By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, March 6, 2007
Christopher A. Warner says he considers himself something of a maverick, a caring physician willing to challenge medical orthodoxy in order to help women.
That's why the 39-year-old board-certified obstetrician-gynecologist recently opened the Laser Vaginal Rejuvenation Institute of Washington in a red brick townhouse off Washington Circle. There, he is building a business as the first area physician to perform controversial procedures that use a laser to enhance sexual gratification by repairing tissue damaged by childbirth, to give women a "youthful aesthetic look" or to make those who are not appear to be virgins.
Warner's fledgling rejuvenation practice, experts say, exemplifies physicians' entry into what some have termed the "last frontier" of plastic surgery -- a realm where medical ethics collide with culture, commerce and technology.
In response to this growing interest, the American Society of Plastic Surgeons began tracking vaginal rejuvenation in 2005 and recorded 793 procedures that year. That figure is widely regarded as low, because many doctors who perform these operations are gynecologists, whose primary professional association, the American College of Obstetricians and Gynecologists, does not keep such statistics.
While numbers are elusive, both critics and proponents of the procedures agree they are increasing. David L. Matlock, the flamboyant California gynecologist who invented or popularized many of these surgeries, says he has performed more than 3,000 in the past 12 years and has trained 140 doctors in a dozen states and 20 countries, including Argentina, Korea and Australia. His trainees -- Warner among them -- have established vaginal rejuvenation centers in New York, Atlanta, Detroit and San Antonio.
The proliferation of such surgeries, fueled in part by the growing popularity of cosmetic surgery and of reality television makeover shows such as the E! network's "Dr. 90210," alarms critics, who say there is no evidence they are safe or effective, because they have never been studied scientifically. Some say the procedures foster -- or create -- insecurity while doing little to treat the underlying causes of female sexual dissatisfaction.
"I'm asked about these procedures a lot," said sex therapist Laura Berman, who directs an eponymous clinic for women in Chicago. "We're in a culture, unfortunately, where most women are falling down a slippery slope with plastic surgery. It's very disturbing."
To doctors who perform the operations, usually in surgery centers or in their offices rather than in hospitals, such criticism is shortsighted. Warner, a graduate of Georgetown University School of Medicine who started an ob-gyn practice in 2000 and also maintains an office in Southeast Washington, said his goal is to empower women. "I see these procedures as taking care of my patients," said Warner, whose laser operations are performed in a downtown surgery center affiliated with MedStar Health.
Warner was trained by Matlock, who promotes the surgeries over the Internet, on television and through a public relations firm he owns.
Warner said he spent $80,000 on a medical laser and training courses given by Matlock, a regular on "Dr. 90210" who tightly controls the dissemination of the procedures through licenses and through trademarks for their names such as "Designer Laser Vaginoplasty." Warner said he has conferred frequently with Matlock in setting up his laser practice, which is expected to move into bigger quarters in the spring. Warner says calls to his practice increase dramatically after each of Matlock's television appearances.
Matlock is himself a controversial figure. He has been disciplined by the Medical Board of California for what he says is a "misunderstanding" with racial overtones and sued for malpractice 10 times in the past decade for what he characterizes as "nuisance cases."
One of the most vociferous critics is Thomas G. Stovall, a past president of the Society of Gynecologic Surgeons. "There is absolutely zero scientific literature that supports . . . the notion that firing a laser of any kind will tighten [vaginal] muscles," said Stovall, who calls the surgery "a ripoff."
"Most sexual gratification has nothing to do with your vaginal muscle tone," said Stovall, a clinical professor of obstetrics and gynecology at the University of Tennessee at Memphis. "It's really a heresy promoting this. But sex sells."
Each laser procedure costs about $3,000 to $9,000, and many women undergo several simultaneously. These surgeries are also often performed with other cosmetic surgeries, such as liposuction. They are rarely covered by insurance.
Berman said she has treated about 15 women who have undergone vaginal procedures to improve their sex lives and developed complications such as painful intercourse.
St. Louis plastic surgeon V. Leroy Young, former chairman of the emerging trends task force of the plastic surgeons' society, said the hype surrounding these procedures underscores a lack of regulatory oversight. There is, Young noted, no counterpart to the Food and Drug Administration when it comes to surgery. Because of the Internet, he said, "much of this stuff can be developed and is almost immediately on the market."
Operating on or near sensitive vaginal tissue, Young added, is inherently risky and can cause scarring, nerve damage and decreased sensation.
"The question I have is, is this being done for the benefit of the woman -- or someone else?" Young asked. Some women undergo the surgery, he said, because a man has told them, "Honey, you don't look like the girl in the movie."
And Nawal Nour, an assistant professor of obstetrics and gynecology at Harvard Medical School, is no fan of what she calls "designer vaginas."
"I have always believed that empowerment is via the brain, not the body," Nour said.What Women Want
"Every single one of these procedures was developed" at the request of women, Matlock said. "All these patients have gynecologists. Why are they coming to me?"
Warner, who has operated on 18 patients, said he does not consider the lack of published studies to be problematic.
"Life isn't all about studies," Warner said. "These are real problems that don't require 50 people to research the same topic. Women are telling us that it's working." He said the laser surgery he performs can also fix stress urinary incontinence, leakage of urine that sometimes occurs after childbirth.
In Berman's view, much of the demand is fueled by ignorance or desperation.
Most women, she said, have no concept of what is normal when it comes to genital appearance or functioning. "We are particularly vulnerable to believing there is something wrong," especially if a partner says something negative, she said. She added that many women do not realize that incontinence often can be successfully treated with far less invasive methods such as exercises, biofeedback and medication.
Matlock says the exercises don't work and that laser rejuvenation is a modification of standard operations called anterior and posterior repair to fix a sagging bladder or rectum. But, he added, laser rejuvenation "goes way beyond" these procedures.
Gynecologists say that some women do report improved sexual satisfaction after standard repairs. But they note that this is incidental to the functional reasons for surgery, which carries inherent risks.'I Did It for Both of Us'
Critics and supporters of vaginal cosmetic surgery say the mainstreaming of graphic images, including pornography, is fueling demand.
Warner and Matlock say that patients frequently request "a nice sleek look" similar to images seen in Playboy magazine and on some cable TV channels. "Women tell us they want to look like they're 18 again," Matlock said.
David Sarwer, an associate professor of psychiatry at the University of Pennsylvania School of Medicine's Center for Human Appearance, said he believes some of these patients could have body dysmorphic disorder, a psychiatric condition that affects between 7 and 15 percent of plastic surgery patients. The disorder is characterized by an obsessive focus on a minor or nonexistent physical flaw.
"Maybe some of these individuals would be better off changing the way they think about their bodies than the bodies themselves," Sarwer said.
Some women, including 32-year-old Lisseth Figueroa, an office manager in Los Angeles, say rejuvenation surgery helped rescue a foundering marriage.
Figueroa said she suffered from stress incontinence after four pregnancies and felt she was being rejected sexually. Two years ago, after hearing a friend extol the virtues of surgery, she borrowed from her mother and her boss to help pay Matlock's $15,000 fee; her husband gave her $8,000.
"I did it for both of us," said Figueroa, adding that their marriage has improved as a result of laser rejuvenation and a procedure she said Matlock suggested to beautify her genitals. "Before the surgery I felt really old . . . and ugly. Since the surgery that's changed. I'm very happy with it -- and so is my husband."
Sometimes rejuvenation is a family affair. Julie Barragan, a 31-year-old single mother who lives outside Los Angeles, underwent vaginal surgery several months after one of her relatives. Another family member followed suit.
Last July, Barragan had what Matlock calls his "Wonder Woman Makeover": several vaginal procedures, breast implants and a breast lift, abdominal liposuction and a "Brazilian butt augmentation," which involves reshaping the buttocks through a combination of liposuction and fat injections.
The surgery, Barragan said, has "definitely given me more confidence. . . . I haven't had any regrets."
Warner's wife, Sharon, who is also his office manager, said that after delivering three children, she wants rejuvenation surgery, which she likens to other age-defying procedures like coloring her hair.Ready for Marriage?
There is little dispute that one procedure, known as hymenoplasty, is performed primarily for the impression it will make on men.
The surgery, which takes about 30 minutes, restores the hymen, the membrane that typically covers the vagina prior to first intercourse. Surgeons say there is a growing demand for the surgery, particularly among women of Middle Eastern and Hispanic descent -- cultures where female chastity can be a prerequisite for marriage.
Warner, who charges $3,000 for the procedure performed in his office under local anesthetic, has done several, he said. In one recent case, a college student was scheduled to return to Egypt to be examined by a gynecologist as a condition of her arranged marriage.
She has recommended Warner to several friends who have scheduled this surgery, he said.
Sometimes the surgery is done for other reasons. "I've been performing this on and off for years," said Marco Pelosi II, a Bayonne, N.J., gynecologist who says the "revirginization" operation has become increasingly popular as a gift for men. Pelosi estimates he has done about 150 hymenoplasties in the past two years.
Some of his patients, Pelosi said, are celebrating a new relationship or second honeymoon.
Tennessee's Stovall said he thinks the procedure is ridiculous. "Sex is more in your head and in your relationships. And for most women, losing their virginity was not the most pleasant experience."
Berman said that hymenoplasty thrives on credulousness and that patients "fall prey to these surgeons who say, 'I can make you look perfect.' "
"It's one more thing we can feel insecure about," she observed. "We women are just suckers for that." ·