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					18          OPINION                                                                                                                                     M AY 2 0 1 0 • O B . G Y N . N E W S

Female Genital Cosmetic Surgery                of ethics “autonomy”? If an educated pa-
                                                                                                 PAIN RELIEVERS
I was very interested and equally disap-       tient requests cosmetic surgery, isn’t it un-                                                        “...Helen?, ... Hi, ...
pointed in the page 1 article entitled,        ethical to prevent her from consenting to                                                            I need a second
“Controversy Rages Over Female Geni-           this option if that’s what she wants? His                                                            opinion ... .”
tal Cosmetic Surgery” (March 2010).            suggestion that labiaplasty surgeons all
While the fact that I am writing a letter      promote a certain aesthetic ideal, “destroy
somewhat illustrates the point in the ti-      women’s self-esteem ... and charge them
tle, I am disappointed that the reporter       a lot of money to fix what [they] have de-
presented what seems to be a very biased       stroyed” is outrageous and uneducated.
report in opposition to these procedures.      First, most labiaplasty surgeons don’t pro-
Including the opinion of a Dr. Indman          mote any kind of ideal; they listen to what
(who is an expert because?) as her major       the patient feels is ideal for her and pro-
resource and highlighting his personal         vide the expertise to create that for her,
opinion below the title and at the end of      as would any cosmetic surgeon for any
the article adds an unfortunate and dis-       body part. The suggestion by Dr. Tracy
tasteful bias to what otherwise could          that most patients requesting labiaplasty
have been a fair and informative piece.        need counseling is paternalistic and de-
   The most important point in this con-       meaning to women. While a subset of
troversy was alluded to in this article but    women seeking cosmetic surgery suffers
not expanded upon. Why have we not ex-         from lack of education, body dysmorphic
plored the obvious double standard that        disorder, or other psychological issues,        published have demonstrated a very low         is something wrong with that, is inter-
this is cosmetic surgery, nothing more and     this is clearly a small minority.               risk and excellent patient satisfaction.       esting. I personally added cosmetic
nothing less, and if one objects to labi-         In my practice I am very careful to tell        Dr. Tracy’s point that women should         surgery to my practice for lots of rea-
aplasty as being “unethical,” then one         all patients seeking labiaplasty that they      be educated about the risk of “bleeding,       sons. There was a demand, I had the
must object to all cosmetic surgeries? As      are “normal.” I routinely show them pic-        infection, pain with intercourse, and scar     skills, I found that I am good at it, I en-
Dr. Matlock said, no one needs their nose      tures of other labia of various shapes and      tissue” suggests that this is not part of      joy it, it makes patients happy, and I get
or their breasts or their tummies done.        sizes and make no statements about              the routine consent for a labiaplasty. In      paid well (in that order). Why are we em-
These are patient-choice elective proce-       which ones are best. Beauty is in the eye       my practice, although I perform several        barrassed to admit that getting paid well
dures. No one is suggesting that they are      of the beholder. Small breasts, saggy eye-      cosmetic labiaplasties a month and have        is a legitimate motivation? Cosmetic sur-
medically necessary. Why are the critics       lids, and big noses are “normal” too, but       never had any complications, patients          geons learned to combine ethical prac-
of cosmetic labiaplasty not attacking their    no one argues that we have a right to           sign a detailed consent form, as they          tice with a lucrative income long ago and
plastic surgery colleagues, suggesting that    change them in an attempt to approach           would for any surgery. Of course this is       are not embarrassed about it. It is no
their practices are unethical and that their   whatever aesthetic ideal appeals most to        done, and suggesting that it is not is un-     wonder that we have not gotten any-
patients should all be sent to a psycholo-     us if we want to. There seems to be a           educated and insulting to cosmetic gy-         where negotiating with insurance com-
gist before having a rhinoplasty?              very fine line between “feminism” and           necologists. People die or suffer major        panies for better payment when as a
   Dr. Indman’s leading quote implying         paternalism. The same feminists who             complications during cosmetic surgeries        group we are so ashamed to place a
that performing cosmetic surgery and           demand that women have equal rights             such as abdominoplasty and liposuction         monetary value on our skills.
providing ethical care are not compatible      and freedom then doubt a woman’s abil-          fairly regularly. Labiaplasty is surgery          As for the criticism that courses in cos-
is ridiculous. Isn’t one of the basic tenets   ity to make an informed decision for            and all surgery has risk, but compared         metic surgery are expensive and secre-
                                               herself when she seeks something that           with major cosmetic surgeries, the risks       tive, I have yet to go to a valuable edu-
                                               feminists don’t approve of (cosmetic            are minor and are discussed with every         cational course that was free. I was
         E DITORIAL                            surgery). No doubt such feminists would         patient in detail prior to the procedure.      happy to pay for the cosmetic courses
     A DVISORY B OARD                          not oppose body alterations such as pierc-         Another double standard that occurs to      that I attended, they were open to any-
                                               ings, tattoos, or even a sex change. Why        me surrounds the routine performance           one who was willing to pay the fee, and
 ERIC J. BIEBER, M.D., Case Western            labiaplasty is singled out as an evil           of male circumcision, which is generally       the information I learned was incredibly
 University Hospitals, Cleveland, Pa.          amongst these is a true mystery to me.          understood to be a cosmetic procedure          valuable.
                                                  The focus of some critics on the “lack       as well, and is routinely performed on            In the past I have paid a high price for
 CONSTANCE J. BOHON, M.D., Georgetown
                                               of data” and particularly the absence of        newborns who cannot consent. Why is            laparoscopy courses and a number of
 University, Washington
                                               randomized controlled trials regarding          alteration of the cosmetic appearance of       courses on various ob.gyn. topics. I am
 EDIE DERIAN, M.D., Geisinger Health           labiaplasty again illustrates the lack of un-   the penis acceptable, so acceptable in         always happy to pay an expert for their
 System, Danville, Pa.                         derstanding that this is purely a cosmet-       fact that it can be performed on a new-        time in training me to learn something
 BRUCE L. FLAMM, M.D., University of
                                               ic procedure, and that no claims are            born, but cosmetic alteration of the fe-       new. Why is this any different?
 California, Irvine                            made regarding outcome other than               male labia in an adult consenting patient         I am happy that you published an ar-
                                               meeting the patient’s desire. As Dr. Pelosi     is suggested to be unethical? What if an       ticle on this subject as it obviously illus-
 CHARLES B. HAMMOND, M.D., Duke                said, the only important end point is pa-       adult male seeks penis enlargement or          trates some personal inconsistencies in
 University Medical Center, Durham,            tient satisfaction. As for the lack of ran-     circumcision because he doesn’t like the       many of our practices that should be ex-
 N.C.                                          domized controlled trial (RCT) data,            way his penis looks? Should he be sent to      amined. While I am disappointed in the
 MELISSA KOTTKE, M.D., Emory                   what a ridiculous idea. How on earth            a psychologist? If a urologist offered these   author’s bias, I am glad that the topic is
 University, Atlanta                           could one do an RCT on a cosmetic pro-          services, would he be criticized?              getting some attention, and I hope to see
                                               cedure? In fact, a number of prospective           The repeated suggestion that gyne-          more discussion of it in the future.
 CHARLES E. MILLER, M.D., University of        studies on the safety and satisfaction rates    cologists are moving toward cosmetic                         Susan Hardwick-Smith, M.D.
 Chicago                                       of labiaplasty have been done, and more         surgery to make money, and that there                                             Houston
 E. ALBERT REECE, M.D., University of          are on the way. Universally the studies
 Maryland, Baltimore                                                                                                           V E R B AT I M
 RITU SALANI, M.D., Ohio State
 University, Columbus
                                                             LETTERS                              ‘If you’re considering induction for a VBAC candidate who
                                                 Letters in response to articles in
 LUIS E. SANZ, M.D., Virginia Hospital           OB.GYN. NEWS and its supplements                 has an unfavorable cervical exam, reconsider it. Research
 Center, Arlington, Va.                          should include your name and address,
                                                 affiliation, and conflicts of interest in
                                                                                                  has also shown that women who require multiple agents for
 LORI SEVALD, R.PH., M.D., private
 practice, West Palm Beach, Fla.
                                                 regard to the topic discussed. Letters
                                                 may be edited for space and clarity.
                                                                                                  induction have the highest rates of uterine rupture—rates
 JAN LESLIE SHIFREN, M.D., Harvard               Mail: Letters, OB.GYN. NEWS,                     that are almost four- to fivefold higher than those for women
 Medical School, Boston                          5635 Fishers Lane, Suite 6000,
                                                 Rockville, MD 20852                              who labor spontaneously.’
 CYRIL O. SPANN JR., M.D., Emory                 Fax: 240-221-4400                                                                                     Dr. George A. Macones, p. 28
 University, Atlanta