Scope and reasons for referral
Surgery of the genital region is one of the areas in which plastic surgery addresses complaints relating to function and hygiene as much as appearance. The reasons for referral arise most often not from a concern about appearance but from concrete problems that affect daily life:
- Friction, irritation and pain within clothing or during sport
- Difficulty in maintaining hygiene, recurrent fungal infection and urinary tract infection
- Damage to tissue and laxity arising after childbirth
- Congenital differences and marked asymmetry
- Problems arising after injury, previous surgery or circumcision
- Anatomical problems that affect sexual function
Procedures carried out in women
- Reduction of the inner lip (labium minus). This is the procedure carried out most often. It is used where the tissue is large enough to give rise to friction and irritation; the aim is to preserve the natural appearance and the sensation.
- Adjustment of the outer lip (labium majus). Correction of the loss of volume that arises with weight loss or with age, or of excess.
- Repair after childbirth. Repair of the damage to the perineum and to the muscles that occurs during birth; planned together with a specialist in gynaecology and obstetrics.
- Correction of congenital differences. A reconstructive approach that keeps function in view in developmental anomalies.
Procedures carried out in men
- Circumcision and corrections after circumcision. Repair of problems such as excess skin, asymmetry or narrowing.
- Correction of curvature. Procedures undertaken in congenital curvature, or in curvature due to disease, assessed together with urology.
- Correction of the excess of fat and skin that gives rise to a buried appearance.
- Repair after injury and loss of tissue.
Assessment and planning
Examination is carried out with the utmost care for privacy and is directed at establishing the anatomical counterpart of the complaint. In the assessment, the duration of the complaint, its effect on daily life and the patient’s expectation are discussed in detail.
In this area a multidisciplinary approach is often needed: gynaecology and obstetrics, urology, and where required dermatology and pelvic floor physiotherapy. The cause of the complaint may be a problem that lies outside surgery; recurrent infection, chronic skin disease or weakness of the pelvic floor muscles, for example. In such cases the priority is the right treatment, not surgery.
Surgery and recovery
Procedures are carried out under local anaesthesia with sedation, or under general anaesthesia, according to their extent; most end in discharge the same day.
- Oedema, tenderness and slight blood-stained discharge are usual in the first few days.
- Hygiene of the region and adherence to the recommended dressing regime are the most decisive part of healing.
- Return to daily life is usually within a few days; the period may be longer in work that puts strain on sitting.
- Waiting 4-6 weeks is asked for before heavy exercise, cycling, swimming pools and sexual intercourse.
- Resolution of the oedema and settling of the final appearance take 2-3 months.
Risks and realistic expectations
Headings that need to be discussed: bleeding, infection, separation of the wound, problems with the scar, temporary or permanent change in sensation, asymmetry and, rarely, the need for a further correction.
In this region preserving the sensation of the tissue comes before form. Removing too much tissue may lead to problems that are difficult to reverse; a measured approach is therefore preferred.
Ethical framework
In this area it is essential that the decision be made of the person’s own will and without pressure. Where a referral comes with the expectation of a partner or of those around the person, the process of decision needs to be reassessed.
This is a region in which anatomical variety is wide; in many referrals the examination shows that no procedure is needed, and the right advice is to say so plainly. An aesthetic procedure is not appropriate in people who have not completed their development; in this age group surgery is planned only where a medical necessity is present.
Assessment
Talking about complaints under this heading may be difficult for patients; yet most of them rest on a concrete anatomical cause and can be treated.
You are welcome to book an appointment for an assessment; examination and consultation are conducted in privacy.