Intimate surgery is not just about appearance. It's about peace of mind, says plastic surgeon Martin Šorma

The topic of labiaplasty remains sensitive for many women. Nevertheless, it is often about very specific reasons - pain during sports, unpleasant feeling during sex, visible overlap in swimsuits or leggings. Martin Šorma speaks about it calmly, openly and without shame. He does not judge. He merely explains what can be adjusted, how the procedure is carried out, and everything that can simplify women's lives.

Sometimes very young patients come. Sometimes women after childbirth, after forty. Each has a different story. But they have in common that they want to get back the good feeling - in the body, in the head, in the relationship. And sometimes a small, technically inconspicuous, but important procedure leads to this.

Labioplasty is a procedure that isn't talked about much, yet it can affect a woman's self-esteem. Doctor, who would you recommend this procedure to?

Firstly we must clarify what labioplasty actually involves. It is a procedure in which we most often reduce and shape the small labia. More procedures are performed in the area of a woman's genitalia, but the term labioplasty usually refers to this specific procedure. Most often, women come to us who feel that their small labia are too large, or are significantly asymmetric, or that there are some other deformities in this area.

What types of labiaplasty do you offer at your clinic?

Given that the spectrum is quite wide, we can encounter excessively large, asymmetrical or variously deformed labia, so the spectrum of procedures is diverse. It depends exactly on what specific deformation on the respective labia we are dealing with. This then results in the variability of surgical techniques. We always adjust them according to the specific situation.

Could you please describe how the procedure works?

Of course. The principle of the procedure is to reduce excessively large labia minora, or to correct asymmetry if the right and left are unequal. And according to the deformation we are dealing with, the extent of the procedure is adjusted. The operation can be performed either under local anesthesia or under general anesthesia. This is always discussed in advance with the patient, what would suit her. During the procedure, we remove or modify the corresponding deformity, remove excess tissue, and then sew the area into a new shape. This is where the procedure ends.

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How does the convalescence proceed?

The convalescence involves always explaining to the patient how important it is to maintain increased hygiene in this area. Since we can not use any dressings to cover the wound, proper hygiene is key. Within approximately 10 to 14 days, the surface wounds that occur after the procedure will heal, but that does not mean that everything is completely healed. The final effect is ensured by scars that form inside and they gain strength after about 6 to 8 weeks. Therefore, we expect the definitive healing after about two months.

Is any special scar care required?

Yes. As I mentioned, the patient must adhere to an enhanced hygiene regimen. Ideally, shower after each use of the toilet. We also recommend specific healing gels that the patient applies at home directly to wounds, which assist in the healing process.

Do women come more for aesthetic reasons or due to health problems?

When we talk specifically about labiaplasty, it is clearly a cosmetic procedure. Of course, there are other diseases in the female genital area that have a medical reason. For example, conditions after injuries, tumour diseases (malignant and non-malignant), or functional disorders in the area of the perineum or vagina. However, these procedures are performed in gynaecology, not with us. And that's why they are paid for by health insurance. With us, we are not dealing with functional disorders, but with appearance disorders, i.e., purely aesthetic reasons, in which patients themselves pay for the procedure.

Do you find that women come to this procedure with embarrassment or fear?

Of course, it's an area that causes women to feel embarrassed - especially when they have to confide in a doctor. Fortunately, thanks to better awareness, which women pass on to each other, the approach to these procedures is different today than it used to be. They see that it is possible to have such a procedure, they know someone who has undergone it, and this makes the first step easier. I believe that this better information contributes to women's greater courage to approach us with this problem.

I personally perceive that there are two main periods when women consider labiaplasty. The first is when they start to lead a sexual life, that is around 17, 18, 19 years old. At this age, they often start to realize that something can be "different" than they thought it should be. And if they feel that the procedure could help them with self-confidence and overall comfort in the future, they decide to undergo it.

The second period occurs in women who usually have children aged around 35 to 40 years. After childbirth, there may be a stretching or enlargement of the small labia, and women then come for correction. Often they did not even know about such possibility before - they never thought about it. But gradually, as more and more talk begins about the topic, they begin to realize that something can be done about it. And they come precisely in this stage of life.

Are there situations when you would recommend labiaplasty to a patient yourself?

Yes, always when a woman comes and tells us about her problems that she perceives in this area, we first examine her professionally. And if we find that her problems are justified, then of course we recommend such a procedure. However, if we conclude that this is a normal anatomical state and it is not necessary to solve it surgically, we try to explain this to the patient and do not recommend the procedure.

Are there other situations when you do not recommend intervention - apart from it not being a real problem?

Yes, for example, I would not recommend the procedure to a woman who has just given birth naturally for the first time, feels there has been some change, but also tells me she is planning another child maybe in two years. In such a case, we would recommend postponing the procedure until after the second birth, because there may be another problem or another change that would need to be corrected again.

What are the most common fears of patients who come to you?

I think the biggest fear women have is of pain. After all, it's a sensitive area. Of course, shame plays a role too, but otherwise, I don't think they have marked fears about the result. They are more worried about pain or possible complications.

What are the real risks in this type of procedure?

I've already partially mentioned that it's very important to maintain enhanced hygiene. If hygiene is not sufficient, there's a risk of infection in this area, which could lead to the wound breaking down. That is the first risk. The second problem could be not adhering to the home rest regime. If a woman is too physically active, and I don't just mean sexually, but any other type of movement or sports activities, there can be bleeding and again also the breakdown of the wound. Therefore, rest after the procedure is really important. So these are probably the biggest risks.

And do you think the appearance of intimate parts can in any way affect a woman's sex life?

I think so, yes. At least that's what women often mention - not as the first thing, but we get to it during the consultation. For example, if the small labia are excessively large or markedly asymmetrical, it can cause burning, cutting, or other unpleasant sensations during intercourse. So if we perform such a procedure, it can positively impact their sex life as well.

Do you find that when a woman is satisfied with how her intimate area looks, she enjoys sex more?

Definitely. Many women claim that if they are satisfied with the appearance of their intimate parts, they feel more relaxed and can enjoy sex more. And from my experience, this is really the case. Women who perceive some problem or deformation often subconsciously feel ashamed. And it is precisely this shame that slows them down. They are not as open and relaxed in sex as women who feel that everything is fine.

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Why do you think some women feel that they are not good enough? Do societal pressures or demands from partners play a role?

I personally believe that the demands of partners play rather a secondary role in this. A very small percentage of women come with the issue that their partner is bothered by the appearance of their intimate parts. Men are usually very tolerant in this regard. Moreover, men often have more sexual experience and know that there is no universal model for how female genitalia should look. I think that men often feel a bit lost in this aspect.

But if a man, for example, once mentions that something bothers him, a woman may perceive it very negatively, and it may lead her to decide to undergo the procedure. In most cases, however, the decision comes purely from her own perception and the feeling that she wants to feel better about herself.

In which specific situations can women be bothered by the appearance of their intimate parts?

For example, during sports. Many women today regularly run, it is very popular. And if there is too much tissue in the area of the small labia, it can physically interfere with them. Sports activities, whether running or perhaps cycling, are often a very frequent reason why women decide to undergo labiaplasty.

Another situation might be wearing swimwear or tight clothing. If a woman perceives that something "protrudes" in these pieces of clothing, that there's simply "too much", she may feel uncomfortable. Some women feel that people around them notice it, and this influences their self-confidence.

So to say it outright: does labiaplasty actually deal with the so-called "camel appearance"?

I don't know exactly what you mean by that, but essentially we are adjusting the shape of female genitals so that the small labia do not protrude beyond the large lips. This protrusion is aesthetically and functionally unpleasant for many women. That is what labiaplasty is addressing.

Has there ever been a case where a woman lost sensitivity after the procedure?

No, fortunately not. The main organ for sensitivity is the clitoris and the small labia. We only touch the area of the clitoris very marginally during a classic labioplasty, as this part is usually not excessively enlarged. Of course, there are exceptions. For example, if the prepuce of the clitoris is hypertrophic, i.e. significantly enlarged. In such a case, reducing it can also be part of the procedure, but this operation must be performed very gently to avoid damage to the nerve endings.

Aside from labiaplasty, is there any other plastic surgery you personally prefer?

Undoubtedly. One of the most common procedures we perform is eyelid surgery. We do quite a lot of those. Breast surgery is also certainly popular. Whether it's about enlargement using breast implants, corrective surgery in the case of sagging breasts, or conversely, reduction in women with excessively large breasts.

When discussing the type of implant for breast augmentation – do you have a particular one you prefer? Brand, shape...?

I'm not sure if I should mention a specific brand, but I can say that the development in breast implants over the last decade has undergone a significant transformation. I have been performing operations with implants for almost 30 years and I remember a time when anatomical implants were very popular, back then we did roughly two-thirds of procedures with them.

Later, however, there was a shift. We began to place implants under the muscle more often and the advantage of the anatomical shape began to fade away. This is why in recent years we prefer so-called ergonomic implants. At first glance, they look round, but they have the ability to adapt very naturally to the shape of the breast and the body. They combine aesthetic effect with natural results, which I consider ideal.

You mentioned that a new type of implant has appeared on the market. What makes it exceptional?

Yes, in recent years, an American company has come up with a new type of implant, which is exceptional in several respects. It has an ergonomic shape, which is slightly different from the types used so far. Sometimes it is said to resemble the shape of a diamond, although I am not sure if this is a completely accurate denomination. Anyway, that shape is really specific and adapts very well to the body shape.

But its biggest advantage is the material used, so-called supersilicone. It's a high-quality silicone used, for example, in the manufacture of heart valves, where extremely long lifespan is expected. In lifespan laboratory tests, these implants have outperformed currently used types by about tenfold, which is a truly extraordinary result.

Who are these implants suitable for?

They are suitable for virtually anyone considering augmentation, i.e. breast enlargement. But their specific advantage is shown especially in the fact that they can be started to be used within a new technique, which is gradually developing, it's about breast enlargement performed only in local anesthesia. And these implants prove very successful in this type of surgery due to their flexibility and natural behavior in the body.

Does the recovery differ depending on whether the procedure is performed under general anesthesia or local anesthesia?

Yes, the difference in recovery is quite pronounced. We have already mentioned that a procedure in local anesthesia carries a lower risk of complications. During surgery under general anesthesia, we usually prefer the patient to stay overnight in the post-operative room. Simply so that we can keep an eye on her and respond in time if problems arise.

On the contrary, during a procedure under local anesthesia, the patient may be able to leave for home care about two to three hours later. Moreover, this technique does not involve opening the wound with a classic incision, instead, the tissues are gently pushed apart, which reduces the risk of bleeding, inflammation, and other complications.

This allows women to return to normal working and social life significantly sooner. While after a classic operation we recommend starting with sports activities roughly after four to six weeks, in the case of a procedure under local anesthesia this time can even be halved.

So this method is suitable for example for mothers, who can't overly limit their movement because they take care of children?

Definitely. But I believe that in this fast-paced world, it's actually more pleasant for every woman, whether she has children or not. Due to work, lifestyle, and physical activities, it's important for most women to be able to return to their normal regime as soon as possible. Any reduction in the period of convalescence is therefore certainly advantageous.

Are there any risks associated with this method in local anesthesia?

There is no operation that would be completely without risk. But this method was developed specifically to minimize as much as possible the risks normally associated with breast enlargement using implants. Implants with an extremely long lifespan are used, and it is even being considered that they may not need to be replaced in the future at all. This is a huge advantage, as the recommendation for replacement is currently around ten years.

As for the procedure itself under local anesthesia, it is not a traditional surgery, where a pocket for the implant is created surgically. Instead, a special tool is inserted under the mammary gland, and a gentle spreading or expansion of the tissue is achieved with a balloon. Therefore, there is no surgical interruption of the tissue and the risk of complications, such as bleeding, is significantly lower.

Are there any restrictions regarding the size of implants?

Yes, certain limits obviously exist. It depends on the type of approach. With newer techniques, which are performed under local anesthesia under the mammary gland, it is possible to use implants up to approximately 250 ml in size. The second approach, which is also currently highly sought after, is the traditional incision under the breast, so the path we most often take for regular breast enlargement. There, larger implants can also be used, usually up to 330 ml in size.

Doctor, thank you very much for your time and your sensitive approach.

I thank you. And I believe that all the women who visit our clinic will feel just as safe and in good hands - just as you feel here.

Sources: author's text, interview, Mediestetik