Genital Rejuvenation In The Post Bariatric Patient

Genital Rejuvenation In The Post Bariatric Patient

One of the great, unspoken burdens of my massive weight loss patients has always been “down there.” I have observed that the problem of my weight loss patients’ genitalia is clearly a heavy burden that almost all of my patients have suffered in solitude. Let’s face it, many people are very uncomfortable talking about their private parts, their insecurities, and their sex lives. I have learned over my 19 years of plastic surgery practice to tactfully touch on this issue with all of my massive weight loss patients. In fact, I consider pubic plasty, also known as mons pubis reduction, (when indicated) an integral part of any abdominoplasty procedure that I perform in my practice. Pubic plasty is indicated in cases where the extra skin hangs down causing intertrigo (flaps of skin that rub together resulting in inflammation, irritation, and skin breakdown). Health insurance may cover this procedure in certain cases. Pubic plasty is the removal of the extra skin and fat that sit on the pubic bone area above the genitals. Liposuction is done as needed, leaving neither extra skin nor extra fat. Furthermore, the male or female genitalia are then “unroofed,” allowing for more normal urination, personal hygiene, and sexual function. Many of my weight loss patients are completely abstinent of sex, for years in some cases, because of this problem. One of the great joys of my practice has been the improved quality of life enjoyed by these patients after surgery.

Labiaplasty is a frequently requested surgical procedure. Labiaplasty candidates complain of overly large labia minora (as well as labia majora and even clitoral hood tissues). These enlarged labia minora can present many challenges to our patients. Overly large labia minora can cause pain when wearing snug undergarments or slacks. Painful sexual intercourse (dyspareunia) can occur from the levering back and forth of these enlarged labia minora. They can cause spraying of urine at urination, requiring the patient to manually retract these enlarged labia minora in order to prevent spraying. Hygiene is often challenging, resulting in foul odors even in the most cleanly and hygienic of individuals. Lastly, vaginal and urinary tract infections can result from the physical barrier effects of these enlarged labia minora. Labia majora reduction is almost always a cosmetic (patient responsible for payment) procedure. In some cases of atrophy (tissue shrinkage), fat transfers from other regions of the patient’s body can plump up the labia. Clitoral hood reduction may be indicated in cases where excess hood tissues prevent clitoral stimulation during sex, thereby interfering with normal sexual function. This is another procedure rarely covered by health insurance.

Vaginoplasty can restore normalcy to the female genitalia. With substantial weight fluctuation, women may find that they are leaking urine when they cough, that there are painful bulges at the front and back of the vagina, and that sexual intercourse is not as pleasing. In cases such as this, one may have a rectocele (painful bulge in the posterior vagina), or a cystocele (a painful bulge at the front of the vagina, often associated with leakage of urine), and/or a patulous (loose) vagina. If the internal vaginal sidewalls are visible when sitting cross legged on the floor, it is likely that a woman will benefit from corrective surgery (posterior colporrhaphy with rectocele repair) as well. In most cases, these types of surgery are covered by your health insurance carrier.

Phalloplasty is the surgical enlargement of a man’s penis. Phalloplasty can be done to increase either the length of the man’s penis or the girth. Lengthening is accomplished via a small transverse incision above the base of the penis through which we release the thick connective tissue attaching the penis to the overlying pubic bone. The patient then wears a small metal weight suspended from the end of the penis for one month, so that the ligament reattaches in such a fashion leaving the penis longer. Girth (thickness) can be increased using autologous fat to thicken the penis, placement of a soft tissue patch such as AlloDermTM (which is an “off label” use of this product), or soft tissue filler as such as JuvedermTM. Most men report increased sexual pleasure for themselves and their partners after these procedures.

Steven Gitt, MD, FACS

Dominic Heffel, MD

Steven Gitt MD, FACS and Dominick Heffel, MD are Board certified plastic surgeons at North Valley Plastic Surgery in Scottsdale, AZ. They have devoted their careers to the surgical care and management of the post bariatric weight loss patient population and are amongst the most experienced plastic surgeons in the Western United States.. The doctors and the team of professionals at North Valley Plastic Surgery have cared for thousands of weight loss patients over the last 15 years. Dr. Gitt is a member of the editorial advisory board of obesity help magazine and has authored numerous published articles about the surgical care as well as the lifestyles of post massive weight loss patients. For more information to go to WWW.NVPSAZ.Com.

-Featured photo courtesy of Peter J. Hodson