After the baby comes the vagina dialogue
Cosmetic reasons are often associated with surgery, but it’s also about getting women’s lives back
Kristin Jones endured a “horrific” delivery when her daughter was born five years ago. It ended with an episiotomy — a surgical cut to enlarge the vaginal area — that led to stitches and an infection. Afterward, she had no sensation in her bladder.
Despite attending postpartum physiotherapy sessions to strengthen her pelvic floor, Jones recalls once standing up and feeling a sudden gush of fluid. She began sobbing in front of her husband, mortified by the experience.
“Changing your daughter’s diapers is fine, but do you want to change your wife’s diapers too?” the 34-yearold Ayr, Ont., teacher says, reflecting on the incident. “Your dignity is gone.”
Eventually, sensation in her bladder returned and, with a lot of physiotherapy, some control returned as well. But after her second child was born, Jones’ bladder problems came back with a vengeance. Coughing, sneezing, laughing, running — anything she did might cause a leak. If Jones went to a boot camp fitness class at night, she’d avoid drinking all day and show up for the intense workout completely dehydrated.
Living in constant fear of a bladder mishap, she went to a urogynocologist in Toronto, who told her she could have an OHIP-covered procedure involving a mesh implant.
The physician told her the procedure only lasts about15 years — or try a pricey vaginal laser therapy treatment called IncontiLase that’s not covered by OHIP but could, potentially, help Jones’ leakage issues.
While female genital procedures have been on the rise in recent years, what’s most often discussed are the cosmetic reasons — women wanting to trim the lips of their labia or reduce the side of their clitoral hood, for instance. But as Jones soon learned, there’s another side to the controversial and rapidly-growing field of female genital surgery that focuses on medical issues.
Research studies and data from international plastic surgeon associations show female genital surgery, for both cosmetic and medical reasons, is on the rise in various countries around the world, from the U.S. to Australia.
And it’s something local plastic surgeons are noticing as well. As the Society of Obstetricians and Gynaecologists of Canada states in a 2013 policy statement, the increasing number of female genital cosmetic surgery procedures available to Canadian women also include clitoral hood size reduction, perineoplasty, vaginoplasty, hymenoplasty, and Gspot augmentation — procedures which typically cost anywhere from $3,000 to more than $6,500.
When it comes to labiaplasty, many women request the procedure for medical needs because of friction, rashes, irritation, or pain during intercourse, says Dr. Mitchell Brown, a plastic and reconstructive surgeon and associate professor at the University of Toronto. The vast majority of women considering the procedure are older and post-kids, he says.
Labiaplasty is not normally covered by OHIP, though exceptions are considered if the repair is required because of an injury, says Ministry of Health spokesperson David Jensen.
More broadly, women coming in for female genital procedures sometimes seek treatment for urinary incontinence or laxity of the vaginal canal after childbirth, which could be hindering their sex life or making the region uncomfortable, Brown says.
In Jones’ case, she opted for the IncontiLase procedure, and says the roughly $2,500 cost was money well spent since the experience was largely pain-free. “I think that alone makes it so much better than having a surgical procedure where you have stitches and you’re recovering for six weeks,” Jones says.
The procedure involves two to three 20-minute laser sessions, in which a physician uses a speculumtype device to guide a laser to heat the tissue lining the vagina — and the collagen layer below — to tighten the region. It might be slightly uncomfortable, but not painful enough to require numbing gel, says Dr. Dean Elterman, the Toronto urologic surgeon who performed the procedure on Jones. (Elterman has financial ties to IncontiLase product provider Clarion Medical Technologies.)
“The pelvic floor — meaning the urethra, the vagina, the bladder — are all supported by a series of layers of collagen, muscles and connective tissue,” Elterman says. “With childbirth, with age, with decreasing estrogen levels around menopause, you get laxity in the tissues.”
That can lead to bladder leakage, because there is no longer the same amount of support in the vaginal tissue below.
Elterman says it’s still a fairly new type of procedure, so how long it lasts remains unknown.
IncontiLase is not covered by OHIP, confirmed Jensen who added there “are no published studies that could be identified on this procedure” for the clinical use of improv- ing mild incontinence.
OHIP does offer coverage for various other female genital surgery procedures, such as a “sling procedure” for stress incontinence.
For Jones, the laser procedure has since been helpful in improving her bladder function, and she questions why it’s not yet covered by OHIP. “If you’re having a breast reduction for cosmetic reasons, you pay for it, but if it’s for medical reasons — OHIP pays for it. This is for quality of life, and I’m paying for it out of pocket.”
Her bladder function post-procedure isn’t “perfect,” she says, but a marked improvement. “I feel like I’m on the way to getting my life back.”
Vaginal trauma from childbirth led to Kristin Jones’ decision to pay for vaginal laser rejuvenation out of pocket to repair severe incontinence.
Urologist Dr. Dean Elterman performs vaginal rejuvenation for medical and cosmetic reasons.