Cosmetic surgery for better sex: does it deliver?

by Heather Smith

Men and women are having breast implants, penile length enhancements, and even labia reductions to enhance their sexuality. Do these procedures deliver? Or could they backfire and cause complications that instead reduce sexual pleasure?

According to the American Society of Plastic and Reconstructive Surgeons (ASPRS), more than 130,000 women had breast implants in 1998. In the last seven years, an estimated 10,000 men have undergone penile lengthening procedures. And a handful of women are now opting for a surgery that clips their labia minora because they feel that their vaginal folds are simply too large.

All these surgeries are designed to improve perceived sex appeal and sexual pleasure. But do they work? Or do these procedures also include risks that could produce the opposite effect—for example, a reduction in sexual feeling and functioning?

Despite the recent controversy over silicone breast implants, Anne and Jessica both feel positive about their augmentations. Anne, who's had her implants 11 days now, remarks that they've "enhanced" her lover's libido. One year after her augmentation, Jessica asserts, "They've had a positive effect on my sex life. I feel sexier since the surgery and much more confident."

Although both are enjoying the effects of their "new breasts" on their sex lives, Anne and Jessica are currently experiencing a problem—loss of breast sensation. Anne says, "I truly hope all my feeling comes back because I used to be able to have an orgasm just from nipple stimulation." And Jessica is experiencing "numbness from just under my nipple to the crease of my breast."

Anne and Jessica are going through the temporary change in breast sensation that "almost all patients have immediately following augmentation surgery," according to Allen Rosen, M.D., a breast augmentation surgeon and member of ASPRS. Usually sensitivity returns to normal within less than six months, he says.

But sometimes the change lasts longer or even permanently. A very small percentage of patients have a long-term sensory change whereby the nipple and areolar area are slightly less sensitive or even hypersensitive. This change is the result of damage to the nerve extending from the underarm to the breast, where the surgeon forms the "pocket" for the implant. As for how many women experience this long-term change in feeling, estimates range from 5% to 8%.

Unfortunately, change in nipple sensation isn't the only augmentation complication to interfere with sexual feeling. Two months after her implant surgery Cindy "lost complete feeling except for constant pain. If my breasts were even bumped in the heat of passion, sex was totally over." Cindy suffered from severe capsular contracture, the tightening of scar tissue around an implant that can become painful.

No one knows for certain what causes capsular contracture like Cindy's, but surgeons believe that it's caused by infection and heavy bleeding. Roughly one in six women who receive implants experience capsular contracture, according to one comprehensive survey. Rosen estimates that the rate can be as low as one in 20, depending on where the surgeon places the implant. If the surgeon inserts a saline implant below the chest muscle, Rosen says, scar tissue doesn't contract around the implant because "the chest muscle is constantly massaging the saline implant." Most surgeons are now placing saline implants below and not above this muscle as a matter of course.

While breast implants remain controversial, penile length enhancement has yet to gain any official approval by the medical establishment. According to the American Urological Association, the surgery "has not been shown to be safe or efficacious."

During this surgery, the ligament connecting the penis to the abdomen is snipped, freeing the previously attached "hidden" penis. This now visible penis provides an illusion of increased length.

The extra length a man might expect to gain from the procedure amounts to two inches at the most. According to Paul Schnur, M.D. President of ASPRS, "The question is whether patients would want to undergo this for just a bit of enlargement."

Urologists warn that following the surgery, men can have complications that seriously interfere with their sex lives. These include the formation of scar tissue that causes the penis to retract, which ironically shortens—rather than lengthens—the organ. And the division of the penis from the abdomen "affects erection because you don't have the same angle as before," says Rosen. In other words, erections are never quite as horizontal again.

Reduction surgery of the labia minora (the inner lips of the vagina) is even more uncommon than penile lengthening—so uncommon that no medical organization has a position on it. But Gary Alter, M.D., a plastic surgeon and member of ASPRS, sees a need for it, and has performed 30 labia minora reductions in the last year. He asserts, "Every woman that I've operated on says to me 'I never knew this was possible and it's been bothering me all my life.'"

Why would a woman want this surgery? Labioplasty is a reduction of the labia minora, the flaps of skin that form the lips of the female genitalia and cover the clitoris and vaginal opening. According to Dr. Robert Stubbs, a Toronto plastic surgeon, some women with large labia have pain during intercourse, because the lips actually get "pulled in." Large or asymmetrical labia can cause chafing and discomfort during everyday activities or while wearing certain clothing, such as pants. Often, women are simply bothered by their appearance, feeling that that they are "ugly down there."

During labia minora reduction surgery, Alter removes a wedge from the middle of a woman's labia. His technique "keeps the normal edges of the labia minora," which are darker and ruffled, achieving a more natural appearance than traditional labioplasty, according to Alter. In 30 surgeries, he's only had one complication—in one woman, the stitches opened. Alter says that other risks include "bleeding and infection." Still, the ASPRS warns that any surgery done on the genital area may cause loss of sensation, loss of function, skin loss, tightness, and scarring.

Despite the potential risks of these procedures, particularly penile lengthening, people may still feel that the surge in confidence is worth it. And risks aren't inevitable, including surgeries approved by the medical establishment or that have low complication rates. As Kathy says of her saline implants, "I am 11 weeks post-op and have all feeling and no pain!"

If you choose to have any of the above surgeries, you should research the procedure and the complication rates and seek a plastic surgeon who is certified by the American Board of Plastic Surgeons. For help finding a surgeon and information on the risks of a procedure, see "Resources" below.