Over the centuries, women have been scrutinized and idolized for the way they look -- and what was considered attractive changed as time progressed. Curvaceous gave way to sleek and svelte as figures were scrutinized; as facial features took the hit, whether the nose was too big or too small, whether the breasts were too big or too small, or the buttocks was flat or too big, gave rise to the popularity of cosmetic surgery as people sought to correct what they were displeased with. As of late, it's not only about correcting perceived defects to give people a sense of well-being and confidence, but now many people seek to correct "assumed" defects to their genitalia.
Obstetrician and gynecologist Dr. Leon Dupuch, director of the Caribbean Institute of Cosmetic Gynecology, who works out of the Bahamas Medical Center, says cosmetic gynecology is now one of the fastest growing segments of female genital surgery as times change. While he said no one talks about it, people are having cosmetic gynecology procedures. For the most part, while uncommon in The Bahamas, he said cosmetic gynecology is becoming more common now that people are finding out about it.
"Although I've done quite a bit of the cosmetic aspect to it, a lot of the surgeries are corrective surgeries -- the women who have had the chronic pain, are having real difficulty and are having painful sex. Most women did not realize that these types of things were available and were just kind of just living with these problems and now they're realizing they don't have to," said Dr. Dupuch.
"With the advent of the oral contraceptive pill and women's liberation, women became more and more sexually empowered and were able to enjoy having sexual intercourse without the worry of getting pregnant and were doing it more and more for enjoyment.
"In 1953 Playboy hit the shelves and women were now seeing their husbands and boyfriends looking at these naked women and what they perceived as normal and thinking this is what [they] should look like. Women started getting more and more plastic surgeries. They would get facelifts, breast augmentation and even buttocks augmentation. With the change in fashion as well in the 18th century, women used to wear underwear that most people would use as pajamas today. Now the underwear has gotten smaller so the genitalia has become more exposed than it was many years ago."
While Dr. Dupuch said women have been portrayed as naked for many years, he said their genitalia for the most part was covered with pubic hair so people weren't able to see what the actual genitalia looked like. With people opting to shave to the point of baldness, the doctor said that the genitalia can now be fully viewed. Through the expression of art, he said women can see different variations in women's genitalia, in the case of "The Great Wall of Vaginas" by Jamie McCartney in a London museum which has casts of hundreds of vaginas on a wall; and the famous Dinner Party by Judy Chicago, who made dinner plates, all of which were in the shapes of vaginas from around the world.
"What this really demonstrates is that images and representations of women's genitalia are becoming less taboo now," said Dr. Dupuch who spoke at a recent Doctors Hospital Distinguished Lecture Series. "Women have become more aware of their sexuality and genitalia and have gotten to a point where they want to change it for various reasons, whether it be for cosmetic or functional reasons."

Cosmetic gynecology
As cosmetic gynecology is a sensitive topic, the doctor said that many women live with symptoms such as pelvic relaxation, prolapse of pelvic organs and urinary incontinence without seeking medical help for fear of embarrassment. He said more than 30 million American women suffer from some form of damage giving birth -- they can tear, the vagina stretches and he said that although in most instances it can be repaired, sometimes it does not come back to normal properly, can cause scar tissue and can cause real problems for women later on.
He said some women experience discomfort with intimate contact, chronic rubbing, vulva pain and an inability to wear certain types of clothing and simply choose to live with the symptoms. Dr. Dupuch, who offers highly specialized surgery to restore and enhance the appearance and functionality of the vaginal area in procedures frequently referred to as vaginal rejuvenation and vaginoplasty - which tightens tissues to reclaim youthful function - says women do not have to suffer.
"This is the fastest area of growing plastic surgery [and] more and more gynecologists and plastic surgeons are performing these operations," said the obstetrician/gynecologist. Although Dr. Dupuch said cosmetic gynecology has been around for many years, he said it really came to the forefront because of American surgeon Dr. David Matlock, known as the "cosmetic surgeon to the stars", who pioneered procedures such as laser vaginal rejuvenation and designer laser vaginoplasty.

Surgeries
Labiaplasty or vaginoplasty is performed on women who may have discomfort during intercourse or have discomfort wearing tight clothing or swimsuits, or participating in activities like riding a bicycle or who are just uncomfortable with the size and shape and just want it trimmed down or removed. He said sometimes surgery is needed if women get disfigured from a previous surgery related to childbirth after being torn, and it doesn't quite heal right, resulting in scar tissue that can cause a problem. Other types of surgeries that can be performed include "The Rim" which includes some trimming of the labia majora, with some of the labia minora left behind. In the "Hybrid" surgery even more of the labia majora is removed. There's also the majoraplasty that removes the wrinkling effect some women get, which he said was not noticed before women started engaging in complete hair removal. He also said some people opt to get a fat transfer, in which fat is taken from other parts of the body to give the labia majora a plumpish appearance. In South American countries the doctor said collagen injections is huge for women looking for that "camel-toe" effect.
The most common request Dr. Dupuch said he gets is for "The Barbie", a surgery that involves the complete removal of the labia, allowing the female's genitalia to have a Barbie-doll like appearance. He said it's a look that women are seeing in magazines and hoping to achieve. It is huge in California, where he said practically every female has had it done.
The secret to the procedures, he said, is the fact that less is more, as tissue can always be removed, but can't be replaced.
Vaginoplasty or vaginal reconstruction (tightening), and clitoral hood reduction are also surgeries that Dr. Dupuch performs. But he draws the line at performing hymenoplasty surgery, which he said is a controversial procedure involving the re-approximation of the hymenal tissue, which he said is done.
"The reason it's so controversial is that in some cases in religions it is important that a woman's hymen be intact when it comes time for marriage, and if it isn't intact she's considered impure. It is a bit deceitful, but some women will come and ask to have their hymen put in place, so that when they have contact on their wedding night they bleed."

You are normal
Before undergoing any form of cosmetic gynecology, Dr. Dupuch said it is important for women to understand that all different variations of genitalia are normal, and that there is nothing wrong with the way their vaginas or genitalia look. He said once they understand that and want to proceed with the surgery, he then explains the pros and cons.
Scissors and lasers are the most common instruments used in cosmetic gynecology procedures and recovery is usually immediate with most surgeries performed under local anesthetic. Dr. Dupuch performs his cosmetic gynecological procedures in an operating theater in the hospital as a precautionary measure.
Two hours prior to the procedure the patient has to apply a numbing cream to the area, which is reapplied again at the time of the operation. A drug that takes away the pain a little is injected into the area, which the doctor said the patient does not feel because of the numbing medication.
"But you're awake and we talk and chat while it's being done, and they get up and go home," he said. Vaginal reduction is the only surgery for which a patient would have to be put to sleep, and may require a night in hospital.
While insurance does not cover the cosmetic aspect of the procedures for looks, Dr. Dupuch said if a woman has scar tissue and the labia is causing severe pain, insurance companies would usually consider it.
According to the doctor, surgeries range between $2,000 and $5,000, inclusive of hospital stay.
While he said in some countries some doctors would perform cosmetic gynecology on teenagers, his personal preference is to wait until a female attains her 21st birthday to ensure that she has matured and developed. He would perform cosmetic gynecology on women up to age 100.

Click here to read more at The Nassau Guardian