With the development of gynecological plastic surgery, women have begun to have new cognition and requirements for their own positioning and lifestyle. It's no longer just about pleasing others, but about making your life more comfortable.
Written by | Ling Jun
In October 2014, the International Urogynecology Journal published the world's first study, in which researchers measured the shape of the vulva in 319 Chinese women over a three-year period.
The project was carried out by doctors from the "Ten Plastic Surgery Departments" of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences (Eight Plastic Surgery Hospitals). Li Fengyong, one of the authors of the paper and deputy chief physician, said that when the team was in the 2008 innovation, the team searched the literature around the world and could not find an accurate description of the most secret part of the female body.
Not only vulvar shape, in those days, the field of gynecological plastic surgery was completely blank. Pelvic floor muscle repair, labiaplasty, and women who come to the clinic have difficulty talking about them. The outside world even thinks that they "have nothing to do", and even "have problems in their private lives".
Today is different. In 2022, the "Ten Plastic Surgery Departments" was officially launched as the "Gynecological Plastic Surgery Center", and the outpatient clinic was overcrowded every day.
From the earliest unattended, to the barbaric growth of the later market, and now to the continuous improvement of diagnosis and treatment norms and industry ethics, Li Fengyong has experienced the development of Chinese gynecological plastic surgery for 15 years. She also saw that with the improvement of women's economic ability and social concepts, their sense of autonomy began to awaken. Those that were once unspeakable can now be said clearly.
Source: Ruijing
Li Fengyong told the "medical community" about the process she went through:
This area is a blank space internationally
About a decade ago, a woman in her 40s came to our department. She has a severe urethral vaginal fistula, in which urine leaks into her vagina when she urinates, spilling out and spilling everywhere.
The patient had previously undergone genital reconstruction in the field. The doctor cut off almost all of her original organs, keeping only a part the size of a bean, and attached it to her pubic bone, telling her that it was the clitoris. Two holes are left underneath, one is the urethra and the other is the vagina, and structures such as the labia majora and minora have not been reconstructed at all.
The appearance became like that, and there was no room for any further repair. When she came, she only hoped that we could help her solve her urinary fistula problem, and there was no other appeal.
This is probably the situation in the field of gynecological plastic surgery and restoration.
hypertrophy and asymmetry of the labia minora, which causes discomfort due to friction in daily life; Postpartum pelvic floor muscles relax, resulting in poor relations between the sexes, leaking urine as soon as you cough and jump... Limited by traditional ideas and closed information, most women choose to endure, and some endure it all their lives.
Some women go to obstetrics and gynecology for help, but most of the time they are told, "You are a healthy person, why should you be stabbed." The attitude is worse, "Everyone looks like this, why can't you stand it." "Very few people pay attention to the aesthetics and comfort of female external genital organs.
After graduating in 2004, I came to work at the Eight Plastic Surgery Hospital and was first assigned to the "Hypospadias Center", which specializes in perineal plastic surgery. Most of the contacts are perineal deformities caused by various congenital or acquired trauma, mostly men, accounting for more than 90% of patients in the department.
Just after two years of work, the head of the department approached me, and he thought that in the future, there will be a large number of female patients (beauty seekers) in the plastic surgery department, and people's demand for beauty will become higher and higher. As the only female doctor in the department, he hopes that I can focus on female perineal plastic surgery, and develop both pathological repair and beauty.
In 2008, our department was officially established and named "Ten Plastic Surgery Departments". In the early days of its establishment, it was rare to see beauty seekers related to the female vulva, and the patients were still mainly male, and the types of diseases were also very diverse.
And a large part of the consultation gynecological plastic surgery, a large part of the vaginal deficiency patients, that is, commonly known as "stone women", the incidence of this disease is about 1/4000, we through flap transplantation or their own oral mucosal microparticle transplantation, etc., vaginal reconstruction of them.
There are also hermaphroditic deformities, due to various congenital or artificial reasons, the patient's vulva development is blurred, unable to distinguish the sex, and requires surgery to make their vulvar characteristics match the chosen sex.
For patients with vulvar morphological remodeling, pathological repair and functional recovery are no longer technically a problem, but we always feel wrong after surgery. Especially for patients with hermaphrodites who choose to be women, it involves the reconstruction of reproductive organs from scratch, like pinching an eraser, we make her a woman, but we always feel that this is not the shape of normal female vulva.
We tried to find a standard to refer to, but after consulting a lot of literature, we finally realized that there was a gap in this area internationally.
319 female vulva were measured over three years
In 2010, the head of the department pulled us to a seminar to start measuring the vulva of normal women in China. With the naked eye, "being a woman" is too general, and we need to fill this gap.
In August of that year, the project was officially launched. How much skin is above the foreskin of the anterior labial distance, the pubic epicephalic distance, and the foreskin of the clitoris, and how is the connection between the labia minora and the clitoris? From the head of the department to the training doctor, as long as consent is obtained, everyone receives the clinic with a ruler, regardless of the type of gynecological patient, they are measured one by one.
Only by collecting these data, whether it is sexual deformities or the repair of vulvar organs, can we have evidence for future operations. The concept of medicine is evolving, doctors not only need to treat diseases, but also minimize the scars on the patient's body surface. And we, as plastic surgeons, have an obligation to work appearance.
Since there were not many gynecological aesthetic patients at that time, the project progressed quite slowly.
The doctors were also busy, and I was still the main treatment at that time, cutting double eyelids, laser scars, rhinoplasty and breast augmentation... These businesses account for nearly 80% of day-to-day work. But everyone also knows in their hearts what the ultimate goal is, and these are only temporary compromises.
After three full years of measurement and vulvar data from 319 Chinese women, we felt that it was telling the story, and continued to expand the sample had little impact on the mean, and began to compile the data and publish articles.
In October 2014, "A Preliminary Study on the Measurement of Vulva in Women in Gynecological Cosmetic Surgery in China" was published in the English journal International Journal of Obstetrics and Gynecology, which is the first related study in this field.
It also gives us a sense of accomplishment. As initiators, we succeeded in bringing the medical community to this untouched area. After the publication of the article, medical institutions in many overseas countries followed suit and released the measurement values of the structure of the local female vulva.
With concrete data, we gradually began to focus on improving surgical protocols.
Labia majora minora, clitoral foreskin trimming, postlabia joint repair, etc... The various surgical options are also almost blank, and there is only a few literature available for reference. However, after long-term patient follow-up, many problems will be found. We have also spent several years constantly exploring and improving.
Since 2018, both the postoperative effect and the long-term feedback on comfort have improved significantly. The improvement of the surgical protocol is basically close to the bottleneck, and we have turned our attention to studying the more nuanced content.
How do the characteristics of the subcutaneous tissue of the labia minora differ from other parts? What is the route of neurovascular, lymphatic distribution and reflux of normal female vulva? Some patients will have long-term tissue edema after surgery, is it due to impaired lymphatic return caused by surgery, or is it a congenital physiological condition? And the probability of postpartum urine leakage is so high, what is the reason?
Again, no one has given an answer, and this is also a topic that we are working on.
It took 15 years for the "Gynecologic Plastic Surgery Center" to be launched
In 2004, after graduating from Bethune Medical School of Jilin University, I came to work in Badachi Plastic Surgery Hospital. After rotating through different departments for the first year, the reason why I finally decided to join the perineal plastic surgery work was purely because the atmosphere of the department was good, which made me feel a sense of belonging. At the same time, I also agreed with the director's judgment on the future industry trend, and also went out for further training at the end of 2007 to study obstetrics and gynecology.
But what I didn't expect was that the industry would move so fast and at a mixed level.
Around 2010, with the rise of the Internet, "labia are too large, too dark in color, etc. are due to promiscuity", and various rumors that demean women went viral on the Internet. It was with these gimmicks that the first batch of private hospitals for "private part surgery" began to rise, vaginal rejuvenation, labiaplasty, vulvar bleaching... From no one to a variety of items, there are almost no indications and surgical procedures.
According to different surgical methods, all kinds of serious complications or sequelae are also concentrated in that period.
I once saw a female patient in her 20s who heard rumors of a "disorderly private life" and went to a private institution for surgery. That was the first time I saw a normal woman with her labia completely removed.
There is also vaginal tightening. There is no injection standard, so everyone takes it for granted to inject hyaluronic acid around the vagina and fill it with fat. These operations not only have no obvious effect, but due to improper filling, the graft is in the blood, and there are cases of cardiopulmonary embolism and death from time to time.
This situation continued until around 2017, when medical science popularization officially emerged as a professional field, and we could finally spread the concept of standardized diagnosis and treatment to the outside world. It was also that year that I was appointed deputy chief physician and began to go out to attend academic conferences, preach and teach.
We have repeatedly advocated that all vaginal fillings should be prohibited as much as possible. And for healthy women who have not given birth, unless there is a specific reason to do so, any need for vaginal tightening is not accepted.
When it comes to labiaplasty, we tell all healthy women that no matter what it looks like, big or small, thin or thick, it is normal. It's just that if it brings inconvenience to life, or feels unsightly, we may be able to help you after a specific assessment.
In 2022, together with scholars from Capital Medical University, Peking University People's Hospital, Sichuan West China Hospital, Shanghai Ninth Affiliated Hospital of Jiaotong Medical and other institutions, we led the release of the "Chinese Expert Consensus on the Treatment of Labia Minora Hypertrophy and Hypertrophy Plastic Surgery". It is proposed that the width of the labia minora should be retained at least 1 cm after surgery, leaving room for possible subsequent repairs. If the natural width is lower than this standard, the doctor should refuse the operation unless there are special circumstances.
Indications, contraindications, aesthetics, choice of surgical style, we hope that with such a reference operating instructions, the girl's tragedy will never be repeated again.
Perhaps it is the lessons of the early blood, coupled with the state's rectification of the chaos in the medical beauty market, the entire field of gynecological plastic surgery is gradually becoming standardized. Last year, our "Ten Plastic Surgery Departments" was also officially renamed and listed as "Gynecological Plastic Surgery".
For 15 years, from no one to overcrowded, even many obstetricians and gynecologists have come to study, and we are finally closer to what we imagined.
To please yourself
About three years ago, I treated a minor girl. Due to some bad information on the Internet, she was extremely unconfident in the shape of her private parts, and when her parents brought her, she was so anxious that she could not go to school normally. When she takes a bath in a public bath, she always feels that others are staring at her with strange eyes.
I helped her with labia minoraplasty. Because I know that what can be brought by parents is that countless times of communication and psychological counseling are ineffective, and parents are also forced to have no way. Obtaining permission from parents, meeting the indications after evaluation, and surgery to regain the child's confidence and return to normal life is what I can help.
In fact, even if it is fully compliant, plastic surgery is often considered "over-medical" until now because most patients are "healthy people". But in my opinion, beauty seekers have psychological needs or preferences for beauty, and we are also providing psychological support for them.
More often, I see that with the development of the times, women have begun to have new cognition and requirements for their own positioning and lifestyle.
A 14-year-old girl learning horsemanship wears her vulva after every training. I told her mother that the child was young, but because of special needs, I could operate on her. But one thing must be said, she is still developing, and by the time she is seventeen or eighteen, she may still have wear and tear.
Her mother said to me, "It's okay, I'll bring her again then." If you are uncomfortable now, why endure it? ”
There was also a 72-year-old lady who came to my clinic alone to have a labiaplasty, and without any hesitation, the surgery was completed within a week. Also because of the friction, she has endured discomfort for decades, but previously did not know it could be treated.
This is also the most obvious change in the field as a whole.
In the past, the main people who came to our department were young girls around 25 years old, but in recent years, the number of women of different ages has gradually increased, and the department has to perform an average of 7 surgeries a day, and occasionally meet regular customer recommendations, which is unimaginable in the past - they can't wait to delete my contact information as soon as the operation is completed, for fear that the second person will know.
There are also many postpartum mothers, and childbirth has caused great trouble in their daily lives. However, unless it develops to the stage of serious diseases such as uterine and bladder prostle, the obstetrics and gynecology departments of most general hospitals will not choose surgical treatment in the past.
The few who come to me are mainly because of the discordant relationship between the sexes. Now, they come to consult with me about pelvic floor muscle repair and share with me some of the changes after giving birth, paying attention to every detail of their body after childbirth. They no longer want to please others, but to make their lives more comfortable.
Source: Medical community