Topics still taboo
Gynecological cosmetics: foundations and means.
Dana SAWAN1Barbara HERSANT2
1Obstetrics and Gynecology Unit, King Abdulaziz Hospital, Jeddah, Saudia Arabia
2Aesthetic and reconstructive Plastic Surgery Unit of Henri Mondor Hospital, Créteil, France
For correspondence: Dr Dana Sawan: Tel: +966 50 560 8206 Email: dana.s.sawan@gmail.com 2737 Abdullah Bin Huthafa Street, Ash Shati District Postal Code: 23414
Introduction
There is no scientific definition for beauty and in particular that which concerns the genitals. The criteria of beauty are today influenced by the media that are advertising and pornography(1). Thus, women's perception of their private parts has evolved over time. From "shameful" organs (official medical terminology) in the recent past, influenced by the Judeo-Christian religion, genitals have become a noble organ in contemporary society(2). Nowadays, women are encouraged to love their private parts, to explore them and to know them as a prerequisite to reach orgasm, and even to show them, to offer them to her partner's gaze.
This change of look has thus taken place thanks to the media at the cost of a progressive stripping of hair and a merciless fight against natural folds judged excessive, leading in the "ideal" case to a juvenile vulva (Barbie look)(1,3). Other criteria of beauty of this perfect" vulva are its pigmentation and functionality (no smell, narrowness, etc.).
To achieve this ideal, several means are used, ranging from simple creams to intimate cosmetic surgery, the demand for which is increasing worldwide, especially among young people. In this article we discuss the means available today gynecological cosmetics.
The search for the "perfect" repaired vulva.
Indications for gynecological cosmetics.
Gynecological cosmetics is not yet a well codified practice based on solid evidence(1).
Indeed, the perception of our body is subjective. Therefore, the request for a cosmetic procedure is more influenced by our own perception of our body than by any scientific consensus or the presence of any pathology in the strict sense.
In addition, the service offering itself is influenced by the gender and beliefs of the practitioner. For example, female surgeons were found to access requests for intimate surgery less often than their male counterparts(1,4).
In 2016, European guidelines were published to frame the management of vulvar pathologies(5).
Their main recommendations are the mandatory gynecological and anorectal examination, respect for dignity, evaluation and prevention of sexually transmitted infections, search for candidiasis in the presence of any vulvar irritation or discharge, evaluation of sexual function, and prior diagnosis and treatment of common vulvar pathologies such as psoriasis, eczema, lichen or vulvar dysplasia.
In addition to spontaneous requests for cosmetic gynecological surgical procedures, potential indications for cosmetic procedures include:
- Pigmentary disorders
- Vulvar atrophy or postmenopausal genitourinary syndrome
- Vulvar discomfort and vulvodynia
- Lichen, psoriasis and eczema
- Post-depilatory folliculitis
- Sexual reassignment
Means
The surgery
Vulvar, clitoral and vaginal reconstructive surgery is known and practiced for a long time to remedy certain traumas such as war rapes or genital mutilation. However, the most requested surgical procedure is the reduction nymphoplasty(1,3). The latter is very popular with young patients who are more inspired by the advertising or pornographic ideal than by a knowledge of the female anatomy. The indication of these surgeries is difficult to ask in the absence of anatomical norms on the size of the female genitalia. Indeed, the few existing studies on the subject conclude to a great variability in the size of the clitoris and labia(6,7). In 1985, labia minora exceeding 5 cm were considered hypertrophied, but today, the limit for some surgeons is around 3 cm, resulting in ever more youthful looking vulvas(1,8). The indication is therefore essentially based on the discretion of the surgeon consulted.
Other surgical procedures include pubopexy (surgical fixation of a falling mount of Venus), lipofilling of the labia majora (enlargement by injection of autologous fat), liposuction (aspiration of excess grease) and Vulva, perineum and vagina lift. The latter is requested by women who complain of relaxation of the pelvic musculature and vagina and results in a decrease in sensations during sexual intercourse and a variable prolapse (cervix, bladder, rectum) through the vaginal orifice (9,10) (see figure 1).
Sex reassignment surgery as for it is practiced to make acquire the sexual organs of the opposite sex in the strict context of gender dysphoria. It is done by a multidisciplinary team (psychiatrist, endocrinologist, gynecologist, urologist, etc.) after a minimum of two years of follow-up(11).
However, surgery is not without complications. Indeed, patients may experience bleeding, bacterial or mycotic infections and postoperative suture loosening (disunions) that require revision.(12).
Gynaecological emollients
The usefulness and effectiveness of emollients have been demonstrated in gynecology(13). They are indicated in vulvovaginal atrophy and have several properties: lubrication, hydration, soothing. Some are now incorporated directly into sanitary napkins (figure 2).
Topical hyaluronic acid
Hyaluronic acid applied several times a week in case of atrophy or every day in case of erosion or vulvar wounds, allows to soothe the mucous membrane, to restore its PH and thus its trophicity. This treatment is often well tolerated but the problem is the persistence. Indeed, the effectiveness stops when the treatment is stopped. It is interesting as an adjunct treatment or on a long-term basis as part of a care routine, in which case it should be applied once or twice a week.
Growth factors
Growth factors are regulatory substances present in small quantities that promote the multiplication of a specific cell strain in the body(14). Compositions containing them contribute to better vaginal health by reducing dryness, improving sensations during sexual intercourse, maintaining a pH between 3.8 and 4.2; improving vaginal secretion by allowing faster healing with increased collagen. Che factors are contained in platelet concentrates that are injected locally in combination with hyaluronic acid. They have been clinically shown to improve vaginal atrophy in postmenopausal women(15) (see figure 3).
Depigmentation of the intimate area
Hyperpigmentation of the intimate area is due to both intrinsic and extrinsic factors. Intrinsic factors are hormonal disorders, use of birth control pills and insulin resistance. Extrinsic factors These include wearing tight underwear, humidity, shaving or hot waxing(16).
Several products are used to remedy hyperpigmentation of the intimate area. They cause a peeling of the affected area or block the synthesis of melanin, the natural pigment responsible for hyperpigmentation.
These include:
Trichloroacetic acid which causes a desquamation of the superficial layers of the epidermis and the appearance of a new lighter layer, dhydrogen peroxide: Stimulates the production of elastin and collagen in the deep layers of the epidermis, dkojic acid: blocks the production of melanin, du CO2 laser reduces or blocks the synthesis of melanin, andes commercial preparations combining various active ingredients, that exist on the market,(figure 2).
Conclusion
Gynecological cosmetics is a rapidly growing field, boosted by advertising and pornography. The growing demand, especially among young women, sometimes teenagers, must be well evaluated in order to discern the deep motivations and expectations of the applicants in order to reduce the risk of dysmorphophobia.
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