Intimate surgery – self-determined!
There are still voices that claim that the desire for a beautiful female pubic is only due to social pressure. However, scientific studies prove that beauty ideals of the media play a subordinate role (Sorice-Virk S, et al., 2020, Aesthet Surg J). The claim that the desire to alter the vaginal area arises from a whim is false, as is the statement that women are increasingly seeking a “designer vagina” or the “perfect vagina.” Women who decide to have intimate surgery are not following a new trend, but on average carry the idea for over 6 years (Kalaaji A., et al, 2019, Aesthet Surg J) until they make the issue concrete.
Studies show that intimate cosmetic surgery positively changes quality of life and that the procedures are considered safe under the high surgical standards required (Turini T, et al, 2019, Plast Reconstr Surg). We respect the self-determination and autonomy of our patients, and orient our open consultations toward the greatest possible benefit for our patients. Nowadays, plastic-aesthetic intimate corrections are no longer a taboo subject. And yet, surgical procedures in the intimate area are a very private matter, which you can discuss and work on discreetly from woman to woman with an experienced specialist and surgeon at CenterPlast.
What is intimate surgery?
The specialty of female genital surgery includes all operations on the female genitalia to improve function and appearance. It thus includes cosmetic genital surgery as well as surgical procedures on the vagina for medical reasons (medical indication). The surgeries are performed on the mons pubis, labia minora, labia majora, clitoral hood or vagina. Most surgical procedures are performed painlessly under local anesthesia (local anesthesia), in twilight sleep, and are possible on an outpatient basis, without an overnight stay (inpatient stay) in a clinic. The plastic surgery techniques used are constantly being refined. These include lifting, minimally invasive procedures such as liposuction and the method of autologous fat treatment. To achieve a harmonious result, several techniques can be combined.
In order to pool medical knowledge and improve the decision-making basis supported by science, two professional societies were founded: DGINTIM, the German Society for Intimate Surgery and Genital Aesthetics, e.V. and GAERID, the Society for Aesthetic and Reconstructive Intimate Surgery Germany.
What is intimate medicine?
Aesthetic medicine applied to the genital area is also called intimate medicine. This includes intimate treatment with hyaluronic acid injections, autologous blood treatment, nano-fat stem cell treatment, fat-away injections, radiofrequency or CO2 laser treatments, and skin lightening procedures. Intimate medicine offers safe procedures to improve sexual function and satisfaction.
Consultation from woman to woman
For the careful selection of the appropriate procedure, a precise knowledge of your complaints (e.g. chafing during sports, itching, discomfort during sexual intercourse, change in urinary stream) and your health condition is required. Therefore, the surgeon will first ask you open-ended questions to get to know you better. Often, people consult their gynecologists or a sex therapist before seeking counseling. Remember to bring the doctor’s findings with you so that Dr. Santos Stahl can get a holistic picture. Our primary concern is maintaining discretion at all times. During the initial examination, the surgeon will evaluate all aspects of your pubic area in order to develop a treatment plan. During the personal consultation, it is extremely important that you make your expectations openly clear. This is the only way that Dr. Santos Stahl can also properly advise you and give you an assessment of whether your goals can be achieved according to your expectations. The recovery period and aftercare following surgery will be discussed with you. Lifestyle habits, such as cigarette smoking or concomitant diseases, can affect the treatment outcome. During the consultation, all questions from A-Z will be answered and any complications will be openly discussed with you in order to choose the best course of treatment together with you.
After the procedure to achieve the desired results has been determined, we can provide you with an individual offer and send you further information, taking into account the desired services, the scope of treatment and the expense.
Intimate surgery – why?
Most women opt for intimate surgery to please themselves or for more fulfilling sex. Among a variety of reasons, better body image and well-being are most often cited. 70% of patients opt for a procedure for “cosmetic reasons.” For many women, the carefree donning of tight clothing such as jeans, swimwear or leggings also means quality of life. Therefore, aesthetic reasons should not be underestimated. In 20 percent, intimate surgery is chosen to relieve pain during sex (Kalaaji A., et al, 2019, Aesthet Surg J). Thus, the desired change is accompanied by the dream of unrestricted sexual stimulation. There are a large number of different forms of female pubic. The size and symmetry of the labia vary greatly. The differences may be hereditary or result from the normal aging process. Natural childbirth can affect appearance, sexual function, and sexual self-esteem, especially if there is a tear or perineal incision. Long or large labia may interfere with sex or athletic activities. Noticeable physical abnormalities may be accompanied by functional discomfort. Vaginal laxity after childbirth causes a loss of friction during intercourse and decreased sexual satisfaction. Surgical reduction and enlargement of the mons veneris or labia majora (labia minora surgery) are often, but not exclusively, performed for cosmetic reasons. Experience shows that men are usually not involved in the decision-making process. The epidemiological indicators of those who decide to undergo intimate surgery in Norway are: Income-middle class, high educational level, and good physical and mental health status, both urban and rural (Kalaaji A., et al, 2019, Aesthet Surg J).
What are the methods of intimate surgery treatment?
The field of intimate corrections includes a wide range of surgical techniques to achieve a beautiful final result and effectively relieve discomfort. The advancement of these techniques and procedures, as well as modern pain management, lead to a higher level of safety and comfort. Knowledge of anatomy and experience with the range of individual anatomical variations are especially important in cosmetic genital surgery. Dr. Santos Stahl is a specialist in aesthetic surgery with many years of experience in the field of cosmetic surgery of the vagina and will be very happy to handle your case.
The goal of aesthetic and plastic surgery in the genital area is to make you feel comfortable with your body after the correction, even in the most intimate moments. The team at CenterPlast places special emphasis on professional and personal consultation in a trusting and discreet atmosphere. Our range of services includes the following procedures:
- Labiaplasty in the form of an enlargement of the labia majora, also known as Labia Majora-plasty.
- Labia reduction of the labia majora, also known as majoraplasty (partial vulvectomy)
- The labia minora reduction or reduction of the small labia (labia minora)
- Pubic mound correction (monsplasty)
- Pubic mound reduction, also known as mons veneris reduction or mons pubis reduction
- Pubic mound lift, also known as mons pubis lift or mons lift
- Clitoris mantle lift, also known as clitoral hood reduction or clitoroplasty
- Autologous blood therapy
- Filler injection of the labia, G-spot injection
For none of these treatments an inpatient stay in a clinic is necessary. Of course, there are also intimate surgical aesthetic treatments for men, but Centerplast does not offer these, as we focus on the female genital area.
Labia minora reduction surgery
Labia minora reduction is the most common surgery in the female genital area. The duration of the surgery is approximately 60 to 90 minutes. The most common techniques are removal of the outer edge of the labia and V-shaped removal of the excess tissue. In addition, over ten different surgical techniques have been described. The technique that provides the best results depends on the size, shape, and proportions of the labia. The labia is sutured with fine self-dissolving sutures. Labiaplasty can be performed together with labia reduction or enlargement of the labia majora. Complementary therapy with platelet-rich plasma may be performed. Labiaplasty should be performed cautiously and moderately by an experienced surgeon, as labiaplasty is difficult and complex. Learn more about labiaplasty of the inner labia on our labia reduction page.
Reduction of the labia majora
Liposuction of the labia majora is often combined with pubic mound correction in the form of liposuction of the mons veneris. Fine suction cannulas, vibratory liposuction and the tumescent technique reduce the likelihood of irregularities and bruising. Removal of excess skin and fatty tissue may be required for drooping labia majora. Cleanly sutured, the scar from a labia reduction is barely noticeable on the side of the labia minora or between the labia minora and labia majora. Reduction of the outer labia must be done carefully and with caution so as not to widen the vaginal entrance. Corrective surgery, especially after a disproportionate reduction, is particularly demanding and may involve several steps of cosmetic surgery. Therefore, entrust yourself to experienced specialists in plastic and aesthetic surgery, with competence and experience in the field of intimate surgery.
Enlargement of the labia majora
The function of the labia majora, which are large and plump in youth, is to enclose and protect the vagina. Age-related loss of fatty tissue or severe body weight loss can result in flat and empty labia. The labia minora, vagina and urethra are then no longer protected, which can lead to dryness, inflammation and discomfort during sex. Fat grafting (lipofilling) gives the labia minora more volume and a more youthful shape. As a result, the labia minora and vaginal entrance become less visible and are better protected. The technique was first described by a Brazilian plastic surgeon (Felicio Y. A., 2007, Aesthet Surg J). Fat cells can be gently harvested from the abdomen or waist while the patient is in twilight sleep. In such an intimate surgical treatment, a total of 20 to 100 milliliters are usually injected. About 70 to 80 percent of the cells are retained for life and behave like normal fat cells in the body. Fat cells change size depending on weight fluctuations. A slight enlargement of the labia can also be achieved with hyaluronic acid. For this, two to six milliliters of filler are injected on both sides. The injection can be repeated after six months. Learn more about this topic on our Shaping the labia minora page.
Clitoral hood tightening, clitoral reduction
The foreskin (praeputium) surrounds the clitoris like a hood and protects the glans clitoridis. An abnormally large clitoral prepuce may interfere with stimulability or be considered unsightly. The clitoral prepuce may be excessively wide or long. The skin may also be asymmetrically expressed and usually results in wrinkling. A clitoral sheath reduction or clitoral sheath tightening procedure removes the excess skin. In pronounced cases of hanging clitoral hood, the glans of the clitoris is gently held aside. The excess skin is removed in the course of an inverted “V” so that the scars between the labia minora and labia majora are barely visible. After clitoral hood reductionplasty (preputioplasty), a discreet foreskin remains, still barely covering the clitoral glans. Clitoral mantle tightening usually does not affect the sensitivity of the clitoris (Placik O.J., et al., 2015, Plast Reconstr Surg). Clitoral mantle reduction is often combined with intimate surgery for labia reduction or augmentation as part of vaginal surgery.
The clitoral glans averages 15 millimeters in length and five to ten millimeters in width (Sale BS, et al, 1992, Obstet Gynecol). An additionally enlarged clitoris (clitoral hypertrophy), may result in a masculinized appearance. Hypertrophy is increased during sexual arousal and often causes psychological distress. When an enlarged clitoris is present, possible causes should be investigated. Common known causes of an enlarged clitoris include genetic and hormonal factors. Nowadays, there are very gentle techniques for intimate correction on the clitoris. Changing the position of a significantly protruding clitoris is called clitoral repositioning (clitoropexy). In this procedure, the connective tissue fibers of the erectile tissue (ligamentum suspensorium clitoridis) are tightened with fine sutures. The technique spares the paired nerve fibers of the pudendal nerve (nervus pudendus) that run headward. You can learn more about the tightening of the clitoral mantle on our page Clitoral Mantle Tightening.
Mons pubis reduction
Weight fluctuations may cause protrusion of the mons pubis or a drooping mons veneris. Changes to the pubic area visible under clothing can cause discomfort and embarrassment. With a bulging abdomen, a large pubic area is often not noticeable. After tummy tuck surgery, a mons veneris may become more prominent and appear unusually large. We therefore discuss the possibility of a pubic correction in advance of an abdominoplasty in order to achieve a harmonious overall result. A slight protrusion of the pubic mound can be treated by liposuction (Mons liposuction). If there is a severely enlarged mons pubis, surgical mons pubis correction by reducing the size of the mons pubis, also called monsplasty, is recommended. In this procedure, excess fatty tissue as well as excess skin is removed. If only the skin is severely sagging, a tightening is performed. The connective tissue layer under the skin is reattached to its original location on the pubic bone with self-dissolving sutures. Experience with the individually different courses of the cutaneous nerves in the pubic area (genitofemoral nerve and ilioinguinal nerve) is very important in order to prevent injuries during surgical changes. Usually, the mons pubis lift leaves a fine horizontal scar of five to eight centimeters above the union of the labia majora (anterior commissure), which is covered by bikini pants. Venous mound reduction can be combined with liposuction (liposuction) of the labia majora or an abdominoplasty, also called abdominoplasty, in one procedure. Visit our mons veneris reduction page for more information.
Vaginal stenosis with autologous fat, stem cell treatment of the vagina
After menopause, the hormone level decreases, especially estrogen. The mucous membrane becomes thinner, the fat and muscle tissue shrinks, the vagina becomes flabby. In medicine, this is referred to as vulvo-vaginal atrophy (urogenital menopause syndrome). To alleviate the symptoms, the use of lubricants during sex is recommended and hormone replacement therapy or estrogen suppositories are prescribed. Sagging of the vulva may also be the result of natural childbirth. The aim of the therapy is to promote the regeneration of the mucous membrane. Thus, the moisture improves, the vaginal flora and pH normalize. Various treatment methods are available to rejuvenate the vagina: Autologous fat therapy, hyaluronic acid and laser treatments. Autologous fat treatment is a widely used technique in plastic surgery. When volume is built up to treat a sagging vagina, both stem cells and fat cells are injected. Thus, narrowing of the vagina can be achieved. In the microfat technique, the fat cells are filtered so that they can be injected with a cannula of a diameter of one millimeter. In the nanofat technique, finer filters are used. The Nanofat procedure is a stem cell transplantation. Stem cell therapy improves tissue perfusion and collagen formation (Charles-de-Sa L, et al., 2015, Plast Reconstr Surg). Stem cells from adipose tissue can promote the renewal of local tissue under the influence of messenger substances (Crisan M, et al., 2008, Cell Stem Cell).
Intimate surgery for minors
Social acceptance of aesthetic surgery has increased significantly in recent decades. However, prejudices and information deficits are still widespread, such as the stereotypical notion that cosmetic surgery is lifestyle surgery for teenagers. In fact, less than one percent of cosmetic surgeries are performed on minors, with two-thirds of these procedures being corrections of sail ears, oversized breasts or man boobs.
Elective genital surgery requires the ability to make a decision or give consent. In these cases, cosmetic surgery can prevent or eliminate stigmatization of the child by the social environment and ensure normal psychological development. Informing young women about the nature, extent, risk and alternatives of aesthetic plastic surgery is a professional duty of the attending physician. The open and at the same time discreet explanatory talks are held in the presence of the parents or guardians. If, following the examination and discussion, there are comprehensible complaints that can be sensibly remedied surgically, the chances of success of intimate surgery are also discussed. It can be performed if it is in the patient’s best interests, taking into account the potential benefits and harms.
What are the risks of intimate surgery?
Disorders of sexuality in affected women can have a variety of psychological as well as physical causes. Occasionally, a very noticeable physical feature can affect the sexual experience. Plastic and aesthetic surgery can improve comprehensible impairments of appearance. If desires and fears have not been discussed in detail prior to intimate surgery, there is a risk that the treatment result will not be consistent with the unstated goals. Intimate surgery can achieve an aesthetically pleasing intimate region and discomfort relief, but it does not promise anatomic perfection. Studies suggest greater than 90 percent satisfaction in terms of appearance and physical discomfort (Lista F, et al. 2015, Aesthet Surg J; Sharp G, et al., 2016, Aesthet Surg J).
Plastic surgery techniques continue to evolve to minimize hazards and increase satisfaction. Nevertheless, even the most carefully and properly performed medical procedures can lead to possible complications such as a wound healing disorder, inflammation, bruising, prolonged swelling, or numbness. Removal of too much tissue can cause dryness and pain.
Complications are rare but not impossible with good planning and execution of vaginal surgery. Therefore, a risk-benefit assessment is essential before any medical therapy. Furthermore, it is advisable to take out a follow-up cost insurance before an aesthetic plastic surgery in the intimate region. Impaired health and certain lifestyle habits, such as cigarette smoking, increase the risk of surgery. Since surgery should only be performed under optimal conditions, cigarette smoking must be abstained from before and after surgery. Make your decision with sufficient time to think it over and free from external constraints.
Do visible scars remain?
Satisfaction with regard to the preserved sensitivity and scars in the intimate area is on average very high after intimate surgery. The scars of a labia or vaginoplasty are barely visible in the natural skin folds. Punctiform scars remain from liposuction. Macrofat, microfat and nanofat treatments leave no scars. Vaginal rejuvenation (by invasive and non-invasive methods) is accompanied by no visible scarring.
What should be considered before an intimate surgery?
In order to keep the risks as low as possible and not to jeopardize a good surgical result, we ask our patients to observe the following measures:
- All your questions about possible complications and alternative treatments should be answered before surgery. If any doubts remain, you should seek a second opinion.
- You should refrain from smoking cigarettes for four weeks prior to surgery. By doing so, you will significantly reduce the risk of wound healing problems.
- Fluctuations in body weight also affect the contours of the intimate area. To ensure an optimal result, you should therefore have reached your comfortable weight before the intimate surgery and maintain it after the surgery.
- Since the surgery can be scheduled at a time of your choosing and risks can never be completely ruled out, surgery cannot be performed during pregnancy.
- If you have a regular cycle, it is helpful to schedule the surgery date outside of your period. Often the intimate area is more sensitive and more prone to swelling during your period.
- Before surgery, all piercings and jewelry should be removed. The jewelry can promote inflammation. Piercing jewelry made of conductive material can cause burns during this procedure and should be removed before surgery.
- The genital area should be free of inflammation.
- Please refrain from shaving the hair around the surgical area for two weeks before surgery. Shaving creates micro-injuries where bacteria can colonize.
- You can help reduce the risk of infection by cleaning your skin in the surgical area with a disinfecting soap (e.g. HiBiScrub® Plus by Mölnlycke, Octenisan® Wash Lotion by Schülke, Prontoderm® Shower Gel by B.Braun). Clean skin areas rich in sebaceous glands particularly thoroughly (e.g. armpits, groin area and perianal and perigenital areas).
- If necessary, stop taking hormone-containing medications (the pill) temporarily.
- Blood-thinning medications (e.g. ASS, Thomapyrin®) must be discontinued at least ten days prior to surgery after consultation with your attending physician.
- Vitamin preparations (A, E) and food supplements (omega-3 fatty acids, St. John’s wort preparations, etc.) must be discontinued at least four weeks before the operation.
- In order to protect yourself from the costs of any complications that may require treatment, we generally recommend that you take out consequential costs insurance before undergoing aesthetic surgery.
What should be considered after intimate surgery?
For the best possible result, optimal aftercare is required. The behavioral recommendations for our patients have grown from years of experience.
- Avoid long walks or standing for long periods of time during the first week.
- Regular cooling helps to keep the inevitable swelling down. After three weeks, the swelling will be largely gone.
- The application of an antiseptic wound gel in the morning and evening reduces the colonization of germs. After intimate surgery, we recommend applying a wound gel for a period of 14 days.
- Good hygiene and daily cleaning of the intimate area help to prevent inflammation. Shower with a disinfecting soap (e.g. HiBiScrub® Plus, Octenisan® Wash Lotion, Prontoderm® Shower Gel) from the first postoperative day. Bathing should be avoided for four weeks. As long as the wound has not healed completely, germs can enter and lead to inflammation.
- As a rule, you can resume your work after one week
- Swimming, saunas, sexual intercourse and sports activities (especially horseback riding, cycling) should be avoided for six weeks, possibly longer if swelling is still present. The scars are not yet able to bear weight during the first six weeks
- For the first two weeks: Wear loose clothing and use pads. Tampons can irritate the tissue and promote inflammation. Placing a compress between the labia in the first few days helps absorb wound fluid and reduces friction on the labia.
- Gently stroking the labia several times a day beginning in the third postoperative week helps reduce swelling. Use an oily cream, such as Bepanthen® ointment or Linola® fat. This measure also helps to keep the scar inconspicuous.
- Avoid waxing and shaving. This will help prevent wound healing problems.
- Please keep the appointments after the surgery to check your comfort and satisfaction. Therefore, before you leave us on the day of surgery, we offer appointments 1, 2 and 6 weeks, and 3 and 6 months after surgery. Removal of sutures is not necessary as self-dissolving sutures are used.
Intimate surgery – When does the health insurance pay?
An application for assumption of costs by the health insurance company is subject to justification and is usually examined by the medical service of the health insurance companies. The health insurance companies cover the costs if there is a “disease in the legal sense”. For surgical interventions on the vulva, there is predominantly no medical necessity. Some doctors often hastily recommend the affected person to turn to a specialist (plastic surgeon) in order to have their corrective wishes covered by the health insurance companies. Issuing certificates carelessly or even as a courtesy violates § 25 of the professional code of conduct for physicians and § 278 of the Criminal Code (StGB). Issuing an incorrect certificate about a patient’s state of health against one’s better knowledge can be punished with a prison sentence of up to two years.
What do intimate surgical procedures cost?
Since many factors influence the cost of a surgical procedure, a blanket general price quote is unreliable. The type of medical procedure and the amount of work involved can be estimated once the findings and your goals are known. Also relevant to the costs are the pre- and post-treatment consultation, the required medications and materials and the costs for the operating room as well as the costs of the anesthesiologist. The experienced specialist Dr. Santos Stahl is highly qualified and takes the time you need. Complex procedures are performed with the assistance of another experienced specialist, also a plastic surgeon. Always inquire about the experience of the surgeon you are trusting so you are sure you are with the right doctor with extensive experience. Read their resume and ask to see before and after pictures (or after pictures). For a rough estimate of cost, visit our cost page.
Testimonials on intimate surgery
Nowadays, patients place a lot of emphasis on patient testimonials and reviews they find on the Internet. Patient satisfaction is our top priority. If you would like to find out what our patients think about our high quality consultation and treatment results, visit our testimonials page.
Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.