Cosmetic Gynaecology

History & Evolution of Cosmetic Gynaecology

May 23, 2022 2 Comments

What is Cosmetic Gynaecology?

Sex is one of the most commonly searched topic on internet. It is because sexual desire is most innate human need and every man wants to have a fulfilling sexual life. This desire is human, and therefore it is logical that every woman also desires an equally satisfying sexual life. However, sexual desires of women have been traditionally ignored and in few conservative cultures, a woman has been labelled if she expresses her sexuality and sexual desires. But with times, things have changed and most cultures now accept that women also need & deserve sexual satisfaction. If any subspecialty of medical sciences has evolved to empower women, it is Cosmetic Gynaecology. Cosmetic Gynaecology deals with surgical and non-surgical procedures of female genital area, which are not purely cosmetic in nature but have an overriding functional aspect, because women ask for these procedures with an intention to have better sexual satisfaction and increased self-confidence.

Choosing the Best Cosmetic Gynaecologist: What parameters to check?

Since it deals with female sexuality, it is extremely important that the provider of the services should be a doctor properly trained in Cosmetic Gynaecology. Cosmetic Gynaecology is a subspeciality of Gynaecology in Medical Sciences, and anything which claims itself to be a medical science must be taught in a medical school under a medical university. It therefore becomes very important for patients to know that the doctor they are trusting for their most intimate needs must be either a university accredited teacher / trainer / practitioner of Cosmetic Gynaecology himself/herself, or else must be trained only & only by a university accredited teacher of Cosmetic Gynaecology, someone who has taught Cosmetic Gynaecology in a medical school, so that the patients get treated by someone whose training and knowledge is based on firm scientific clinical & academic principles. This is the most basic parameter on which your Cosmetic Gynaecologist must qualify.

Training in Cosmetic Gynaecology: How to choose the best training?

In this blog, we shall trace the trajectory of development of Cosmetic Gynaecology as a subspecialty in university teaching system in the world. This shall help doctors across the globe to choose only a university accredited teacher & trainer in Cosmetic Gynaecology so that their teaching & training is based on firm scientific principles which have evolved in university teaching systems and also help women across the globe to choose their doctors based on this information by checking if their doctors have had their training by a university accredited teacher & trainer in Cosmetic Gynaecology. This is the first volume of this blog article which shall take you through the journey of Cosmetic Gynaecology from its birth as an illegitimate love child of gynaecology to it getting legitimacy at the banks of River Ganges in India by establishment of University division of Cosmetic Gynaecology at All India Institute of Medical Sciences, Rishikesh. From there on, the further progress of Cosmetic Gynaecology shall be covered by the second volume of this blog.

History of Cosmetic Gynaecology:

Emperors, Maharajas & their Palaces

History is replete with examples that women have been considered as objects of pleasure and desire, oppressed and exploited in every way possible. Women have been looked upon as a piece of land, as if they are territories to be conquered and put to service. Allaudin Khilji is said to have more than 50,000 concubines, out of which more than half were widows of men who were killed by Khilji’s soldiers under his orders. Mongolian ruler Genghis Khan is said to have impregnated over 1000 women, and according to a study, is believed to have 16 million descendants. King Edward VII of England, who is believed to have slept with close to 20,000 women in his lifetime had even a French designed “sex chair” by which he was able to have sex with two women simultaneously. Indian Maharajas were no less. Like the many sex addict rulers in history, Maharaja Bhupinder Singh of Patiala has been referred to as womanizer and philanderer by noted author Khushwant Singh in review of the book, ‘The Magnificent Maharaja’. Maharaja got married five times, had 88 children from them, and also had many hundreds of concubines. When Maharaja Patiala would come to enjoy swim in his private pool, hundreds of his concubines used to sit bare-chested around the pool so that while enjoying his swim, Maharaja could intermittently come and fondle a few breasts and sip his favourite scotch whiskey. Jarmani Das, in his book, “Maharaja” has captured captivating but true stories, full of intrigue, adventure, desire and romance from the royal households, stories of love and betrayal which have been retold across generations. He has mentioned that Maharaja Patiala took part in massive orgies where men including the Maharaja poured alcohol over virgin women and suck the liquor off their bodies. When he died, he had 332 women in his harem and 10 wives.

But the only difference among Allaudin Khilji, Genghis Khan, King Edward VII of England and Maharaja Bhupinder Singh of Patiala was that Maharaja was the one who cared for his women, and had the French, British and Indian surgeons to take care of hygiene of their private parts and these surgeons are the first recorded in history to remodel and redesign and rejuvenate his favourite concubines. Maharaja was keenly interested in sexual medicine and was anxious to ask the French doctors how they could turn a middle age woman into a young maiden so as to be equally attractive in generating passions of her lord and master. He used to get their breasts and genitals shaped and sized, to stimulate sexual vigour.

Vagina, Labia and Clitoris:

Female pudendum, which refers to female vulva is a latin word meaning ‘The part about which one should be ashamed’. Female sexual passage was anonymous till 1680, before which word “vagina” in latin referred to a scabbard or sheath for a sword.   It was Soranus who described vagina as female pudenda, attached internally to cervix uteri and externally to labia. It was again Soranus only who described outer parts as wings: labia majora, forming as it were lips of vagina, ending above in clitoris, while the rough fold of the lip being labia minora. Clitoris as we know it today, is the gateway to female pleasure, which leads to a majority of women achieve orgasm. Clitoris (or “Clit” as it is popularly called) has eight thousand nerve endings in its glans, which is twice the number of nerve endings in male penis.

Clitoris & History of Clitoral Surgery:

Clitoral surgery dates back to third century AD when Philumenos of Alexandria described excision of a hypertrophied clitoris. Soranos, a Greek physician published first written record of clitoral excision, where haemostasis was achieved by vinegar and styptic powder, subject was held in restraints by strong assistants and clitoris was amputated.

Labia and History of Labia Surgery:

It was in seventh century A.D. that Paulos Egineta first performed and then described excision of enlarged labia minora, referred to as ‘cauda pudenda or pudendal tail’ in his ‘Seven books’ describing it as a fleshy excrescence arising from the mouth of the womb, which projects as a tail externally and can be removed similar to the nympha. In his writing, he referred to hypertrophied clitoris as meaning nympha. Labiaplasty was described as excision of nymphaea by Persian Surgeon Pierre Dionis in his 1707 work,  Cours d’opérations de chirurgie which he based on his work in late 1600s in Court of Louis XIV. A military surgeon with German military, Lorenz Heister described labia minoraplasty in full details in his text, Institutiones Chirurgicae published in 1739: “The nymphae in women are sometimes so large, as not only to hang without the labia pudenda, but also to prove troublesome to them in walking, sitting, and in their conjugal embraces; and may therefore require the surgeon’s assistance. The operator is therefore in the first place to lay the patient in a proper posture, and taking hold of the nymphae with his left hand, he is then to cut off so much of them with a pair of scissors in his right, as he shall judge necessary, taking care to have in readiness styptics for the haemorrhage, and medicines to prevent the patient from fainting. When the operation is over, the  wound may be dressed with some vulnerary balsam, and healed without much difficulty in the common method.” Briefly, Heister describes cutting off the nymphae according to the surgeon’s judgement with necessary medications.

Loose Vagina and Vaginal Tightening Surgery:

It is a known fact that a loose vagina leads to sexual dissatisfaction. Ways and means to tighten a loose vagina have been matter of medical research for centuries. Vaginal Tightening has been done for centuries and different methods have been used for the same. Vaginal Tightening (which is a part of Vaginal Rejuvenation) is over one thousand years old, and it was indeed, first conceived by women. Female physician Trotula de Ruggiero of Salerno published “Treatments for Women” in 1050 AD, where she mentioned five non-surgical treatments for “restoring virginity”. The text says, “A constrictive for the vagina, so that women may be found to be as though they were virgins, is made in this manner”. Monica Green who translated versions of Trotula ensemble after a thorough research says that may be that some of these constrictive agents were meant only to tighten the vagina to enhance friction during vaginal intercourse, not necessarily to mimic a blood flow of ‘defloration’, meaning thereby that the vaginal constricting agents may have been intended as aids to sexual pleasure within an existing marriage or a relationship.

Vaginal Rejuvenation:

Trotula di Ruggiero’s  “Treatments for Women” describes suturing of vaginal lacerations at childbirth. She also described constrictive procedures to restore virginity, which were indeed meant only to tighten the vagina to the enhance the friction of vaginal intercourse, to increase pleasure during intercourse, and origin of all vaginal rejuvenation can be traced to the same.

“Love surgery” and the controversies

Practice of labiaplasty in the modern era has been surrounded by controversies. Dr James C. Burt, an American gynaecologist claimed to transform women into ‘horny little mice’ by his ‘love surgery’.  He asserted that the difference between rape and rapture is salesmanship. However, since it was proven that she did the surgeries without the consent, he got sued and lost his medical license.

Modern Cosmetic Gynaecology: Delivering what women want:

The dramatic transition has been in 21^st century, where cosmetic surgery has become a woman’s choice, and women come and ask for it, and doctors perform it only after taking an elaborate consent.

Modern Era of Cosmetic Gynaecology:

It was Dr David Matlock, a contemporary obstetrician – gynecologist working in Beverly Hills, USA who started using the term Vaginal Rejuvenation at the turn of this century. He is the one who patented the terms, Laser Vaginal Rejuvenation (LVR) and Designer Laser Vaginoplasty. Dr Marco Antonio Pelosi II in New Jersey, along with his son, Marco Antonio Pelosi III, both gynecologists, coined a term ‘Cosmetogynecology’. Though apart from cosmetic vaginal surgeries, Pelosi was more into liposuction, abdominoplasty and breast surgery, they formed ISCG in 2004, a company with headquarters based in Bayonne, New Jersey. Dr Red Alinsod, a veteran with American Air Force, was another contemporary gynecologist who was working at South Coast, who joined Facey Medical group in Southern California after leaving Air Force, where he developed interest in cosmetic surgery, established CAVS (Congress for Aesthetic Vulvovaginal Surgery) and has also contributed to designing vaginal handpiece of ThermiVa RF device. He is the one who started using the term ‘Barbie’ look labiaplasty. Apart from the above three, Charles Runnels was another American physician, who trademarked the ‘O shot’ procedure. Though not a gynecologist, being a MD in Internal Medicine, Runnels trademarked vampire facelift, vampire breastlift & Priapus shot. It can thus be seen that Cosmetic Gynecology had been growing in United States independently from beginning of this century, in different corners, with intermittent spurts, but only as a business with foundations of various companies, and not as an independent subspeciality in any medical university. Though all techniques flourished in market well, but it ran into trouble with American College of Obstetricians & Gynaecologist, which brought out a committee opinion no. 378 in Sep 2007, where they raised concerns with business like practice, wherein ACOG wrote: “Also of concern are ethical issue associated with marketing of these procedures and the national franchising in the field. Such a business model that controls the dissemination of scientific knowledge is troubling.” In 2016, Alexendros Bader, a Greek Gynecologist, who took a 4 days training with Red Alinsod, registered his own company ESAG Limited, with headquarters in Cyprus, along with his wife, Maria Papadopoulou. Bader previously worked with ECAMS, a company with headquarters in Foxrock, Dublin founded in 2007 by Peter Prendergast, a Cardiothoracic Surgeon and his then wife, Pyn Lim, who specialized in sales and marketing.

Cosmetic Gynecology in India started growing simultaneously, but independently. As that time, cosmetic gynecological services were dominated by American & European companies. India with more than 40 thousand gynecologists and Asia being home to more than half of the world’s population, Western World became quite skeptical about this growth. Nevertheless, a group of Indian gynecologists in 2015 formed a scientific society,

Urogynecology and Pelvic Health Association of India registered under the Indian Societies Registration Act of 1860. UPHAI initially catered to Cosmetic Gynaecology also, but soon it was realized that a subset of gynecologists wanted to pursue pure Cosmetic Gynecology, against those who were also into Urogynecology. The birth of The Society of Cosmetic Gynecology (TSCG)

was imperative and TSCG was registered in 2016 as an NGO, again under The Indian Societies Registration Act of 1860. Dr Navneet Magon, an Indian Gynaecologist who was championing the cause of Cosmetic Gynaecology in India in a very ethical & scientific manner was elected as the President of The Society of Cosmetic Gynaecology at the Founding Meeting of TSCG. Soon, besides Indian doctors, TSCG included doctors from Europe, U.S.A., South America, Africa and rest of Asia beyond India also. TSCG became the first scientific society of Cosmetic Gynaecology, which was not a company. It was followed by important milestones in scientific recognition of Cosmetic Gynaecology as a subspeciality by mainstream national & international associations of Obstetricians and Gynaecologist first, and then, finally in 2019, to establishment of Cosmetic Gynaecology as a medical subspeciality in university medical teaching for the first time in the world.

January 2016: At All India Congress of Obstetrics and Gynaecology (AICOG), which is attended by more than 10,000 gynecologists from across the globe, Cosmetic Gynecology got a full independent workshop and main congress representation. It was the very first time anywhere in the world that mainstream national association of Obstetricians and Gynaecologists recognized Cosmetic Gynaecology. AICOG is the official annual congress of Federation of Obstetricians and Gynaecologists of India (FOGSI). Dr Navneet Magon was asked by AICOG to conceptualize and execute this workshop, which was attended by a hall overflowing with audience. This was done in association with UPHAI at that time.

June 2017: At 25^th Asia and Oceana Congress of Obstetrics and Gynecology (AOCOG) 2017 at Hong Kong,  which is the official biannual congress of Asia and Oceana Federation of Obstetrics and Gynaecology (AOFOG), The Society of Cosmetic Gynecology, India was asked to organize a session to introduce Cosmetic Gynecology to its 27 member nations. Once again, it was the very first time anywhere in the world that mainstream international intercontinental federation of associations of Obstetricians and Gynaecologists across the world recognized Cosmetic Gynaecology. Dr Navneet Magon was once again asked by AOCOG President to plan & execute this international session in association with TSCG. The session was jampacked.

August 2017: Sri Lanka College of Obstetrics & Gynaecology (SLCOG) asked TSCG to organize a Cosmetic Gynaecology session at their 50^th Golden Jubilee Congress in Colombo. Three TSCG speakers, two from India, including Dr Navneet Magon and one from U.S.A. delivered lectures at SLCOG Congress in Colombo.

October 2017: RECOGYN 2017, The First World Congress of Reconstructive & Cosmetic Gynaecology was organized jointly by UPHAI and TSCG, at Gurugram, Delhi NCR in India and attended by more than 350 delegates, from than 2 dozen nations across five continents. This was the largest Cosmetic Gynaecology event held ever in the world till date.

March 2018: Royal College of Obstetrician & Gynaecologist, London, U.K. invited Dr Navneet Magon to RCOG World Congress in Singapore as an official RCOG speaker to deliver an invited guest lecture on topic, “Female Cosmetic Genital Surgery: Delivering What Women Want” in the prime time session “HOT TOPICS in OBG”. It was a very historical milestone as it was the very first time that RCOG, who had been skeptical till then about Cosmetic Gynaecology recognized Cosmetic Gynaecology by inviting Dr Navneet Magon as the RCOG speaker at RCOG World Congress to speak on Cosmetic Gynaecology. The session was jampacked. It was the international recognition of the honest, sincere & untiring efforts of Dr Navneet Magon to establish Cosmetic Gynaecology on strong foundations of scientific integrity.

November 2018: The Society of Cosmetic Gynaecology of India organized its national congress, COSMOGYN 2018 in Kolkota which was fully sold out event. Once again, Dr Navneet Magon was the President & Scientific Chairman of this congress.

December 2018: In view of his unparalleled commitment to the scientific & ethical development of Cosmetic Gynaecology, All India Institute of Medical Sciences, an Institute of National Importance in India and the premier medical university invited Dr Navneet Magon to join AIIMS at Rishikesh campus and conceptualize and establish the world’s first independent and dedicated medical university Division of Reconstructive & Cosmetic Gynaecology, and formally institutionalize a post doctoral M.Ch. residency program in Cosmetic Gynaecology.

January 2019: Dr Navneet Magon accepted the invitation, and committed to the cause of establishing the subspeciality of Cosmetic Gynaecology, left a roaring private practice for the cause to get Cosmetic Gynaecology a scientific acceptability and respect from the medical university teaching systems. Dr Magon was appointed as the Founder Head of Division of Cosmetic Gynaecology at AIIMS, Rishikesh and Program Director & Thesis Guide of M.Ch. Cosmetic Gynaecology program.

March 2019: M.Ch. program in Cosmetic Gynaecology was announced with Dr Navneet Magon as the Program Director & Thesis Guide for M.Ch. Cosmetic Gynaecology.

May 2019: M.Ch. Program in Cosmetic Gynaecology started at AIIMS, Rishikesh. This post doctoral M.Ch. residency fellowship program was the first ever university teaching & training program in Cosmetic Gynaecology anywhere in the world in any medical university across the globe. This marked the recognition of Cosmetic Gynaecology as a formal subspecialty of Medical Sciences.

October 2019: After AICOG in 2016, ISAPS, AOCOG & SLCOG in 2017, RCOG in 2018, European Society of Gynecology Congress asked TSCG to conduct a complete session on Cosmetic Gynaecology in their 13^th International Congress at Vienna, again a first time introduction of the subspeciality of Cosmetic Gynaecology to the entire European Society of Gynaecology. Dr Navneet Magon were specifically invited and given the honor & responsibility of introducing Cosmetic Gynecology for the first time to the entire European Society of Gynaecology at their 13^th Congress by the President of ESG, Professor Andrea Genazzani himself.

May 2020: M.Ch. Cosmetic Gynaecology was approved by National Medical Commission of India, with Dr Navneet Magon as the Thesis Guide and Program Director of M.Ch. Cosmetic Gynaecology program. This was a landmark milestone in itself.

September 2021: Indian College of Cosmetic Gynaecology was established by a very senior lady educationist of India, to promote and propagate the teaching and training of Cosmetic Gynaecology. The only reason to establish ICCG was to help the doctors get the correct teaching & training into Cosmetic Gynaecology, because a need was felt a two levels, both of patients and doctors. First, to cater to needs of millions of women who were now becoming aware of their medical conditions which could be improved by Cosmetic Gynaecology, a huge number of doctors were required to be properly trained into Cosmetic Gynaecology. Second, to meet the career aspirations of doctors who wanted training into Cosmetic Gynaecology, but couldn’t get the same as there was only one university accredited teacher & trainer available for Cosmetic Gynaecology training, and since he was available at an institution where the admission policy was restrictive, therefore only a very limited number of doctors and that too, only up to a certain age limit (35 years only) were permitted. Senior medical administrators of the ranks of Air Marshals & Lt Generals, as well as many national & international luminaries were brought on board of ICCG to chair various committees of the college. ICCG Board reached out to Dr Navneet Magon to accept the position of Dean of Indian College of Cosmetic Gynaecology to give the required leadership & scientific direction to teaching & training activities of ICCG. When ICCG Board brought out the issue that thousands of gynecologists want to learn Cosmetic Gynaecology and need proper training from a university accredited teacher of Cosmetic Gynaecology, Dr Navneet Magon agreed to accept the position of Dean of ICCG on a honorary basis, but expressed that he can start working with ICCG only once he signs the thesis of  his M.Ch. student, so that the Cosmetic Gynaecology is fully established and completely qualified human resources have been created by Dr Navneet Magon who could take the responsibility in the university. Understanding the deep commitment of Dr Magon towards the subspeciality, ICCG agreed to wait till the thesis was signed.  The teaching & training courses were planned accordingly.

December 2021: Dr Navneet Magon signed the first thesis of 3 years M.Ch. Cosmetic Gynaecology program, finally marking the completion of the post doctoral residency fellowship and fulfilling all requirements of establishment of Cosmetic Gynaecology as a recognized subspeciality of Medical Sciences. Cosmetic Gynaecology became a fully recognized subspeciality of Medical Sciences with relentless efforts put up by Professor Navneet Magon, the person who first made Cosmetic Gynecology be accepted by national societies of mainstream Obstetrics & Gynaecology and then single handedly made Cosmetic Gynaecology enter the high corridors of medical university and recognized as a medical science curriculum even by National Medical Commission.  With his unflinching dedication, sincere devotion, matchless vision & disruptive creation, Dr Navneet Magon is credited with establishment world’s first Division of Reconstructive & Cosmetic Gynecology at AIIMS and then conceptualizing & establishing Masters of Chirurgiae (M.Ch.) in Cosmetic Gynaecology, again world’s first ever structured postdoctoral residency fellowship program in Cosmetic Gynaecology, the world on firm scientific pillars.

To be continued in Volume II…..