Loss of volume in the outer vaginal lips (labia majora) is a common issue in women as they age, especially after giving birth and during menopause, which usually happens at about age 50. Labial fillers increase the volume of the genital lips.
“It has a place for women who are concerned about how their labial majora look. It’s nice that there’s a totally safe, easy and not overly painful treatment that can fix it and last a year or two,” says Salmond, who has 10 years’ experience with anti-ageing injections and fillers.
The 30-minute procedure involves injecting hyaluronic acid, a substance that is naturally present in the body, into the labia.
I had a 70-year-old come in the other day and she said, ‘You need to fix me down there, I’ve met the love of my life and I want to have sex again’
Cells lose the ability to produce hyaluronic acid and to hold water as we get older, so tissue loses its elasticity, as well as its smooth and plump appearance. The hyaluronic acid injection gives the labia volume, improves the appearance and, according to the literature, also increases sensation during sex.
“The labia majora are there to protect the inner labia. If they atrophy and have less volume there is less protection, so people might feel uncomfortable with friction sometimes, like when riding a bike,” Salmond says.
When patients express concern about the appearance of their vaginas, she first refers them to British artist Jamie McCartney’s 30-foot-long (nine-metre) sculpture of more than 400 women’s genitalia cast in plaster of Paris.
“There is so much variety in vulvas, they all look different,” Salmond says. “I show them The Great Wall of Vagina [the sculpture’s name] so they realise that not everyone looks like a porn star. Women should be assured there is no normal.”
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Labial fillers have been widely available in the West for about seven years, but Salmond believes she may be the first doctor to offer this niche treatment in Hong Kong.
“In the UK, nurses and dentists as well as doctors can do [the procedure], but in Hong Kong it’s much more regulated – you must be a doctor and only the top brands of fillers are allowed,” she says, adding that the risk of infection is rare.
There is scant academic research on this outpatient procedure. A study published in December 2016 in the Aesthetic Surgery Journal analysed 54 patients in Italy who opted for it. With all of them, a single injection was able to provide significant rejuvenation with no complications.
A review of female genital cosmetic surgery in the International Journal of Women’s Health in 2017 noted the paucity of research in this field. It did conclude, however, that hyaluronic acid injection “seems to be safe and easy to perform, although more research is needed to provide firm evidence of its effectiveness and safety”.
The authors recommended that all women seeking any form of genital cosmetic surgery undergo counselling as “it may help some women identify that their problems, including sexual dysfunctions, may have other origins, such as the quality of the couple’s relationship”.
Nikki Green, a Hong Kong-based sexual and marital therapist and psychotherapist, advises clients thinking about this procedure to research the product well and carefully consider their reasons for wanting it.
“You’ve got to be careful not to get addicted to plastic surgery. If it’s just one more way to change the body you hate, then doing some work on your body is the way to go. But if this is really your bug bear and affecting you deeply, then go for it,” Green says.
With so many plastic surgery options available today, Green urges caution but says for some women it may greatly increase their confidence in the bedroom.
The procedure isn’t cheap. Optimal Family Health charges HK$10,800 (U$1,380) for the treatment and its effects are expected to last one to two years.
“Cost is a big issue and, I think, it would have to bother you. Many people would rather spend the money on their face,” Salmond says.
In addition to external atrophy, as women age there can also be internal atrophy of the vagina, which can make the tissues more tender and prone to infection.
“Menopause is lack of oestrogen. Your ovaries don’t work any more, and the vagina starts atrophying which can make sex more painful because the tissues get thinned,” Salmond says, adding that disturbance of the tissues can lead to an overgrowth of bacteria, triggering discharge and discomfort as well.
That is unlikely to happen for women on general hormone replacement therapy, which includes oestrogen. But for women who don’t need or want to take HRT, another option is to treat vaginal atrophy with oestrogen.
“I had a 70-year-old come in the other day and she said, ‘You need to fix me down there, I’ve met the love of my life and I want to have sex again,’” Salmond says. “It will take a little while to replenish the vaginal oestrogen, but it will help.”
Many women experience diminished libido after menopause because oestrogen is hugely important for sex drive. Replacing hormones can make a difference and, Salmond says, often helps keep the mojo in a marriage.
“With HRT, women have to discuss the pros and cons,” she says. “If they have low bone density, then the benefits of HRT often outweigh the risks. But if women are using purely vaginal oestrogen … then it’s safe.”
