Sex and self-confidence: Do genital enhancements help?

Within the field of plastic surgery, genital cosmetic surgery has been picking up steam for both women and men. In this article, we look at some of the options, whether they can bring added general or sexual satisfaction, and what to keep in mind when considering genital cosmetic surgery.

Recently, one news outlet reported a shocking new trend among some men in Thailand: penis bleaching. This has brought the attention back to the often controversial procedures of "enhancing" one's private parts.

Nowadays, there are plenty of genital cosmetic interventions and other genital "improvements" that have become available to both men and women who, for one reason or another, may feel dissatisfied with their nether regions.

According to the American Society of Plastic Surgeons (ASPS) 2016 statistics for plastic surgery, the demand for labiaplasties, or interventions that alter the size and shape of the inner or outer labia, went up by 39 percent in 2016 compared with 2015.

Men are also fans of aesthetic interventions, making up 8 percent of all those who seek cosmetic procedures in the United States, say the ASPS. Worldwide, more than 8,000 penis enlargement procedures take place annually, state the International Society of Aesthetic Plastic Surgery.

What kinds of genital "update" are available, and why do we choose them? Also, are they likely to improve our sense of self-satisfaction and well-being?

Below, we tackle these questions and give you an overview of genital cosmetic surgery, and what you should keep in mind before you go under the knife.

Female genital cosmetic surgery

Women have a choice of genital enhancement or rejuvenation procedures, some of which focus on making their private parts look aesthetically pleasing or feel more comfortable, while others aim to help women achieve improved satisfaction under the sheets.

Labiaplasties

Many women opt for labiaplasties because excess inner labia skin makes them physically uncomfortable.

Labiaplasty is probably the best-known genital cosmetic intervention for women. In it, the size of one or both of the inner labia — the "lips" flanking the vaginal opening — is reduced.

This is usually done when one labium is visibly longer than the other one and is aesthetically unpleasing, or when the size of one or both of the labia makes sex or other physical activities uncomfortable or painful due to excessive tugging and twisting of the skin.

Paul Banwell, a consultant plastic and cosmetic surgeon and member of the British Association of Aesthetic Plastic Surgeons (BAAPS), told Medical News Today that most women who come to see him about a genital cosmetic procedure "present because of functional issues such as discomfort with exercise, horse riding, cycling, and yoga."

"Certain types of clothes, underwear, and swimwear," he goes on, "may also be uncomfortable [to them]. A proportion of these patients may also mention aesthetic concerns in concert with their physical symptoms."

According to the ASPS, a labiaplasty costs approximately $2,730, on average, in the U.S.

Sometimes, labiaplasties are accompanied by a clitoral hood reduction procedure — though this type of intervention can also be carried out separately — which involves reducing the folds of skin that "sheathe" the clitoris.

This can be done purely to improve appearance following a labiaplasty or to improve clitoral sensitivity, though the BAAPS note that "there is little information on outcome, other than anecdotal."

Women may also opt for an intervention to reduce their labia majora (labia majoraplasty), which are the outer "flaps" of skin that cover the labia minora.

As with the labia minora, some women may feel discomfort from the tugging and twisting of the labia major experienced during various physical activities, or they may simply be uncomfortable with their physical aspect.

Monsplasty and vaginal tightening

Another type of cosmetic intervention offered in some clinics is the monsplasty, or the reduction in size of the mons pubis, which is the area just under the belly and above the labia majora. This part of the female body forms a natural protuberance, but some women may feel uncomfortable about its size.

In these cases, liposuction is often performed to remove excess fat from that area, and sometimes the removal of some skin is also necessary.

Vaginal tightening, or vaginoplasty, is a "rejuvenation" procedure in which a woman's vagina is tightened, often required by women after having gone through natural childbirth, which can cause the vagina to become more stretched.

Vaginoplasty can involve "going under the knife," though sometimes noninvasive procedures such as laser surgery are also available. This type of intervention has also been shown to help with stress urinary incontinence.

More controversial procedures

Some "restorative" or "enhancing" genital procedures for women have been the target of much more controversy than others. One such example is that of hymen reconstruction surgery, an intervention that aims to "repair" a ruptured hymen, the thin membrane that lines the vaginal opening.

The hymen can occasionally rupture during sexual intercourse or even due to strenuous physical exercise, which does not usually affect gynecological health. However, its traditional association with virginity has led to many debates about the legitimacy of hymen repair procedures.

The so-called O-shot and G-shot aim to boost women's sensitivity in the areas most likely to lead to an orgasm.

And more recently, injections that claim to boost female sexual satisfaction, called "O-shots" and "G-shots," have also attracted much attention.

O-shots — short for "orgasm shots" — are interventions wherein platelet-rich plasma, derived from a person's own blood, is injected into the clitoris and neighboring vaginal area. This is supposed to boost clitoral sensitivity, allegedly making women more likely to experience "mind-blowing" orgasms.

Similarly, G-shots — short for "G-spot shots" — aim to enlarge the surface area of the controversial and elusive G-spot with the same goal of enhancing sexual gratification.

But in speaking to experts, MNT have learned that the effectiveness of these procedures relies on anecdotal evidence, and no conclusive studies have yet been conducted to confirm success rate.

"These particular procedures are considered somewhat controversial at the present time and many doctors feel their claims do not have merit. [...] whilst there are anecdotal reports of some benefits, it is agreed that well-designed scientific studies are required to confirm the efficacy of these concepts."

Paul Banwell

Prof. Ash Mosahebi, a consultant plastic surgeon and BAAPS council member, also told us that it's hard to tell whether — or to what extent — these orgasm-boosting shots achieve the desired effect.

While these interventions might "have some potential, theoretical advantage of improving the sensitivity of these spots, so that it may [perfect] intercourse or [render it] more intense," Prof. Mosahebi said, we should be aware that this approach "is not going to work for everybody."

"Some women are more sensitive in the clitoral area, some are more sensitive in the vaginal area," he added, which makes it difficult to tell when these types of shots will be effective and for whom.

Male genital cosmetic surgery

In the case of men, fewer genital cosmetic procedures are available. The best-known interventions are those related to penis enhancement, and they are usually of two types:

  • penile elongation surgery — this procedure usually relies on making what is already there more visible by cutting the ligament that connects the base of the penis to the lower pelvis, so that more of the male member is uncovered
  • penile girth enhancement — this refers to adding thickness to the penis, which is usually done by removing fatty tissue from other areas of the body where it is found in excess, such as the abdomen, and injecting it under the skin of the penis

Other available procedures include scrotal reduction and testicular implants. Scrotal reduction, or scrotoplasty, involves removing excess skin from the scrotum. This may be required by men who are unhappy about their scrotum size or, more rarely, who have a congenital condition.

Testicular implants are usually opted for by men who have lost a testicle following a surgery for cancer tumor removal or men whose testicles never developed naturally.

Does genital surgery make us happier?

Regardless of why we may choose to undergo one of these procedures, their degree of success is, to a large extent, also decided by how satisfied we are with the end result. In this respect, there seems to be a sizeable gap between the response of men and that of women.

Research has shown that ladies who opt for one of the more common types of genital cosmetic surgery, such as labiaplasties, are generally pleased with the results.

One review gives an overall satisfaction rate of 90–95 percent for women, while postoperatory sexual satisfaction ranks at 80–85 percent.

Mr. Banwell confirmed this to MNT, saying that "patient satisfaction with this procedure is generally very high and the medical literature supports this."

"However," he added, "as with any cosmetic procedure, the consultation is key with clear discussions required about expectations and understanding the complication profile."

Men much less satisfied than women

Men are the least likely to be achieve postoperatory satisfaction due to their unrealistic expectations.

Baseline expectations are key to how satisfied someone will be after undergoing their genital cosmetic surgery, and this may have something to do with why men are, on average, not nearly as satisfied with their penis enhancement procedures.

Surprisingly, according to Prof. Mosahebi, more men than women choose genital cosmetic surgery — specifically penile enhancement — but they are also likelier to be unhappy with the results.

"I think, probably, more unusually, the male side is [...] more popular than the female side [when it comes to these sorts of intervention]," Prof. Mosahebi told us.

Researchers, however, show that men have very low satisfaction rates after surgery, and this may all come down to particularly unrealistic expectations.

"Overall only 35 percent of the patients were satisfied with the outcome of surgery," a study found.

"Men feel like they haven't quite achieved what they had in mind, as a kind of generality, while women can be more content and happier [with the results]," Prof. Mosahebi also noted.

Always seek professional advice

Since the stakes — emotional as well as physical — in genital cosmetic surgery can be so high, it is crucial to get trustworthy professional advice before embarking on such an endeavor.

"Any operation," Mr. Banwell said, "elective or emergency, carries risks and complications. Standard issues of bleeding, infection, and wound problems also occur in labiaplasty as well as other surgeries."

Prof. Mosahebi also added that "particularly for females [...] some of the surgeries [might] tread a fine line between female genital mutilation and cosmetic surgery" if they are not performed responsibly by a certified specialist.

"There are so many people who portray themselves as a plastic surgeon or as an expert, but they are not really," he also stressed.

Thus, Prof. Mosahebi advised that anyone considering any type of cosmetic surgery should "make sure [that] they go to a certified surgeon, [...] get very good advice and that they are treated appropriately, and hopefully they will get some benefit from it."

The first port of call should be your physician, who will be able to give you some baseline advice about which procedures will and will not be appropriate for you. Going forward, make sure to consult your relevant local authority to ensure you work with a certified plastic surgeon.

Have a look at the advice offered on the ASPS website if you're based in the U.S., or on the BAAPS website if you're based in the United Kingdom.