Extreme Makeover: GYN Edition

On today’s show, Dr. Oz and I chatted with a woman about an issue that might sound familiar. Her urine sprayed in many directions instead of coming out in a straight stream. While there are a number of things that might obstruct the flow of urine, labia that are on the lengthy side are a common culprit. I never realized just how common this problem was until I mentioned it in my book, The Essential Guide to Hysterectomy. Suddenly, women were coming out of the woodwork telling me that they wanted to have their labia shortened; they had never before asked because they were too embarrassed.

Extreme Makeover: GYN Edition
Extreme Makeover: GYN Edition

On today’s show, Dr. Oz and I chatted with a woman about an issue that might sound familiar. Her urine sprayed in many directions instead of coming out in a straight stream. While there are a number of things that might obstruct the flow of urine, labia that are on the lengthy side are a common culprit. I never realized just how common this problem was until I mentioned it in my book, The Essential Guide to Hysterectomy. Suddenly, women were coming out of the woodwork telling me that they wanted to have their labia shortened; they had never before asked because they were too embarrassed.

While some women are motivated by being tired of cleaning urine off the toilet seat, others request a labioplasty because they experience discomfort and irritation during sexual or athletic activities. And then there are those that simply don’t like the way their labia look.


With the current “less is more” trend in pubic hair, women are able to see what things really look like, and (like every other part of the body), they tend to be overly critical. I’ve even had a few patients who were so self-conscious about the appearance of their labia that they avoided sexual intimacy altogether and desired a trim even when reassured that their labia were perfectly normal.

When opting for surgery, it’s important to keep in mind that there is always the risk of complication. And, like any cosmetic procedure, sometimes the result isn’t exactly what you had in mind, which is why it is so important to communicate with your doctor (and this discussion includes a mirror!).

Labial shortening isn’t the only vaginal cosmetic procedure women request. Vaginal tightening (also known as “vaginal rejuvenation”) is often asked about. A vaginal opening that gaps due to childbirth usually does not detract from sexual function and response; nevertheless, some women desire a tightening of the vaginal opening. This procedure, called perineoplasty, involves making a small incision just inside the vagina, taking out a small V shaped segment of skin, and restoring things to a pre-pregnancy appearance. Often, vaginal tightening is performed as part of a more extensive surgery, such as repair of a dropped bladder, rectum or an incontinence procedure.

The goal is to restore normal anatomy without making things too tight. Some women are curious if we need to know the measurement of the penis in her life prior to surgery. Fortunately, that’s not necessary, but of course every gynecologist has had the experience of the witty guy who requests “an extra stitch to tighten things up for me” during a pre-op consultation. The best response? To look piercingly at the guy’s crotch and inquire just how small he needs it.  

Your Parent Has Dementia: What to Talk to Their Doctor About

Make sure all their doctors are aware of all the medications she is taking.

Q: My mom is 94 and has dementia. She is taking a whole medicine cabinet-full of medications and I think they actually make her fuzzier. How should I talk to her various doctors about what she is taking and if she can get off some of the meds? — Gary R., Denver, Colorado

A: Many dementia patients are taking what docs call a "polypharmacy" — three or more medications that affect their central nervous system. And we really don't know how that mixture truly affects each individual person.

A new study in JAMA Network that looked at more than 1 million Medicare patients found almost 14% of them were taking a potentially harmful mix of antidepressants, antipsychotics, antiepileptics, benzodiazepines such as Valium and Ativan, nonbenzodiazepine benzodiazepine receptor agonist hypnotics such as Ambien or Sonata, and opioids. And almost a third of those folks were taking five or more such medications. The most common medication combination included an antidepressant, an antiepileptic, and an antipsychotic. Gabapentin was the most common medication — often for off-label uses, such as to ease chronic pain or treat psychiatric disorders, according to the researchers from the University of Michigan.

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