After the baby comes the vagina di­a­logue

Cos­metic rea­sons are of­ten associated with surgery, but it’s also about get­ting women’s lives back

Toronto Star - - ENTERTAINMENT & LIFE - LAU­REN PEL­LEY STAFF RE­PORTER

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.”

NAKITA KRUCKER/TORONTO STAR

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.

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