Cosmetic genital surgery - labiaplasty and phalloplasty

Cosmetic genital surgery involves reshaping the labia, vulva or penis. Some people choose this surgery because they feel unhappy about the look of their genitals. An operation to change the look of the genitals is sometimes referred to as ‘aesthetic genital surgery’.

Female genital reshaping, or labiaplasty, aims to change the size and shape of the inner labia or the inner lips of the vulva. Penis enlargement or augmentation surgery (phalloplasty) is used to increase the length, width or both of the penis.

Labiaplasty and phalloplasty are not the same as gender reassignment surgeries.

If you are concerned about the way you look, or are thinking about cosmetic treatments to boost your confidence, there are alternatives. Another option is to accept yourself the way you are and realise that normal, healthy genitals come in a wide range of shapes and sizes.

Things to consider about cosmetic genital surgery

Before you choose cosmetic genital surgery, there are some important issues to keep in mind:

• Be aware that you will have scars. Although the scars may fade significantly with time, they will always be visible.
• Labiaplasty will not make the vagina smaller or tighter. This requires a different operation called a vaginoplasty.
• Phalloplasty can only increase the length or width of the penis shaft, not the head.
• Phalloplasty to lengthen the penis will only make the penis appear longer when flaccid – it will not be longer when erect.
• Think about the financial burden. Cosmetic surgery does not usually qualify for rebates from Medicare or private health insurance companies.
• Smokers are at increased risk of complications. If you are serious about undergoing cosmetic surgery, you should try to quit smoking.

Finding a medical practitioner to perform cosmetic genital surgery

You may want to ask your doctor for advice on a suitable and reputable doctor or hospital where cosmetic genital surgery is performed. At your first consultation, you should ask the medical practitioner about their training and experience. It is preferable to have this procedure done by a reputable professional who is specially trained to perform cosmetic genital surgery and has a lot of experience in carrying out this type of surgery.

Medical issues with cosmetic genital surgery

Before surgery, you need to discuss a range of medical issues with your medical practitioner including:

• Physical health– an examination will help your medical practitioner to decide if the treatment is appropriate.
• Medical history – some pre-existing conditions and surgeries you have had in the past may influence decisions about this operation, including the type of anaesthetic that is used.
• Psychiatric history– some medical practitioners may suggest or insist that you receive counselling before you consider cosmetic genital surgery.
• Risks and possible complications – it is important that you understand the risks and complications so that you can weigh up whether cosmetic genital surgery is right for you.
• Preparations and supplements – tell the medical practitioner about any that you take on a regular basis or have recently taken, including over-the-counter preparations such as fish oils and vitamin supplements.
• Past reactions to medications – tell the medical practitioner if you have ever had a bad reaction or a side effect from any medications including anaesthesia.
• Preparation for surgery – your medical practitioner will give you detailed instructions on what you should do at home to prepare for surgery. For example, you may be advised to take a particular medication or alter the dose of an existing medication. Follow all instructions carefully.

Details of cosmetic genital surgery

The details of the surgery will depend on individual factors, but generally include:

• Labiaplasty – the operation is usually performed to reduce the size of the labia minora (inner lips). General or local anaesthesia may be used. The medical practitioner removes the unwanted tissue and remodels the labia into the desired size and shape. Alternatively, a wedge-shaped section of the labia is removed. Some medical practitioners use a laser instead of a scalpel to reduce bleeding. Occasionally, a labiaplasty is performed to reduce the size of the labia majora (outer lips). Some women choose to have surgery to tighten the vagina (vaginoplasty) during the same operation
• Enlargement phalloplasty – this operation increases penis length. General or local anaesthesia may be used. The medical practitioner makes an incision (cut) at the base of the penis and cuts the ligament that attaches the penis to the body. This will cause the penis to extend out further from the body. The penis is not actually longer, but more of it is visible
• Girth enlargement phalloplasty – this operation increases the width of the penis. General or local anaesthesia may be used. Using fatty tissue harvested (removed) from another part of your body, the medical practitioner may sew strips of fat underneath the skin of the penis (dermal fat grafting) or inject fat into the penis (fat transfer or fat transplant)
• Full phalloplasty– some men choose to have their penis increased in both length and girth during the same operation.

Immediately after cosmetic genital surgery

After the operation, you may expect:

• bruising and swelling
• possible numbness
• pain and discomfort
• to wear dressings or bandages.

Complications of cosmetic genital surgery

All surgery carries some degree of risk. Some of the possible complications of cosmetic genital surgery include:

• risks of general anaesthesia including allergic reaction, which may (rarely) be fatal
• surgical risks such as bleeding or infection
• scars that may be severe, raised, reddened and itchy
• unevenness – the labia may not be symmetrical
• permanent colour change to the labia
• nerve damage to the labia or penis, including permanent loss of sensation
• irregular shape to the penis following fat transfer
• impotence (inability to get or maintain an erection)
• tissue death along the wound or skin loss
• further surgery to treat complications.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. You need to speak to your medical practitioner for more information.

Self-care after cosmetic genital surgery

Recovery may take at least six weeks. Be guided by your medical practitioner, but general self-care suggestions include:

• Follow all instructions on looking after your wounds.
• Wear penile weights as directed for a few weeks after you have phalloplasty.
• Avoid sex for at least six weeks.
• Report any bleeding, severe pain or unusual symptoms to your medical practitioner.

Long-term outlook after cosmetic genital surgery

Scarring will be permanent, but should fade in time. Be patient. Improvements to scars may take around a year or so. The results of labiaplasty are permanent. If fat transfer has been used to widen the penis, this is not permanent and it will disappear over time, because the body tends to reabsorb about 50 per cent of the injected fat. Top-up injections may be required.

Following phalloplasty to lengthen the penis, the angle of the erection may be lower, but this should not affect sexual intercourse.

Alternatives to cosmetic genital surgery

Most people choose to have cosmetic genital surgery because they are unhappy with their appearance. If you are concerned about your appearance, talking to a counsellor or psychologist may help you overcome your concerns, and you may decide that you like yourself the way you are.

A good place to learn more about women's genitals is The Labia Library. This website features a photo gallery showing real, unaltered images of women’s genitals and aims to help people understand that normal, healthy genitals come in a wide range of shapes and sizes.

Where to get help

• Your GP (doctor)
• A medical practitioner specially trained and experienced in performing cosmetic surgery
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Private Hospitals Unit, Department of Health Email privatehospitals@health.vic.gov.au
• Australian Society of Plastic Surgeons Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200