The term “vaginal rejuvenation” evokes beaches and spa treatments. I can imagine it now: My vagina sitting by the ocean in Fort Lauderdale, sipping Bahama Mamas and intermittently jogging to the spa to get pampered. Vaginal rejuvenation is not a treatment that you can add to your hotel tab along with manis, pedis, and room service; it is a serious and expensive surgical procedure—one for which there are no industry standards.

According to the Manhattan Center for Vaginal Surgery, vaginal rejuvenation is a combination of labiaplasty and vaginoplasty, which can be performed (for a mere $9900.00) to restore or improve the vagina’s cosmetic appearance or function. Labiaplasty is a “cosmetic genital surgical procedure that will reduce the size or change the shape of the small lips on the outside of the vagina (the labia minora).” In case this is confusing (and it is), the labia minora and labia majora are both part of the vulva, or external architecture of the female genitalia. They are both technically “outside” of the vagina, but the labia minora constitutes the “inner lips,” which are directly proximal to the vagina, while the labia majora constitute the “outer lips,” which are more distal to the vagina. In a labiaplasty, skin is removed from the inner lips, so they are more even in appearance and do not hang beyond the outer lips. In a vaginoplasty—a procedure involving the internal vagina—the vagina is tightened by “removing excess vaginal lining and tightening the surrounding soft tissues and muscles.”

The Laser Vaginal Rejuvenation Institute of Los Angeles—featured in Dr. 90210—has a slightly different conception of what these procedures entail. According to The Laser Vaginal Institute, “Laser Vaginal Rejuvenation (LVR) will effectively enhance vaginal muscle tone, strength, and control. It will also effectively decrease the internal and external vaginal diameters as well as build up and strengthen the perineal body.” I am curious as to what they mean when they say that the treatment “effectively” performs these miracles, instead of performing them in actuality. LVR is a modification of a procedure designed to remedy urinary incontinence.

Designer Laser Vaginoplasty (DLV) is the “aesthetic surgical enhancement of the vulvar structures.” Laser Reduction Labioplasty (no acronym for this procedure’s name) is just one of many procedures that fall under this category. See also: Vulvar Lipoplasty. Yes, you can surgically remove unwanted fat from the labia. The Institute coins the term “liposcultpturing” to denote the removal of “unsightly fatty bulges.” I suppose excess vaginal fat is as unsightly as any. It seems as if the categories, under which specific vaginal-modification procedures fall, have more to do with branding than medical accuracy or congruence.

Irrespective of the specific procedure one seeks, why would a woman wish to surgically alter her vagina? First let us review what happens to a woman’s vagina—or as The Institute refers to it, a woman’s “vaginal integrity”—as she ages. Masters and Johnson’s 1966 book, Human Sexual Response, explains that during menopause, when a woman’s ovaries stop producing estrogen, her skin loses elasticity, the uterus and cervix undergo some shrinkage, the walls of the vagina become thinner, less blood pools in the vaginal walls during sexual arousal, the length of vagina decreases, and less vaginal lubrication is produced. Women who remain sexually active evidence fewer problems; they show less of a decrease in vaginal lubrication and less shrinking of the vaginal muscles. It is unclear whether their active sex lives prevent age-related changes or whether they maintain active sex lives because they do not experience these declines in functioning.

In addition to the changes associated with age, childbirth is a factor. During childbirth, the vagina and surrounding tissues are stretched and often do not return fully to their pre-pregnancy states. In a vaginoplasty, as performed by the Manhattan Center for Vaginal Surgery, excess vaginal lining is removed and the surrounding soft tissues and muscles are tightened. The Center claims that some women complain about feeling “loose” and notice a decrease in friction during intercourse, which results in lower levels of sexual satisfaction. After surgery, vaginal tightness returns to that of the “pre-baby days.” The Center notes, “You will feel the difference and so will your partner.” Of course, no surgery goes without complications, and the complications for this one exceed a $9900.00 bill plus six weeks of healing; ridding yourself of excess vaginal tissue increases tightness and therefore friction, but it also diminishes the amount of nerve endings in the vagina and this, in turn, decreases sensation. It is a trade-off at best.

The first question to ask upon suggestion of surgery is, “Is there a non-surgical alternative?” There is a simple and bonafide antidote to vaginal looseness: Kegels, or exercises that strengthen the pubococcygeus muscles. Both the Manhattan Center for Vaginal Surgery and The Laser Vaginal Rejuvenation Institute of Los Angeles decry the efficacy of this time-tested exercise. The Center alleges, “Women throughout the nation and the world have told us that Kegels do not work—but no one is listening.” The institute, likewise, alleges, “Kegel exercises are often recommended but rarely succeed in restoring vaginal tightness.” For these allegations there is no proof—no studies are cited. The catch is that the procurement of a virginally tight vagina is not unpleasant. The easiest way to increase the strength of vaginal muscles and, thus, vaginal tightness is to have a lot of sex.

During sex, the outer third of the vagina engorges with blood and the vaginal opening constricts to grip the penis. The more sexual encounters a woman has, either with a man or a sex toy, the more toned her vaginal muscles will become. Furthermore, the more aroused she is, the more her muscles will contract. There is no magical cure for vaginal looseness. Vaginal tightness is achieved through regular sexual encounters and sexual encounters with someone to whom you are attracted. If you are not lucky enough to have a regular partner, there exist a vast variety of sex toys to keep your vaginal muscles in tip-top shape. Dr. Laura Berman designed a toy specifically for this purpose: the Juno Weighted Pelvic Exerciser. The claims the Kegels do not work are ludicrous. I understand that when you are older it is more difficult to build muscle mass; after all, I have never seen an elderly body builder. However, I have also never heard of a reputable doctor telling elderly patients that they should stop exercising because it stops working.

There are different factors at play in the case of labiaplasty, which is purely a cosmetic procedure. The Laser Vaginal Institute of Los Angeles cites, “Most women tell us that they do not want inner lips to project beyond the large outer lips. Many women bring us Playboy and say that they want to look like this.” This brings us closer to the roots of these elective vaginal procedures: self-esteem issues and societal standards. The Manhattan Center for Vaginal Surgery reiterates, “Many women are born with large or irregular labia. Others develop this condition after childbirth. The appearance of the enlarged labia can cause embarrassment or loss of self-esteem. Some women just want to look ‘prettier’ like the women they see in magazines or in films.” The Center also cites “chronic labial irritation” for women who wear tight clothing as a reason to opt for the procedure, but I will brush over this reason because it begs the question: “Why not wear looser clothing?” 

Ultimately, the decision to undergo vaginal rejuvenation procedures is up to the woman—much like getting a breast enhancement or other cosmetic surgery options. However, there are less intrusive and less expensive alternatives to vaginal plastic surgery that are recommended and at least be tried before opting to go under the knife. If vaginal tightness is not the issue and the appearance of the labia (or how you think your partners perceive them during sex) is greatly affecting your ability to derive pleasure from sex, then perhaps modern medicine has found a solution after all.