In an Only Fans world, what does “normal” really look like?

Welcome back to the Doctor Rich channel! Today, we’re answering questions from viewers. Vegan Woman asks, “Is sex tightened after a sacro surgery?” Stick around to the end to find out!

Don’t have time to read this post? Watch the video here instead!

Doctor Rich:

Hi, I’m Doctor Rich — and my passion is to provide every woman with practical knowledge about the world of women’s health. Today we’re answering a question from a viewer who asks:

Vegan Woman“Does sex tighten after sacro surgery?”

Well, let’s rewind. 

Let’s talk about the sacrocolpopexy. So this is a prolapse repair surgery. It is the gold standard — it has a high success rate for prolapse. Prolapse is when the vaginal skin becomes loose, the connective tissue fails, and the vagina itself (and the organs behind that — the bladder rectum, small bowel) actually push the vagina outside of the body where a woman can feel it. They’ll often describe it as feeling something “down there” when they’re showering or cleaning — like they’re sitting on an egg, sitting on a ball, or something like that. 

So this symptom (this problem) is very common — 33% of women will have prolapse during their lifetime. 18% of women will have prolapse surgery that can be repaired by the surgery sacrocolpopexy. Now this word is made up of three parts: sacrum (which is the sacral ligament), colpos (or “colpo” — which is vagina), and pexy, which just means “tie together.” 

So the abdominal mesh is placed during robotic surgery. It is attached to the top of the vagina, the other end is attached to the ligament — which functionally reduces (or removes or gets rid of) that bulge because it restores the normal anatomy. It elevates the vagina back internally instead of being able to be palpated (or felt outside the body). For more details around this surgery, please check out our last video here

So this question brings up the concept of elective cosmetic vaginal surgery. 

Now this idea (this concept) is a poorly defined collection of a number of different surgical procedures — that essentially are only done for cosmetic benefit. These include:

  • labial reduction
  • augmentation of the labia majora
  • clitoral hood reduction
  • G-spot stimulation or amplification
  • hymenal ring reconstruction or hymenoplasty 
  • and in general, the term vaginoplasty (which can be done surgically or with use of laser)

Now — in some cases — these surgeries can be done for clinical indications such as pelvic pain, sexual pain, prolapse incontinence, prior injury, reversal of female genital mutilation, and a number of other indications. 

In the majority of cases, these cosmetic surgeries are done purely for nonclinical indications (non-medical indications) — for the express purpose of altering the physical appearance. And the procedures are often marketed to also enhance sexual function. However, the data for all of this is very lacking. There are complications that can occur from these cosmetic surgeries, including:

  • worsening of appearance
  • pain
  • scarring
  • bleeding

…and all of these risks need to be taken into consideration if you are considering having cosmetic surgery. 

The other factor that really should be taken into account is that there is a wide range of different appearances that are all considered normal for external genitalia! You can also reference here. But (for one example) the opening of the vagina can be anywhere from one to seven centimeters — and this is all just considered in the range of normal

Cameraman [offscreen]:

So contrary to what Only Fans tries to make you believe?

Doctor Rich:

So it’s funny you mentioned that… Surgeries such as labiaplasty have DOUBLED in the last ten years — and the literature has shown it’s because patients have access to a very strict sense of what is considered “normal” on social media (and readily available access to pornography). 

When you’re only shown one particular way that things should appear, you don’t consider the fact that a normal part of aging and a normal part of birth is that there is a wide range of normal anatomy — and you’re looking at 1%. A patient would want to seek out a surgeon that has some proficiency in training (and expertise!) in this particular specialty. 

So why this sudden increased interest in cosmetic vaginal surgery? Well, a recent survey showed that among women between 18 and 69, 79% of them had waxed or shaved all or most of their pubic hair. 

So now that there’s better visualization of the anatomy, it’s easier to detect discrepancies (or what someone might consider imperfections). And there’s a lot more attention on that now. 

So what’s my take on all this?

Well, certainly anybody’s entitled to their natural sense of how their appearance is — whether that’s their nose, their breasts, or any part of their body. And they’re entitled to feel better about things and to seek out cosmetic surgery. At the same time though, it is incumbent upon us to provide accurate information. There’s a natural change anatomy around birth, around menopause… And these things don’t represent disease processes (in and of themselves) that need correction. But again, if someone chooses to have that — it’s certainly something that I would support. But do it because you want to, not because the world’s making you feel insecure about it!

So what does any of this have to do with sacrocolpopexy? 

This is a clinically indicated, medically indicated surgical repair. Whereas a byproduct of that repair is likely to provide a narrowing of the vaginal opening (and in that sense more of a tightening) — this is never the primary goal of that repair. The primary goal is to restore normal, functional anatomy. And in most cases, cosmetic procedures for the purposes of tightening are not clinically indicated — and not covered by insurance for that matter! Those are things that certainly can be done and can be offered — but usually is not the prime focus of a pelvic reconstructive surgery. 

So really the answer to your question is that you need to speak with your gynecologist (or your urogynecologist or your pelvic reconstructive surgeon) about what the goals for the repair are so that this can be coordinated with what the anatomy is and what the end result is going to be. (And how that matches up with authorization with your insurance!) 

Did that answer the question?

[clip of Paul Rudd as Antman saying, “Perfectly not confusing!”]

So at the end of the day, it’s a topic that you need to discuss with YOUR provider to make sure they understand what your goals are — and they can reconcile that with a planned repair. 

Hopefully this helps, and we’ll see you in the next video!