Better Sex From the Knife? An Intimate Look at the Effects of ...
SCIENTIFIC FORUM Better Sex From the Knife? An Intimate Look atthe Effects of Cosmetic Surgery on Sexual Practices Guy M. Stofman, MD; Timothy S. Neavin, MD; Praful M. Ramineni, MD; and Aaron Alford, MD Dr. Stofman is Chief of Plastic Surgery, The Mercy Hospital of Pittsburgh, and Clinical Associate Professor of Surgery, University of Pittsburgh School ofMedicine, Pittsburgh, PA. Dr. Neavin and Dr. Ramineni are surgical residents at the University of Pittsburgh School of Medicine. Dr. Alford is a surgical resi- dent at The Mercy Hospital of Pittsburgh.Background: The positive effects of aesthetic plastic surgery with respect to body image and self-esteem have been reported inthe literature. However, the possible effects of aesthetic surgery on the sexual practices and characteristics of patients havebeen largely unexplored.Objective: This paper seeks to examine the degree to which a major aesthetic procedure affects the patient’s postoperative psy-chosexual life.Methods: An anonymous questionnaire regarding preoperative versus postoperative psychosexual health and sexual behaviorswas mailed to 330 male and female patients who had undergone a major aesthetic procedure by the senior author (G.M.S).Major procedures were deﬁned as breast augmentation and/or mastopexy; facial aesthetic surgery, including face lift, browlift, and rhinoplasty; and body contouring procedures, including abdominoplasty with or without lipoplasty, or lipoplastyalone.Results: Of the 330 surveys mailed out, 54 were returned as undeliverable. Seventy completed surveys were returned. All therespondents were women, with a mean age of 38 years. More than 95% of respondents reported improvements in bodyimage. Eighty percent of breast augmentation respondents and 50% of body surgery respondents declared improvements insexual satisfaction. Fifty percent of breast and 60% of body respondents had changed to more provocative attire.Approximately 70% of the breast and body group testiﬁed that their partner’s sex life had been enhanced. More than 30% ofbreast patients and 50% of body patients reported an enhanced ability to achieve orgasm. When body and breast respondentswere compared with face surgery respondents, statistical signiﬁcance (P < .01) was found among most psychosexual variablesinvestigated.Conclusions: The results of this study afﬁrm that cosmetic surgery patients overwhelmingly tend to feel better about theirbody after surgery. The sex lives of both patients and their sexual partners can be strikingly enhanced after elective cosmeticsurgery, particularly if the surgery is focused on the breasts, abdomen, and thighs. (Aesthetic Surg J 2006;26:12-17.)A esthetic plastic surgery is no longer a luxury beauty or “anti-aging” products plays off the popularity restricted to celebrities and the extremely of cosmetic surgery. wealthy. More than 11 million cosmetic proce- It is also clear that for cosmetic surgery patients,dures were performed in 2004, including more than beauty is indeed more than skin deep. The literature475,000 lipoplasty procedures, 334,000 breast augmen- suggests that self-esteem and body image levels aretations, 176,000 rhinoplasties, and 150,000 abdomino- high in “attractive people.”2,3 Studies also indicate thatplasties, according to ASAPS 2004 statistics. 1 This positive outcomes from surgical modifications to therepresents a more than fourfold increase in procedures body and face can truly alter one’s life,2-9 to the extentoverall from only 8 years ago. that the plastic surgeon is sometimes labeled a “psy- Aesthetic surgery has not only become “mainstream” chosurgeon” because of the effects of a positive out-in the United States but also has developed into a cultur- come on the patient’s psychological development. Inal phenomenon exploited by mass media. “Extreme their quality-of-life outcome studies, Rankin et al 8Makeover,” “The Swan,” and “Dr. 90210” are some of demonstrated that after cosmetic surgery, patients arethe more popular reality television shows highlighting more self-confident, more satisfied in their appearance,cosmetic surgery, and national advertising for a host of and demonstrated increased psychological well-being.12 AESTHETIC SURGERY JOURNAL ~ JANUARY/FEBRUARY 2006
SCIENTIFIC FORUMThey reported positive changes in their social lives, sex cosmetic surgeries, and general reconstructions werelives, and interpersonal relationships. Patients also excluded from our initial patient survey pool. A letterenjoyed more leisure activities. The authors reported that accompanied our questionnaire described the inten-that patients have lower depression scores after cosmet- tions of our investigation while stressing the anonymousic surgery. Bolton et al 9 asked the question, “Does nature of each questionnaire.abdominoplasty affect body image function by reduc- Of the initial 330 surveys mailed, 54 were returned asing negative body image evaluations and dysphoric undeliverable, mainly because of address changes. Overbody image emotions?” By using various body image the course of the following 4 weeks, 70 anonymouslyquestionnaires and evaluations, they concluded that completed surveys were collected, representing a 25%after abdominoplasty, body image improved, exposure participation rate. Of this collection, 100% were female.avoidance experiences during sex decreased, and self- The median age range of patients who responded was 33consciousness declined. Goin and Rees10 showed that to 44 years. Demographics, including marital status andin psychologically stable patients, rhinoplasty reduced ethnicity, were not explored.self-consciousness, anxiety, and interpersonal sensitivi- Data were analyzed using 2 different paradigms.ty, and could increase self-esteem. It has been noted First, to incorporate such a vast variety of major elec-that self-consciousness about the mid torso and other tive cosmetic surgeries, 3 groups were devised: breastweight-sensitive areas of the body can erode sexual sat- (BR) (n = 26), body (BO) (n = 25), and face (F) (n =isfaction and functioning. 11 However, the possible 19). Of the BR group, 25 (96% underwent breast aug-effects of body-enhancing surgery on sexual practices mentation; 1 patient underwent mastopexy withoutand characteristics have been largely unexplored. The breast reduction. Patient ages in this group rangedpurpose of this paper was to explore this intimate rela- from 26 to 40 years. The BO group comprised 20 par-tionship and expand the literature on the psychosexual ticipants, most of whom were in the 41- to 50-year agedynamics of human sexuality inherent in positive plas- range, although several patients 17 to 25 and over 60tic surgery results. years of age were included. Of this group, 20 (80%) underwent abdominoplasty with or without adjunctivePatients and Methods lipoplasty, 4 underwent combinations of thigh and A 3-page postal questionnaire was developed to inves- waist lipoplasty, and 1 underwent labia reduction. Oftigate whether or not patients perceived changes in their the face group, 5 participants (26%) underwent rhino-psychosexual health and habits after undergoing a major plasty, whereas the other 14 (74%) underwent combi-elective cosmetic procedure. The questions (see sidebar) nations of face lift with and without lid and browdealt with pre- and postsurgical frequency of sexual rejuvenation procedures. Not surprisingly, patients inencounters, modiﬁcations in attire postoperatively, body this group were somewhat older, with most aged 51 toimage perception changes, personal and perceived part- 60 years.ner sexual satisfaction, change in willingness to experi- It has previously been reported that augmentationment sexually, and ability to achieve orgasm. Additional mammaplasty may positively affect a patient’s desire toquestions concerning pre- and postsurgical exercise fre- have sexual intercourse, increase sex quality and fre-quency, occupation changes, and friend and family quency, and help achieve orgasm, while also improvingdynamics were included in the questionnaire, but are self-image and self-confidence.3 Given the premise thatbeyond the scope of this investigation and will not be body altering procedures could in fact improve one’staken into consideration here. self-image, we hypothesized that psychosexual alter- Questionnaires were mailed to the last 330 adult ations from elective cosmetic surgery would be mostmale and female patients who had undergone a “major” influenced by “body” surgeries, that is, breast augmen-elective cosmetic surgical procedure by the author tation, abdominoplasty, and lipoplasty. To investigate(G.M.S.) between January 2001 and December 2002. this idea more precisely, 2 groups were thus developed.“Major” cosmetic procedures included breast augmen- The BO group in this analysis was expanded to includetation mammoplasty and/or mastopexy; facial rejuvena- the 26 breast procedures from the BR population. Ourtion procedures, including face lift, brow lift, and F group was not modified. The more inclusive bodyrhinoplasty; body contouring, including abdominoplas- group (EB) was then compared to our F group amongty with and without lipoplasty, or lipoplasty alone. multiple variables as outlined in the Table using chi-Patients who had undergone breast reduction, minor square analysis.Better Sex From the Knife? An Intimate Look at the AESTHETIC SURGERY JOURNAL ~ JANUARY/FEBRUARY 2006 13Effects of Cosmetic Surgery on Sexual Practices
SCIENTIFIC FORUMResults obtain orgasm. Psychosocially, 18 (95%) had improvedIntra-group analysis of breast, body, and face body image; 2 (11%) were wearing more provocative clothing postoperatively, and 16 (84%) would repeat the The patients were originally divided into 3 groups as surgery. Results are summarized in the Figure.discussed previously. Of the BR group, 12 of 26 respon-dents (46%) reported increased sex frequency after Expanded body versus face analysissurgery. No one declared a reduction in sexual encoun- After an initial investigation of responses from BR,ters or frequency of sex postoperatively. Twenty-ﬁve of BO, and F participants, it was apparent that psychosexu-26 (96%) reported an increase in body image satisfac- al and psychosocial differences existed between the Ftion, with 11 of 26 (42%) changing from “desire for sig- group and the BR and BO groups. Intragroup analysisniﬁcant improvement” preoperatively to “completely” or demonstrated profound pre- and postoperative psycho-“near completely” satisﬁed with body image postopera- sexual and psychosocial alterations affecting respondents,tively. Fourteen of 26 (54%) modiﬁed their attire postop- especially among BR and BO participants. This is noteratively to dress more provocatively. Ten of 26 (39%) surprising. Previous literature has supported the idea thatreported they willingly experiment sexually more often breast augmentation could have a positive impact on sex-and achieve more comfort in new sexual positions. A ual relations and body image.6remarkable 21 of 26 (81%) declared a significant As a result of our observations and the previous studyimprovement in sexual satisfaction after surgery, and 19 by Baker et al,6 we decided to compare BO participantsof 26 (73%) reported perceived improvements in their with F participants, hypothesizing that body procedurespartner’s sexual satisfaction. Eight respondents (31%) will generally correlate more positively with improve-claimed their ability to achieve orgasm had improved. All ments in psychosexual and psychosocial arenas postoper-but 3 (88%) participants noted a marked increase in atively. The 70 participants were divided into 2 groups.compliments related to their postoperative outcome. Group 1 comprised an expanded body population (EB) inWith the exception of 1 participant, all BR group which all BR group participants and BO group partici-patients said they would have the surgery again. pants were collected (n = 51). The F group (n = 19), In the BO group, only 5 of 25 (20%) reported having which included patients who had undergone a combina-more frequent sex postoperatively. However, 13 (52%) tion of rhinoplasties and variety of facial rejuvenationwere enjoying more sexual experimentation (loosely procedures, remained unmodified. Chi-square analysisdefined as “more sexual positions” and/or “unconven- was performed and results are outlined in the Table.tional sex”), 17 (68%) declared a marked improvement Although 33% of EB participants versus 22% of F par-in sexual satisfaction, 14 (56%) perceived improvements ticipants reported increase in postoperative sexual activity,in partner sexual satisfaction, and 13 or 52% achieved the distribution is not signiﬁcant. That is, there is no statis-orgasm more easily postoperatively. tical evidence to support the idea that persons undergoing Not unexpectedly, all but 1 participant in this group body surgery will, as a result of their body surgery, engagehad an improved body image postoperatively. If this cate- in sex more frequently postoperatively than those whogory is examined more closely, we find that 15 (60%) have had facial surgery. Examination of personal sexualreported an increase in body image satisfaction, changing satisfaction responses demonstrates that 73% versus 37%from “desire for signiﬁcant improvement” preoperatively of EB and F groups, respectively, reported an increase into “completely” or “near completely” satisﬁed with body postoperative surgical sexual satisfaction. This difference isimage postoperatively and, likely as a consequence of an statistically signiﬁcant (P < .01). A similar trend was foundimproved body image, wearing more provocative skin- when exploring partner sexual satisfaction; 67% versusrevealing clothes. Twenty-one (84%) noted a marked 37% of EB and F participants, respectively, noted a per-increase in body compliments, and all but one would ceived improvement in partner sexual satisfaction as awillingly undergo the same procedure again. result of their body surgery. This is also statistically signiﬁ- Among the F group, only 4 of 19 respondents (21%) cant (P < .01). Additionally, there was a statistically signiﬁ-reported having more frequent sex postoperatively. One cant difference between the EB and F groups with respect(5%) was experimenting sexually more frequently, 6 to postoperative ability to achieve orgasm (39% of EB(32%) reported an increase in sexual satisfaction, 4 group versus only 6% of F group reported increased abili-(21%) perceived an increase in partner sexual satisfac- ty, P < .01). When questioned about willingness to engagetion, and only 1 (5%) noted an improved ability to in unconventional sex, 41% of EB participants versus only14 Aesthetic Surgery Journal ~ JANUARY/FEBRUARY 2006 Volume 26, Number 1
SCIENTIFIC FORUMTable. Expanded chi-square analysis: body versus face 6% of F participants reported postoperative changes, a sta- tistically signiﬁcant difference (P < .025).Category Change (%) after Change (%) after Both EB and F groups demonstrated remarkable body surgery facial surgery improvements in body image (92% and 95%, respective-Wear provocative clothing (P < .01) ly). With respect to postoperative changes in attire, a Same 45 88 remarkable 88% of the EB group versus only 12% of the Increase 55 12 F group stated that they were wearing more revealingPersonal sexual satisfaction (P < .01) clothes (“showing more skin”). This difference is statisti- Same 27 63 cally signiﬁcant (P < .01) and somewhat intuitive. Increase 73 37Partner’s sexual satisfaction (P < .01) Discussion Same 33 63 Increase 67 37 Thirty years ago, Baker et al6 published a comprehen-Ability to have orgasm (P < .025) sive article on the psychosexual dynamics of women Same 62 94 undergoing breast augmentation. It demonstrated the Increase 38 6 positive influence augmentation mammaplasty had onUse of unconventional sexual positions (P < .025) building self-conﬁdence, sexual relations, and psychoso- Same 59 94 cial health. Baker and colleagues demonstrated that after Increase 41 6 breast augmentation, many women found more pleasure in breast play and sexual intercourse; 13% of patients even reported their ability to achieve orgasm was Psychosexual Questions From Mailed Survey enhanced. Many spouses were pleased with their wives’ cosmetic outcomes, leading, in many cases, to more fre- Approximate sexual encounters before surgery per quent sexual relations. He also noted that clothing styles month: _____ became more provocative and that an improved feeling of Approximate sexual encounters after surgery per sexual adequacy was achieved among his patients. month: _____ We have confirmed these profound psychodynamic alterations in our participant pool. Furthermore, we have Please rate how you feel about your body, 1 to 5, expanded on Baker’s study to investigate potential sexual before the above cosmetic surgical procedure: influences resulting from multiple body procedures and (1=unsatisﬁed, 3=neutral, 5=very pleased) _____ compared the results with those from a facial surgery group. Body image was enhanced in 96% of BR group, Please rate how you feel about your body, 1 to 5, after 91% of the F group, and 60% of the BO group. Following the above cosmetic surgical procedure: (1=unsatisﬁed, surgery, over half of the participants in the BR and BO 3=neutral, 5=very pleased) _____ groups changed their attire to dress more provocatively. Psychosexually, postsurgical changes were most pro- How would you describe your sex life/sexual satisfac- found among BR and BO participants. Most striking was tion since your cosmetic surgical procedure? (Less sat- isﬁed, no change, more satisﬁed) _____ the postoperative inﬂuence on sexual satisfaction, partner satisfaction, and ability to achieve orgasm. Approxi- How would you describe your partner’s sex life/sexual mately one half and one quarter of the BR group and BO satisfaction since your cosmetic surgical procedure group participants, respectively, reported engaging in sex (Less satisﬁed, no change, more satisﬁed) _____ more frequently after surgery. More than 80% and 50% of BR group and BO group participants, respectively, How would you describe your willingness to sexually declared an improvement in their sex life after plastic experiment or participate in unconventional sexual surgery. In addition, more than 30% of BR and 50% of activity since your surgery (Less willing, no change, BO participants reported enhanced ability to achieve more willing) _____ orgasm. Many of these women indicated that they felt more comfortable with unconventional sex and often How would you describe your ability to achieve orgasm engaged in more sexual positions. since your cosmetic surgical procedure? (More difﬁcult to achieve, no change, more easy to achieve) _____ It is important to note that only women responded to our survey; therefore, we do not have data from maleBetter Sex From the Knife? An Intimate Look at the AESTHETIC SURGERY JOURNAL ~ JANUARY/FEBRUARY 2006 15Effects of Cosmetic Surgery on Sexual Practices
SCIENTIFIC FORUMFigure. Changes in body image (BI), dress (D), frequency of sex (SF), sexual satisfaction (SS), partner sexual satisfaction (PSS), frequency of uncon-ventional sex/willingness to engage in new sexual positions (US), and frequency of orgasm (O).patients or responses from female patients’ male partners group based on age alone. Among all patients respondingwith regard to the effects of surgery on their sex lives. to the survey, there were exactly the same numbers in theHowever, approximately 70% of combined EB group categories under age 40 as in the categories over age 40.participants testiﬁed that their partner’s sex life had been This is the median split. Additional analysis was done toenhanced. determine if there were differences in sexual practices We also compared overall body contouring participants based on the age component alone. Except for the(mainly breast augmentation, abdominoplasty, lipoplasty) responses concerning unconventional sex, there was noto facial surgery patients (rhinoplasty and facial rejuvena- statistical difference in the sexual patterns of womention procedures). Although more than 90% of participants under 40 and those over 40 when looking at increase inin both groups had improved body image after surgery, the sexual activity, partner satisfaction, and revealing clothes.psychosexual component of their postoperative lifestyles The differences were not as dramatic, as they are baseddiffered dramatically. Statistically signiﬁcant differences on operation type. Using age as the alternative explana-favoring the EB group did exist in 5 categories studied: tion for the results does not explain why younger womenpostoperative personal sexual satisfaction, partner satisfac- are so prone to change the frequency of their sexualtion, ability to achieve orgasm, willingness to engage in behaviors after aesthetic surgery.unconventional sex, and provocative attire. Both the literature12 and our own clinical experience When reviewing the data, age differences became an suggest that breast augmentation can be an incentive forimportant consideration. Interestingly, the F group recovery from anorexia. Although it was recently sug-demonstrated very little change in postoperative sexual gested that a correlation between augmentation and sui-behavior and/or psychosexual attitude. It should be noted cide exists,13 this claim has been disputed by others14that the F group participants on average were the oldest and is not supported by our personal observations.participants in the group. If their responses are correctedfor age, a small majority of F group participants reported Conclusionenjoying better sexual relations. We considered whether Our study indicates that women who have undergonethe F group had different sexual tendencies than the BO aesthetic plastic surgery are having not only more sex16 Aesthetic Surgery Journal ~ JANUARY/FEBRUARY 2006 Volume 26, Number 1