Үй сыртқы мүшелерінің пластикалық хирургиясы: Кіші еріншелерді түзету

Plastic surgery procedure for altering the labia minora

Labiaplasty (also known as labioplasty, labia minora reduction, and labial reduction) is a plastic surgery procedure for creating or altering the labia minora (inner labia) and the labia majora (outer labia), the folds of skin of the human vulva. It is a type of vulvoplasty. There are two main categories of women seeking cosmetic genital surgery: those with conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their vulvas because they believe they do not fall within a normal range. The size, colour, and shape of labia vary significantly, and may change as a result of childbirth, aging, and other events. According to a 2011 review, overall patient satisfaction is in the 90–95 percent range. Risks include permanent scarring, infections, bleeding, irritation, and nerve damage leading to increased or decreased sensitivity. A change in requirements of publicly funded Australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the number of surgeries performed. Unlike public hospitals, cosmetic surgeons in private practice are not required to follow these rules, and critics say that "unscrupulous" providers are charging to perform the procedure on women who would not want it if they had more information. and advertising and do not appear in some anatomy textbooks, while community opposition to sex education limits the access that young women have to information about natural variation in labias. At the same time, many pornographic images of women's genitals are digitally manipulated, changing the size and shape of the labia to fit with the censorship standards in different countries. Medical researchers have raised concerns about the procedure and its increasing prevalence rates, with some speculating that exposure to pornography images on the Internet may lead to body image dissatisfaction in some women. Although it is also suggested that evidence for this is lacking,

The external genitalia of a woman are collectively known as the vulva. This comprises the labia majora (outer labia), the labia minora (inner labia), the clitoris, the urinary meatus, and the vaginal opening. The labia majora extend from the mons pubis to the perineum. The size, shape, and color of women's inner labia vary greatly. One is usually larger than the other. They may be hidden by the outer labia, or may be visible, and may become larger with sexual arousal, sometimes two to three times their usual diameter. The size of the labia can change because of childbirth. Genital piercings can increase labial size and asymmetry, because of the weight of the ornaments. In the course of treating identical twin sisters, S. P. Davison et al reported that the labia were the same size in each woman, which indicated genetic determination. In or around 2004, researchers from the Department of Gynaeology, Elizabeth Garret Anderson Hospital, London, measured the labia of 50 women between the ages of 18 and 50, with a mean age of 35.6: The resection proper is facilitated with the administration of an anaesthetic solution (lidocaine + epinephrine in saline solution) that is infiltrated to the labia minora to achieve the tumescence (swelling) of the tissues and the constriction of the pertinent labial circulatory system, the hemostasis that limits bleeding. Complete amputation of the labia minora is more common with this technique, which often requires additional surgery to correct. In addition, the trim method does not address the clitoral hood. Clitoral hood deformities are common with this approach, again requiring additional corrective surgery. Some women complain of a "small penis" when the trim procedure is performed, owing to the un addressed clitoral hood tissue and completely removed (amputated) labia minor. Most plastic surgeons do not perform this procedure, and instead favor the extended wedge approach, which is technically more demanding, but produces a more natural result and is able to create a natural and proportioned appearance to the vulva. Reconstructive procedures are often required after the trim (amputation) labiaplasty.

Labial reduction by means of a central wedge resection involves cutting and removing a partial thickness wedge of tissue from the thickest portion of the labium minus. The central wedge resection technique is a demanding surgical procedure, and difficulty can arise with judging the correct amount of labial skin to resect, which might result in either undercorrection (persistent tissue redundancy), or the overcorrection (excessive tension to the surgical wound), and an increased probability of surgical wound separation. The benefit of this technique is that an extended wedge can be brought upwards towards the prepuce to treat a prominent clitoral hood without a separate incision.

Labial reduction occasionally includes the resection of the clitoral hood when the thickness of its skin interferes with the woman's sexual response or is aesthetically displeasing.

Labial reduction by de epithelialization cuts and removes the unwanted tissue and preserves the natural rugosity (wrinkled free edge) of the labia minora, and preserves the capabilities for tumescence and sensation. Yet, when the patient presents with much labial tissue, a combination procedure of de epithelialization and clamp resection is usually more effective for achieving the aesthetic outcome established by the patient and her surgeon. In the case of a woman with labial webbing (redundant folding) between the labia minora and the labia majora, the de epithelialization labiaplasty includes an additional resection technique – such as the five flap Z plasty ("jumping man plasty") – to establish a regular and symmetric shape for the reduced labia minora. In Australia, the Royal Australian College of General Practitioners has issued guidelines on referring patients with dissatisfaction with their genitals to specialists. A change in requirements of publicly funded Australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the numbers of surgeries performed. This has led to increased numbers of women complaining of pain and discomfort from chafing of the labia minora, as well as cosmetic concerns around how the appearance of genitals. In many countries, media regulation classifies "hardcore" and "softcore" pornography – demanding that magazines with "hardcore" pornography be wrapped in black plastic and sold only to people over 18 who show photo ID. Sales of magazines in black plastic tend to be low, and thus many magazine publishers choose to comply with the "softcore" standards. Although female genital mutilation – the practice of cutting off a woman's labia and sometimes clitoris, and in some cases creating a seal across her entire vulva – is illegal across the Western world, Simone Davis, a professor and gender theorist at Mount Holyoke College in Massachusetts, argues that "when you really look carefully at the language used in some of those laws, they would also make illegal the labiaplasties that are being done by plastic surgeons in the U. S." The WHO writes that the term is not generally applied to elective procedures such as labiaplasty. The American College of Obstetricians and Gynecologists (ACOG) published an opinion in the September 2007 issue of Obstetrics & Gynecology that several "vaginal rejuvenation" procedures were not medically indicated, and that there was no documentation of their safety and effectiveness. ACOG argued that it was deceptive to give the impression that the procedures were accepted and routine surgical practices. It recommended that women seeking such surgeries must be given the available surgical safety statistics, and warned of the potential risks of infection, altered sensation caused by damaged nerves, dyspareunia (painful sexual intercourse), tissue adhesions, and painful scarring. In the UK, Lih Mei Liao and Sarah M. Creighton of the University College London Institute for Women's Health wrote in the British Medical Journal in 2007 that "the few reports that exist on patients' satisfaction with labial reductions are generally positive, but assessments are short term and lack methodological rigour." They wrote that the increased demand for cosmetic genitoplasty (labiaplasty) may reflect a "narrow social definition of normal." The National Health Service performed double the number of genitoplasty procedures in the year 2006 than in the 2001–2005 period. The authors noted that "the patients consistently wanted their vulvas to be flat, with no protrusion beyond the labia majora some women brought along images to illustrate the desired appearance, usually from adverts or pornography that may have been digitally altered." The International Society for the Study of Women's Sexual Medicine produced a report in 2007 concluding that "vulvar plastic surgery may be warranted only after counseling if it is still the patient's preference, provided that it is conducted in a safe manner and not solely for the purpose of performing surgery".