By Elise Worthington.
The Royal Australian College of General Practitioners (RANCGP) has introduced world-first guidelines to respond to the increasing number of women visiting GPs to ask about female genital cosmetic surgery.
The guidelines are designed to help doctors navigate women’s concerns about their genital appearance and understand the underlying reasons why they may believe they look “abnormal”.
Author Dr Magdalena Simonis from the RANCGP said often GPs were the first point of contact for women with questions about genital appearance.
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“They might come in requesting a referral or they might just express some embarrassment when they come in for a gynaecological check-up,” Dr Simonis said.
“A lot of women don’t know enough about their own genital anatomy to define what it is they want modified and they don’t understand this could have negative long-term implications for them.
“They say things like ‘I feel this is ugly or horrible’, they use terms like ‘disgusting’ and ‘hanging out’ so most of the comments are related to their aesthetic appearance as opposed to a functional issue.”
Dr Simonis said the increase in women consulting GPs about genital cosmetic surgery had concerned doctors who felt they needed more education.
“I received a very distressed email from a colleague who reported one of her patients had actually attended a surgeon in Thailand who reported when she awoke, she found that she had not only a labiaplasty but a complete clitoridectomy [removal of the clitoris], so she was devastated,” she said.
Medicare crackdown on funding the procedure
The number of women seeking Medicare rebates for medically necessary genital surgery doubled in the decade between 2003 and 2013 without a corresponding increase in medical conditions that could explain why.
Medicare statistics show between July 2014 and June 2015 more than 1129 claims were made for the item number covering vulvoplasty — a decrease from the 1584 claims made in 2013 to 2014.
Australian Society of Plastic Surgeons president Associate Professor Hugh Bartholomeusz said the decrease in taxpayer-funded procedures was likely due to a crackdown on those claiming for the procedure.
“Medicare basically have said ‘we are not prepared to pay for this procedure on the public purse if there isn’t a reason for the procedure being performed other than purely cosmetic reasons’,” he said.
“I think that’s a very responsible attitude Medicare is taking.”
Dr Bartholomeusz said Medicare now requires pre-approval for patients to claim for vulvoplasty and only covers congenital abnormalities and functional problems.
“The doctors concerned need to send photographs to Medicare, they have a panel that review these photographs and then make a decision as to whether they will allow the item number to be used,” he said.
But Dr Bartholomeusz said that had not stemmed the popularity of private genital cosmetic surgery that can be performed without formal training by any doctor.
“There’s been an increase in the number of female genital surgery procedures done,” he said.
“It seems to have been driven by the media and by the perception that women have of abnormalities within their genitalia.
“These procedures can be performed by other plastic surgeons or gynaecologists. So because the Medicare system isn’t involved there’s no visibility about who is performing this procedure, where or how.”
Dr Simonis said the new GP guidelines emphasised the importance of assessing the reasons women want the procedure.
“[The guidelines are] to help them understand that normality is a big range and also to actually inform them of the risks of surgery that is irreversible in respect to their genital region — it’s very sensitive tissue, it’s not just skin,” she said.
“The guidelines recommend that doctors listen and explore the reasons for the patient’s concerns and also look at what influences have generated the desires for this.
“It’s about finding out really what their concerns are and really addressing those concerns individually.
“Surgery is a risky procedure, they can suffer anything from long-term scarring [to] increased nerve sensation which causes discomfort.
“The aesthetic result might not be what they expected.”
Psychologists warn not to make comparisons with pornography
Women’s health psychologist Professor Jane Ussher from the University of Western Sydney said more needed to be done to educate both sexes about women’s genitals.
“What we are seeing is that in heterosexual relationships men are making comments about women’s vulvas and women’s vaginas because they’re judging the women against pornography,” she said.
“So you’ve got a vicious cycle where the women are seeing the images externally and then having the comments in the relationships and thinking there’s something wrong with them and then going for surgery.”
Professor Ussher said it was critical the underlying psychological reasons for surgery were addressed.
“There might be issues in their relationships where the partner is being abusive by making comments about their bodies and actually tapping into those issues rather than just offering a quick surgical fix,” she said.
Dr Bartholomeusz said women should consult a gynaecologist before considering surgery and that more research was needed.
“These procedures have been performed for many years but the volumes of procedures that are being performed now are much increased,” he said.
“I think obviously a long-term study, a proper study needs to be conducted into the effects of this procedure.”
This post originally appeared on the ABC and was republished here with full permission.
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