Your botched labiaplasty is not your fault

Jessica Pin

In nearly every account I see of botched labiaplasties, I see women blaming themselves.

Self-blame has been present in nearly every story I get privately sent from other patients who have been hurt. And today I am seeing more self-blame on Reddit.

“I almost feel like it’s the punishment I deserve for not being able to love my body in the first place. I feel like I don’t ever deserve to be happy again or enjoy sex.”

“I’ve spent thousands […] to try to fix this problem that I pretty much created for myself.”

This is incredibly frustrating to me, knowing what I know about the field of female genital cosmetic surgery.

First of all, there are no training standards for labiaplasty, and neither OB/GYNs nor plastic surgeons are trained to do these procedures in residency.

Secondly, detailed surgical anatomy of the vulva, vulvar physiology, and vulvar biomechanics are generally missing from both OB/GYN and plastic surgery literature.

Compare getting a labiaplasty to getting a rhinoplasty (nose job). If you go to a board certified plastic surgeon for a nose job, you know your surgeon has been trained in rhinoplasty during their plastic surgery residency. You know they have performed this procedure under supervision during their training, and that they have received detailed instruction in techniques. You additionally can rest assured that they have detailed knowledge of the anatomy and physiology of the nose.

But with labiaplasty, you have none of these assurances. Getting a labiaplasty with your average board certified OB/GYN or plastic surgeon is like getting a rhinoplasty with a dermatologist. Is there a dermatologist out there who can perform rhinoplasty safely? I’m sure there is. But if you go to a dermatologist for a rhinoplasty, there are almost no safeguards in place to ensure your doctor is qualified.

Female genital cosmetic surgery has been controversial. For that reason, regulatory bodies, especially in OB/GYN, have not wanted to be involved in ensuring high standards of care. For example, while the American College of OB/GYNs approves these surgeries for medical reasons, they refuse to cooperate in the establishment of training standards.

Meanwhile, at surgery centers, privileging policies are typically in place to keep surgeons from performing surgeries they have not been trained to do. Going back to the rhinoplasty example, no surgery center would allow a dermatologist to perform a rhinoplasty. However, they will grant privileges to do labiaplasties to OB/GYNs and plastic surgeons who have never been trained to do labiaplasties.

What people need to understand is this all amounts to systemic negligence. As long as women keep blaming themselves instead of directing blame at those actually responsible, this will not change.

Currently, victims of this systemic negligence are invisible, as outcome studies are only published by experts with significant experience. While surgeons tell me they see many patients who have been severely harmed, these patients essentially do not exist in the female genital cosmetic surgery literature.

What laypeople need to understand is those who do publish FGCS outcome studies do so to promote their practices. Only surgeons with great outcomes and a large sample of patents have the incentive and ability to publish. There is meanwhile no incentive to publish bad outcomes unless there is money to made in repairs. As a result, the evidence basis for FGCS is not representative of the standard of care the average patient receives.

Personally, I suffered a dorsal nerve injury in a clitoral hood reduction performed without my consent during a labiaplasty. In my efforts to protect other patients from harm, I have done a dissection study with my dad, which we submitted to the Aesthetic Surgery Journal.

Though the potential for injury is clear, and though ignorance of the innervation of the clitoris is consistently demonstrated in OB/GYN and plastic surgery literature, the editors of the Aesthetic Surgery Journal question whether dorsal nerve injuries are a problem.

It is notable that when I consulted with one of the biggest FGCS experts in the country, he had no explanation for how I could have lost sensation. In order for me to know I suffered from a dorsal nerve injury, I had to do my own research, teach myself the anatomy, diagnose myself, and then find a doctor qualified to confirm it. How many patients diagnose themselves?

To those still blaming themselves, your botched labiaplasty was not your fault. And if you want to protect future patients, speak up. Healthy sexual function is a human right. Get angry at the people who took that from you.

Jessica Pin

Written by

Getting clitoral neural anatomy included in OB/GYN textbooks. It was finally added to 1 OB/GYN textbook for the first time in July 2019. BME/EE @WUSTL

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