Embodying Barbie: Cosmetic gynecology on the rise in Canada [Friday, June 30, 2017]
By Maryse Zeidler, CBC News

After six years of wishing she looked better below the belt, Alyssa recently shelled out $4,200 to have part of her labia removed. "Esthetically, there's nothing hanging, there's nothing really excess in that area so it does look better," said Alyssa, whose name has been changed to protect her privacy. The procedure she got done, known as labiaplasty, was performed in 35 minutes under local anesthetic at the Toronto Cosmetic Clinic and is part of a trend toward cosmetic gynecology being seen in Canada and the U.S. Cosmetic surgeons argue the procedures can help women build confidence and resolve problems with sexual dysfunction. But critics say the desire to get labia changed is driven by unattainable standards set by the prolific porn industry, and there is little evidence to support any claims the procedures provide women with any benefit. The clinic's managing director, Sina Kashani, says the procedure has spiked in popularity since it was first offered in 2005. Patients can choose from a range of styles from the "Barbie," "for a perfectly smooth look," to the "more conservative" "peek-a-boo."

Four-fold increase "Patience is the key when it comes to recovery," Alyssa said. "The first couple of weeks is uncomfortable because it's a very, very sensitive area." The Toronto clinic offers a range of cosmetic gynecology procedures that also include vaginoplasty to tighten the vaginal muscles, labia puffing to increase the outer labia, and hymenoplasty to repair broken hymens. While these surgeries aren't new, Kashin says the procedures have increased four-fold since the clinic started offering them and it's now one of several busy plastic surgery centres in Toronto that does so. Canada doesn't keep statistics on cosmetic procedures, but according to the American Society for Aesthetic Plastic Surgery labiaplasty is the second fastest-growing cosmetic procedure in the U.S. Cosmetic gynecology has grown so much, the International Urogynecological Association included it as a sub-topic for the first time at its annual conference this weekend in Vancouver.

'This isn't just a trend' Dr. Robert Moore has clinics in Atlanta, Beverly Hills and Dubai that specialize in reconstructive and cosmetic vaginal procedures, which they've been performing for the past 15 to 20 years. "This isn't just a trend," Moore said at the conference. "There's actually more science behind this that the members of the society want to know about." Moore said cosmetic gynecology first began with vaginal rejuvenation, which is often performed on women who suffer from a prolapsed uterus, urinary tract or rectum post-childbirth and may experience pain during intercourse as a result. "In the past we kind of just said, well, you're a mom now. If things get worse and you start leaking urine all over yourself come see us, we can then do something about it," he said. "Sexual dysfunction is a real problem, why do we have to wait for things to get so extreme?" The procedure is now also performed on older women who want to tighten their vaginas, also usually after having had children, and not necessarily because of any problems with pain. Hymen repair is performed mainly for women who are preparing to marry, but is only a small portion of the business. In the past five to 10 years, the greatest growth in the specialty cosmetic field has been labiaplasty, which also has some roots as a medically necessary procedure it is sometimes done to help women who experience pain because of friction caused by unusually large labia. But Moore admits the surgery is often performed on women who feel uncomfortable being sexual because they don't like how their genitals look.

Reconsidering 'normal' That's where Vancouver-based gynecologist Dr. Nicole Todd takes issue with cosmetic procedures like labiaplasty and vaginoplasty. Todd says she regularly has patients ask her about altering their labia, and although they are of all ages, the majority of them are under 19. "I do feel that there's an increased focus on the appearance of genitals as this is pushed forward by increased access to images on the internet as well as in pornography," Todd said. "I feel as a medical community it behooves us to know and reassure women that the majority of them do fall well within normal limits." One of Todd's tactics when patients come in asking about the procedure is to show them medically or feminist-oriented websites like the U.K.'s Great Wall of Vagina to demonstrate the wide variety of vulval shapes and sizes. She also screens her patients for mental health issues, and warns them of the risks of surgery which include infection, scarring, nerve damage and increased pain. As for the science supporting cosmetic procedures for sexual dysfunction, Todd says plastic surgery often suffers from publication bias the industry is more likely to only publish studies with positive results and not the negative ones. Instead, she says proven results for post-partum problems include pelvic floor exercises and physiotherapy.