ORLANDO, FLA. — Achieving a successful outcome after vaginal tightening surgery requires operating on the right woman for the right reasons using the right procedure. Fulfilling all three parts of this equation depends on conducting an in-depth preoperative consultation so the surgeon understands the woman's issues and desires, and the patient appreciates what the surgery can and cannot deliver, said Michael P. Goodman, M.D., at the International Society of Cosmetogynecology Workshop presented by the American Academy of Cosmetic Surgery in Orlando, Fla., in January.
"It is incumbent on us to find out why the patient is seeking surgery and understand her issues, to determine if surgery can be expected to deliver the expected results. If a patient is trying to turn around a poor sex life, save a crumbling relationship or overcome a true sexual dysfunction, the surgery will not succeed," says Dr. Goodman, a board-certified gynecologist and private practitioner in Davis, Calif., specializing in female genital plastic surgery, integrative gynecology, and menopausal and sexual medicine."Vaginal tightening procedures enhance sexual function, but will not cure sexual dysfunction. Appropriate candidates are women who are basically happy in their relationship but would like to improve it," Dr. Goodman explains.
COMMUNICATION, EDUCATION To screen for sexual dysfunction, surgeons must be comfortable talking about sexual issues with their patients. This requires educating oneself and practicing while being at ease using the vernacular when discussing sexual relations.
"Uncovering problems requires that a woman feels comfortable with you and trusts you. Surgeons don't have to be a certified sex therapist, but they must not be embarrassed talking about sex," Dr. Goodman says.
Information and education can be acquired through sponsored meetings and publications issued by a number of organizations, including the International Society for the Study of Women's Sexual Health, the Society for Sex Therapy and Research, and the Society for the Scientific Study of Sexuality. Psychosexual survey instruments, including the Arizona Sexual Experience Scale, Female Sexual Function Index, and the Female Sexual Distress Scale, may be useful screening tools. While they are not necessary, they can be helpful in situations where it is unclear whether the patient has sexual dysfunction.
"The dictum, 'Measure twice, cut once' does not apply only to surgical technique, but also to emotional and psychosexual screening, as well," Dr. Goodman says.
HELPFUL QUESTIONS Dr. Goodman suggested a series of questions that should be asked to uncover sexual dysfunction. These include:
"However, surgeons should realize — and educate patients — that only about 40 percent of women who are orgasmic experience climax via penile stimulation alone," Dr. Goodman says.
During the consultation, the surgeon should also explore how patients feel about their body in terms of its shape, size, attractiveness and responsiveness, and explore relationship issues. Some women will be in between relationships and seeking to reinvent themselves in preparation for a new relationship, and that does not mean they have a body dysmorphic disorder.
"However, the surgeon must be able to distinguish these individuals from women who have already had multiple procedures and are seeking an unobtainable goal, and instruct women appropriately that surgery will not fix a relationship issue," Dr. Goodman says.
Patients who are thought to have sexual dysfunction should be referred to an appropriate source for therapy rather than simply turned away. Ultimately, after successful treatment of an existing sexual dysfunction, some of these women may come back seeking surgery to enhance sexual function.
Dr. Goodman also encourages surgeons who are performing vaginal tightening procedures to make contact with a pelvic floor physical therapist in their area. He notes that his fee includes three sessions with the therapist.
"The best repair in the world is only as good as the muscular function. The surgeon can bring tissues together, but a woman must be in touch with the function of the muscles so that they will work and the surgery will be a success," Dr. Goodman says.