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“There really is no such thing as Instead, it’s the reality that marketing One area that can be fixed is
vaginal rejuvenation and revirgination. procedures that are not yet proven the labia. While it may seem that a
What we are really doing, or what in the field of gynecological cosmetics redundant labia is a trivial issue, he
we should be doing, is treating exposes women to undisclosed says noting could be further form the
conditions that affect the appearance complications. truth. Such issues can seriously impede
and conditions that affect urogenital For Dr. Sepulveda, what stood out a woman’s sense of freedom and
function.” most in the report was the specific confidence.
However, based on evidence warning that physicians “should be “Simple things like getting onto a
from other areas of cosmetic surgery, cognizant of the evidence regarding spinning bike or going horseback riding
energy based procedures such as laser innovative practices, and should be – even wearing a swimsuit – makes
and radio frequency have been used wary of adopting new or innovative them uncomfortable in the way they
as a substitute for surgical repairs and approaches on the basis of promotions look.”
established vaginal therapies. But not so or marketing.” Reduction labiaplasty, however, is
fast, said the FDA. Because women with He has long believed gynecologists not without risk, he notes. There is risk
vaginal dryness or prolapse “should have an ethical responsibility to provide of disfigurement, bleeding, cutting too
not be treated with a lasers under the accurate and current information to much, cutting too little and it has been
heading of vaginal rejuvenation.” patients regarding the efficacy and approached in all different ways, lasers,
Not to say that certain laser safety of treatment options in order sutures.
systems have not been cleared by for them to be fully engaged in the Adherence to sound surgical
the FDA for indications in unrelated informed decision-making process. principles translates into the best results.
medical specialties and dermatology “Suffice to say, my practice does “Experience makes a difference.”
procedures. But the specific indication not deal in unproven techniques,” he So before pursuing a vaginal
for the treatment of vulvovaginal states. “Notwithstanding, there is going cosmetic procedure, Dr. Sepulveda
atrophy, urinary incontinence or to be space for energy-based devices suggests educated consumers take the
prolapse is not one of them. in gynecological cosmetics, but first we following steps:
Also, to be fair, preliminary need the studies to support their use. • Do a search to determine the
observational data have shown some qualifications of doctors. You will
potential benefits with the use of this What a Woman Wants want to go with to someone who
technology in treating patients with So what are the top conditions is board certified, preferably in
vulvovaginal atrophy, incontinence women want to address? gynecology
and prolapse. Anecdotal reports We as a surgical specialty do many • Visit the website of American
may even seem promising. However, reconstructive procedures for women Board of Obstetrics and Gynecol-
these reports lack long-term follow- who have a prolapse, that is, a feeling ogy to see who is certified in the
up, scientific design with professional of a vaginal bulge. In fact, one out of subspecialty of Female Pelvic Medi-
scrutiny and do not evaluate the use 11 women will require a procedure cine and Reconstructive Surgery.
of concomitant treatments, that is, for prolapse in their lifetime. We have • Find out how many cosmetic pro-
treatments that take place one after the also been very good at clearing up cedures they do in a month.
other. urinary incontinence – and in the • Determine what kind of technique
Additionally, no randomized trials process, giving self-assurance back the doctor uses. Do they use
or comparative effectiveness studies to our patients with evidence based microsurgical technique? Ask about
have been published in a peer reviewed procedures. healing expectations and establish
publication. So what comes next? After all that realistic goals.
The FDA’s conclusion was clear: work, what women often wants next is • Find a doctor that best lines up
additional evidence is needed to assess a cosmetic procedure in the vulva and with your goals and expectations.
the efficacy and safety of this procedure, the vagina. In fact, reduction of the vulva
particularly for long-term benefit. represents about 40 percent of all cases. “Our objective is to provide
“Many patients request a cosmetic procedures that have a reasonable
What’s the Problem procedure to look better once prolapse level of evidence, reduce the risks and
So the problem isn’t with the idea and incontinence has been treated. It improve the life of women through
of vaginal cosmetic surgery. After all, is something that they will share with empowerment in the decision for
there’s no question women deserve the their partners, something that will make surgery” says Dr. Sepulveda. “That is why
opportunity to explore options to make them more like ‘themselves’ again,” says I often say, “in God we trust, all the rest
themselves look better and feel better. Dr. Sepulveda. is evidence.’’

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