosmetic. For instance, a plastic surgeon removes burn scars, warts, attaches amputated body parts like a cut ear or finger, or reconstructs faces horribly mutilated cancer surgeries. He also performs procedures/surgeries to enhance the aesthetic appearance of a person that include a nose job, breast enhancement, facelifts, hair transplant and so on. Such procedures are not medically necessary but boost the person’s self-confidence. Though intimate aesthetic surgery too is performed for the above two reasons, it has an additional benefit of improving sexual function. Couples have not had sexual satisfaction on account of vaginas that are enlarged while giving birth to a child. Age and menopause compound the issue, resulting in marital discord and a diminished sense of self-worth.
Also, ever since the shaving of pubic hair has come into vogue, more and more women and/or their partners are dissatisfied with the size and shape and appearance of their private parts. An increasing number are now willing to go any extent, be it pain, surgery or expense to better what God has given them.

When can reconstructive surgery be done?
Medical reasons for doing reconstructive surgery on the female genitalia could be:
· Repair of vaginal tissues that have been torn at childbirth. Kegel exercise can help those with minor defects but with age and menopause, the area becomes still more lax leading to a deterioration in sexual function. As sex forms an integral part of married life, couples do come even at this age for restoration. Sometimes the tear can be so severe that the vaginal and anal canal become one and the woman is unable to control the passage of gas or faeces! If not diagnosed and addressed at the time of delivery, this horrible situation needs to be rectified whenever diagnosed.· Stress incontinence – again due to trauma during childbirth, there is leakage of urine every time the woman sneezes, coughs, or laughs, decreasing the quality of her life. A minor vaginal surgery is all that is needed to alleviate these embarrassing symptoms.· Dyspareunia or painful intercourse could be due to fibrosis and scarring of the vaginal tissues after episiotomy (the cut made on the posterior wall of the vagina facilitates delivery which is stitched after childbirth). Again, a minor surgery is all that is required.· Congenital conditions like an absent vagina. An artificial vagina can be prepared to serve coital function. The procedure is also performed in a transgender person – a woman trapped in a male body for gender reorientation.· The hymen usually has a small opening to allow the passage of menstrual blood. Rarely, the hymen is imperforate, which leads to the collection of menstrual blood in her vagina leading to severe cyclical pain. A small incision is made on the hymen, a procedure called hymenectomy, allows the free flow of menstrual blood. Some women have a rigid hymen that needs to be cut under anesthesia to allow coitus.· If there are growths like warts, lipoma around the external genitalia they can be removed surgically, with the help of laser or cauterized.

What are the cosmetic procedures?
Procedures done purely for cosmetic reasons or to enhance pleasure include:
· Vaginal tightening – though usually done surgically, Botox can also be used. Nowadays laser treatment is available, which is as simple insertion of a transvaginal probe for an internal ultrasound. The procedure takes just ten minutes. Not only does it tighten the vaginal canal and narrow its opening, it also increases the blood flow to the vagina, there heightening sensitivity and sexual pleasure as does Thermiva, that uses radio frequency to achieve the same goals.· Sexually active unmarried girls get their “virginity” restored a procedure called hymenoplasty, to satisfy the demands of the marriage mart.· Labiaplasty – the inner lips of the external genitalia, the labia minora, are trimmed to decrease their size because they look ‘ugly’ or are visible through tights. Others have genuine reasons as they can interfere with penetration during intercourse or rub against their underwear leading to irritation and pain. There could be issues of hygiene and infection.· Removal of large overhanging clitoral hood that diminishes pleasure or shortening an elongated clitoris.· Plumping of thin outer lips, the labia majora or increasing sponginess of the vagina fat transplant.· Some women get the fat from their mons pubis removed liposuction so that it is not visible through tight clothing.
Are there risks involved?
As with any surgery, there could be complications with potential damage to tissues due to scarring, adhesions, dyspareunia, altered sensations, wound infection and you could end up worse than before. Keep this in mind when you go for procedures that are not medically necessary. However, if your self-esteem or marital relationship is being adversely affected, if there are psychological issues on this account, choose your doctor with care. Being a lucrative branch, those not qualified for cosmetic gynaecology too, are giving it a go, enticing customers making false claims of success.
I cannot forget a neighbour, a plump pretty woman of 35 whose husband constantly body-shamed (he would call her a fat cow) her till, in desperation she went for bariatric surgery. One of the clips applied to her stomach gave way and she died within days of the surgery, leaving two young sons behind. Such a tragically futile exercise. So, think twice before opting for cosmetic procedures and go to a special experienced in this field.