Hey, I’m actually not against these procedures. My biggest ally in all this is an expert who has built an entire practice around female genital cosmetic surgery.

The problem here is the lack of training standards, which persists largely due to the controversy surrounding these procedures. The fact is some women may need them for medical reasons. ACOG actually approves them for women under 18, where “medically indicated.”

The issue is that patients are put at risk when doctors do surgeries they are not trained to do on anatomy they don’t know. Categorical opposition to these procedures has actually been the cause of professional organizations shirking their responsibility to keep patients safe by establishing training standards. ACOG actually approves these procedures while simultaneously refusing to offer CME (continuing medical education) because they don’t want to be seen as encouraging them. The result is many OB/GYNs do them without training at all because they “look easy” (quote from an OB/GYN who asked my dad if he thought she could do it). They could issue an opinion saying that doctors should not be doing these without special training. They don’t. Meanwhile ABOG and ACGME have told the biggest ambulatory care provider in the country that residency training and board certification in OB/GYN qualifies them to do these.

I do think that female genital cosmetic surgeries are the exploitation of an ignorance. I personally would not have gotten mine if I hadn’t googled about my anatomy. However, many steps have been taken in the past decade to educate women about normal anatomy. Were I 17 today, my Google searches would have gone differently, as I would have been dissuaded by normative studies indicating my anatomy was well within the normal range.

However, despite activists efforts to educate, the popularity of these procedures continues to grow. There is a great deal of misleading advertising. Doctors not only. claim no risks to sexual function. Many claim these procedures can improve sexual function, and the problem is this is true, but not for the reasons you might think. Many women have poor sexual function ratings prior to surgery because they are self conscious. Some may refuse to receive oral sex. Fixing their aesthetic surgically is a way to solve this problem. There may even be an anatomical reason in some cases, but no surgeon ever considers vulvar biomechanics, so it’s not like this is intentional. Meanwhile, there are risks because many doing these have not been properly trained and do not know the anatomy well. There are no training standards. The ally I mentioned says he sees more and more botched cases, all of which are preventable with training.

But are no numbers for how many patients are harmed. There aren’t even numbers for how many are done (if anyone knows how to get these without spending a lot of money, I’d appreciate it). Thus has been an issue for me. But I don’t think a lot of people should have to get hurt for people to realize driving 200 miles an hour down a highway is a bad idea and there should be speed limits.

You don’t see this level of ignorance surrounding surgical anatomy and function in other cosmetic surgery literature. To me, that is very significant.