Thursday, 16 December 2010

Vaginal Appearance and Construction

So today I'm going to talk about Lady Bits. With as much delicacy as I can, but because this is the kind of thing every woman should know. Every woman, including standard factory models.

None of us can be certain we won't get some cancer, requiring radiotherapy or radical surgery. And all of us should be warned about pursuing some ideal, via cosmetic surgery, because we don't "look normal".

Ok, some of us don't, but unless you're Transsexual or Intersexed, you almost certainly do. "Normal" covers a wide range.

So what if reconstruction is necessary, due to a congenital problem, accident, or cancer treatment? Genital Reconstruction Surgery is one of the more difficult surgical procedures. Complications are common. Female genitalia is easier to construct than male, but that doesn't mean it's easy.

From The pitfalls of vaginal construction Davies, M. C., Creighton, S. M. and Woodhouse, C. R. BJU International (2005), 95: 1293–1298.
Fourteen patients had complex congenital anomalies of the lower genital tract and 11 of these had associated anomalies of the urinary and gastrointestinal system; four were XY females. The 15 patients had had 31 vaginal procedures, including ileal vaginoplasty, mobilization of perineal skin flaps and split-skin grafting. Three patients required osteotomies to increase pelvic outlet diameter. The commonest complications were stenosis (six patients) and fistula formation (four). Eight patients are now sexually active; the remaining seven have not attempted sexual intercourse.
Complications are common and can be major; most patients require many repeat operations to achieve a patent vagina. Unfortunately at present, this is the only option for this group of young women to achieve a functional vagina. Patients with complex congenital anomalies of the reproductive and genital tracts are increasingly surviving into adulthood, and the numbers of these patients is likely to increase in the future.

I think they could learn from the best specialist surgeons, such as Brassard and Suporn. Suporn has performed perhaps 2,000 of these procedures - without a single case of fistula, and usually using a male or somewhat male initial configuration.

One thing - female genitalia varies. From Female genital appearance: ‘normality’ unfolds. Lloyd, J., Crouch, N. S., Minto, C. L., Liao, L.-M. and Creighton, S. M. (2005), BJOG: An International Journal of Obstetrics & Gynaecology, 112: 643–646
Population Fifty premenopausal women having gynaecological procedures not involving the external genitalia under general anaesthetic.

Methods A cross sectional study using digital photography and measurements of the external genitalia.

Main outcome measures Clitoral size, labial length and width, colour and rugosity, vaginal length, distance from clitoris to urethral orifice, distance from posterior fourchette to anterior anal margin.

Results A wide range of values were noted for each measurement. There was no statistically significant association with age, parity, ethnicity, hormonal use or history of sexual activity.

Conclusion Women vary widely in genital dimensions. This information should be made available to women when considering surgical procedures on the genitals, decisions for which must be carefully considered between surgeon and woman.
The Numbers:
Clitoral length (mm)5–35
Clitoral glans width (mm)3–10
Clitoris to urethra (mm)16–45
Labia majora length (cm)7.0–12.0
Labia minora length (mm)20–100
Labia minora width (mm)7–50
Perineum length (mm15–55
Vaginal length (cm)6.5–12.5
Tanner stage (n)IV 4
V 46
Colour of genital area compared with surrounding skin (n)Same 9
Darker 41
Rugosity of labia (n)Smooth 14
Moderate 34
Marked 2

On a personal note.... I'm Tanner Stage III. But otherwise I could have been one of the study group. I'm a scientist, and no-one who's been through what I have can retain any shreds of maidenly modesty. But there are limits, even for me. My OB/Gyn has need to know more, but no-one else.

1 comment:

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