Pretty in pink

Never heard of cosmetic gynecology? Well, gird your loins.

For the most part, this niche medical specialty—which some liken to mutilation—is exactly as it sounds: plastic surgery to improve the appearance of one’s vagina. It’s also fodder for a story that’ll reference genitals constantly, so here goes.

Years ago, when a mentor encouraged her to learn about the practice, “I was like, ’Eh, I really don’t know about that,’” said gynecologist Elizabeth Hutson. “I don’t want to do anything just to make money. I want to help my patients.”

But because she’d always respected the doctor in question, she took one of his classes.

“He was so meticulous,” Hutson said of gynecologist Red Alinsod, whose practice is in Laguna Beach. Just as stunning was feedback she began to get from her clients in Reno.

“They’re among my happiest patients,” said Hutson, who seems to be the only local gynecologist offering cosmetic work alongside standard OB-GYN care. “They’ve had something that’s bothered them their whole lives,” she said, “or they’ve had babies, and things [haven’t been] the same. It’s really a cool thing.”

Labiaplasty, which amounts to shortening or altering the inner and/or outer labia, is a common request. So’s vaginoplasty, which can involve tightening the area after childbirth.

“People don’t know who to go to,” Hutson said. “They’re told by everyone that everything looks normal—it’s fine, it’s in the normal range—and that’s true, but it’s not functioning the way they want it to if they have long labia, or if their vagina is kind of lax. It’s pushing or pulling or rubbing, and it’s driving them crazy. So who am I to say it’s normal?”

Practical benefits are part of the picture, in other words, which is why some of Hutson’s cosmetic work doubles as standard medical care. Plastic surgeons offer “vaginal rejuvenation,” too, including Reno doctor Phillip Dahan, who’s apparently been at it for 17 years. If that’s surprising, maybe it shouldn’t be.

“People go to work and say, ’Oh, I had a nose job,’” said Dahan’s assistant, Madison Wilson. “It’s water-cooler talk. But ’I had my labia done’ isn’t really the same thing.”

Female genital mutilation has made headlines for decades, generating nonprofits and new legislation, including in Nevada. According to the World Health Organization, FGM “includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons,” such as removal of the clitoris, and all but sealing the vaginal opening. It’s chilling, violent stuff steeped in old-world traditions, usually endured by girls younger than 15.

The W.H.O.’s definition of mutilation is also broad enough to cover piercings, and could technically include cosmetic gynecology, depending on how it’s read. (The organization’s media office didn’t respond to a short-notice request for comment on this story.)

Meanwhile, the American Congress of Obstetricians and Gynecologists has published a committee opinion on vaginal plastic surgery—and you can bet it’s not sunshine and rainbows.

“We aren’t fans,” an ACOG spokeswoman said in an email as she forwarded the information. Understatement.

“Over the past several years,” reads an official press release, “an increasing number of physicians have been offering various types of vaginal surgeries that are marketed to women as ways to enhance genital appearance and sexual gratification. Some of these procedures, such as ’vaginal rejuvenation,’ appear to be modifications of traditional vaginal surgical procedures for genuine medical conditions.”

Treatments for pelvic prolapse and chronic irritation are on the go-ahead list, as is the reversal of FGM and “female genital cutting.” But the list has its limits.

“Many women don’t realize that the appearance of external genitals varies significantly from woman to woman,” added doctor and committee member Abbey Berenson. “As OB-GYNs, we know this to be the case from years of experience.”

Terms like “designer vaginoplasty,” “revirgination,” and “G-spot amplification,” are being bandied about, ACOG members complained in their published opinion, and all without medical necessity or much peer-reviewed study.

Hutson is well aware of the controversy. She said any genital-mutilation references are way off the mark, but that ACOG’s stance should be acknowledged.

“That’s my college,” she said, drawing out the word. “That’s how I trained. How can you go against that sort of thing?”

You can hear a little smile in her voice, though. She always seems to have one.

Hutson’s office, for its part, is an unusually upbeat place. There’s an absence of ego as she introduces her staff—a happy, joking bunch of women who meditate together once a week, and barbecue out back when the weather’s nice.

Art is everywhere, from fashion photography and modern décor in the lobby-to-ceiling decorations you’ll only see if you’re face-up on an exam table. Hutson shares the space with gynecologist Pamela Netuschil, her business partner and longtime friend. Seemingly at random, their office also includes a med spa with “injectables” such as Botox for the face. Nurses Neece Boyden and Rina Netuschil run this area.

Nurse Netuschil is rather outspoken about the whole pretty-privates thing.

“I had [labiaplasty],” she said outright. “Snip, snip. I didn’t want to see it when I was standing there looking in the mirror.”

She may get more work done, she said, as she’s now single for the first time in years.

“I’d love to put filler and laser [work] down there, and puff up the plump parts, too.”

Her voice got softer.

“You do feel sexier,” she said. “You can let them look at you naked.”

Another patient—an avid runner in her late 50s, who asked not to be named—went to Hutson because her anatomy was pinching when she exercised.

“It’s not about cosmetics,” she said. “It’s about comfort.”

Some patients are young, late teens to early 20s. Others have had one or more children, and though they’re not in any medical straits, they hope to reverse birth injuries and the like. Once in a blue moon, someone will ask to have her hymen reconstructed before her wedding night.

Most operations are outpatient procedures, without general anesthetic.

There’s a popular labiaplasty look known as “the Barbie,” which might be described as minimalist (or severe, depending on where you stand) that heals especially well. If you’ve ever watched mainstream porn, we’re guessing you’ve seen this one.

But porn has no sway in her office, said Hutson. Cosmetic patients usually just arrive for routine care, then start bemoaning the quirks and folds that have annoyed them for years.

Any post-surgical scarring is undetectable to the eye, she said. “Do it correctly, and you’d never know you’ve been there. It’s the way [the area] heals; it has great vascular supply, so the healing is fantastic.”

Elective surgeries are just a small fraction of her practice, for the record—around 5 to 10 percent. And they’re a cash business, because insurance won’t step in.

The industry “is in its infancy,” Hutson said, “but it’s one of the fastest-growing areas of cosmetic surgery.”