NIP AND TUCK

5 September 2002

"Women don't usually spend a lot of time examining each other's labia," Dr. G. said to the patient who was half sitting, half lying on the exam table, a mirror in her hand.

"I do," he smiled.

Then he picked up a large q-tip and began giving her a tour of the landmarks of her genitalia. He explained that there was no standard labia size, and he showed her the labia majora (big lips) and labia minora (little lips) and explained how some women had large labia majora and some women had very small labia majora. He explained the function of the labia minora in stimulating the clitoris and the reason why it was the size and shape it was.

The woman was in for a consultation regarding labioplasty. Essentially that's plastic surgery of the labia, in this case making the lips smaller and reshaping them.

I've certainly been getting an education as I'm learning how to become a mediocre medical assistant. I can look at something that looks like a moving test pattern on a teeny black and white television screen as Dr. G moves the ultrasound wand up and inside a vagina and show you where ovaries are, where blood and stool are moving about, where the endometrial stripe of the uterus is.

I can watch a woman lie back on the exam table and know, even before Dr. G carefully opens the front of her gown to begin his examination, whether or not she has had breast augmentation.

I've learned about the different ways to have breast augmentation. One woman surprised even Dr. G, with implants in her breasts and no visible scar that he could see. When he asked her where the incision had been made, she told him that the doctor had inserted the implants through her navel and kind of threaded it up her abdomen until it could be positioned under her existing breast and then inflated.

(this gives new meaning to "blow job," I suppose!)

But "labioplasty" was a new one for me. Dr. G got his expertise at doing this procedure by repairing lacerations following births, when it's not uncommon for various and sundry parts where the sun don't generally shine to rip, tear or perforate. (Ouch--hurts just to think of it!)

Because he's had so much birth-related experience, women have sought him out for reconstructive surgery as well. It's a very weird feeling standing in the room watching Dr. G and his patient having a nice little chat while her coochie shorcher (thank you, Vagina Monologues) is sitting there with a spotlight shining on it, and she and the doctor and going over the various options and where he should cut his wedge in order to remove a bit of skin and then sew the remaining pieces together, to create something more appealing to the patient.

I don't know about you, but the very terms "cut" and "sew" in relation to that part of my body that didn't become injured because someone had just hauled a 10 lb baby out of there just doesn't do much for me.

The funny thing was that the two of them were chatting as dispassionately as if they were discussing what to buy at the grocery store, and here she was with a mirror between her legs while he's sitting between her knees, shining a spotlight on the area, lifting and separating and pointing with the non-padded end of a giant q-tip and offering options and she's describing what exactly she's hoping for as a final product.

He hastens to explain that, since women don't generally examine each other's genitalia very often, they aren't aware that there are all degrees of "normal" and what may seem extra large to one woman may be perfectly within normal limits.

Still, the patient is adamant in wanting this reconstructive surgery.

You have to wonder why.

The patient is a middle aged woman, tall, thin, unmarried, severe looking. A Miss Gulch (from Wizard of Oz) type of person--very nice, very friendly.  She looks like someone who might be overly fond of her cats, but certainly not someone you would expect to be so inordinately obsessed with the appearance of her genitalia that she would go under anesthesia and a scalpel to change what Dr. G assures her are "perfectly normal" labia.

I don't even want to think about the post-operative course. You could get a kidney infection from holding back so long!