Aesthetic vaginoplasty

Aesthetic vaginoplasty

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  Aesthetic Vaginoplasty: A gynecologistPerspective Mahmoud Abdel-Aleem Professor of Obstetrics and Gynecology, Assiut University
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  Definition According to WHO;these are procedures involving partial or total removal of the external female genitalia or any injury to them for socio-cultural and non-therapeutic reasons”.
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  • Reconstructive Vaginoplasty • Sex Reassignment surgery •Aesthetic Vaginoplasty Vaginoplasty
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  Reconstructive Surgery Improving the function ofa body part Cosmetic Surgery Changes the aesthetics of essentially normal anatomy Vaginal rejuvenation" and "designer vagina Changing paradigm !!!
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  The story In 1973,a French, Belgian, and Italian dermatologist met on a Mediterranean cruise ship while traveling on holiday. The three friends little suspected that a few days of chatting would give birth to what they termed a “restless and revolutionary Aesthetic Medicine”
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   Diverse proceduresfrom “chemically remodeling the body’s silhouette” (SBME 2011) to “prevention and treatment of all types of aesthetic pathology” (SEME 2011). This field incorporates diverse specialties and has already procreated new hybrids such as “aesthetic gynecology” and “aesthetic endocrinology”.
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  Concept of aestheticmedicine Health Beauty
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  Conflicts of aestheticmedicine Hippocrates Rule Appearance Vs
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  “Quotations”!!! 1- An aestheticmedicine presents a puzzle for critical studies of medicalization. 2- An anomalous medical practice in that it makes aesthetic improvement the exclusive aim of surgery, even to the point of justifying health risks in an otherwise healthy patient. 3- Cosmetic surgery is often combined with a growing number of medical procedures that harm beauty and sexuality.
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  4- The boundariesbetween reconstructive and cosmetic rationales in plastic surgery have shifted. In the late 19th century, even procedures such as correction of a cleft palate, now widely perceived as reconstructive, were considered cosmetic (Gilman 1998).
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  5- The “inferioritycomplex”—a psychoanalytic concept popularized in the United States in the 1920s—lent credibility to the idea that appearance has profound effects on mental health.
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  Surgeons performing FGCS
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   Gynecologists, urogynecologists,and urologists.  Gynecologists are most comfortable with vaginal and vulvar surgery.  More plastic surgeons have been performing FGCS, and have added modifications such as fat grafting.  Formal survey: 50% only received formal training.
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  Indications  Loose vagina64%  Change in sexual pleasure 30%  Unattractive gaping introitus 48%  To improve self-image 33% Goodman MP, Placik OJ, Benson RH, et al. A large multicentre outcome study of female genital plastic surgery. J Sex Med 2010; 7: 1565e77
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  Techniques
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  T y p e s
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  Vaginal Rejuvenation techniques Classic:  Non-surgical.  Surgical.  Update:  Laser technique  Radiofrequency  Collagen injection  “G-Spot augmentation”
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  Surgical vaginoplasty  RestoreYouthful healthy vagina (Appearance, Function & Sexual gratification)  Techniques:  Full depth & length repair.  Muscles & torn Fascia are re-sutured.  Relaxed Ligaments are shortened.  Excess Vaginal skin removed.  Disadvantages: Bleeding, Injury, Infection, Adhesions, Scarring, Narrowing, Recurrence, Altered Genital Sensation.
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  Laser Rejuvenation  LaserVaginal Tightening by using a vaginal probe; laser energy is delivered safely to full circumference of vagina to promote collagen production, vaginal mucosa shrinkage, remodeling & strengthens the supporting ligaments.  Advantages:  Non-invasive & Safe.  Increased Sexual Gratification to both.  Reduction in Stress urinary incontinence .  No Surgery, Anesthesia, Pain, Downtime. Disadvantages:  A series of 3 settings, 4-5 weeks apart.  More Cost & Experience.
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  Radiofrequency Rejuvenation  Thisis in-Office Vaginal Rejuvenation surgery under mild Sedation and local Anesthesia.  Ellman Surgitron Radiofrequency device to make precise and minimally traumatic incisions.  Less destructive than lasers. It takes about 60 minutes.  Enhance Sexual Gratification” as well as a Cosmetic procedure Sekiguchi et al., 2013
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  Collagen injection “G-Spot augmentation” A simple, non surgical collagen injection that can augment the Grafenburg spot (G-Spot) in sexually active women to amplify sexual sensation.  80% effectiveness.  Must be repeated every 4-6 months.
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  Labiaplasty= labioplasty The bestestablished female genital cosmetic procedure is reduction labioplasty. Indications: Aesthetic dissatisfaction or discomfort. During exercise or sexual intercourse.
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  Designer vaginoplasty It isa trade mark registered term for the reshaping and resculpting of the external vulva including  Clitoral unhooding.  Labiaplasty of the labia minora and majora,  Augmentation labiaplasty of the labia majora.  Liposuction of the vulva and mons pubis.
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  A gynecologist Perspective
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  10. It’s notmedically indicated. 9. It’s not been proven to be safe & effective; potential long-term complications may occur. 8. Women are not educated about the wide range of “normal.” 7. Women requesting these procedures often really need psychological counseling. 6. Doctors are promoting an unrealistic ideal. “Top 10 Arguments Against Performing Cosmetic Gynecology.”
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  5. Doctors aredoing it just for the money. 4. It’s unethical. 3. Women are being forced by social pressures. 2. Seminars offer industry secrets for a high price. 1. ACOG doesn’t support it.
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  A woman Perspective
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  Do women knowwhat is normal ?  A wide variability in the appearance of normal female external genitalia is a fact.  Sexual function does not appear to be associated with genital dimensions.  This information is important for women and surgeons alike when considering cosmetic vulvar surgery. H. Krissi et al. /Anatomical diversity of the female external genitalia and its association to sexual function. European Journal of Obstetrics & Gynecology and Reproductive Biology 196 (2016) 44–47
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  Do women know“genital aging”? Preadolescent Adulthood Aging vagina Mons pubis Adherent to periosteum. More fat Atrophy Labia majora Adherent to periosteum. More fat (perineal ptosis) Atrophy Clitoris and prepuce Small Wrinkled Dryness Labia minora Pink and hidden Darker Exposed Wrinkled
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  On the otherhand ! Pros clearly agree that there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. Data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent. Goodman MP, Placik OJ, Benson RH III, Miklos JR, Moore RD, Jason RA, Matlock DL, Simopoulos AF, Stern BH, Stanton RA, Kolb SE, and Gonzalez F. A large multicenter outcome study of female genital plastic surgery. J Sex Med 2010;7:1565–1577.
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  Precautions !!  Fineline between female genital mutilation and female genital cosmetic surgery.  Both plastic surgeons and gynecologists performing this type of surgery should be aware of potential damage being caused and which in the future may be classified as ‘mutilation’.
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  Thank You