做了一段时间妇科方面的手术,又参考了国内外妇科手术经验后,我将病人们常常提出的问题做了个总结。下面是一篇关于这方面的英文,我将做如实的翻译,同时也加入自己的经验,仅供病人参考。
这是比较常见的阴道松弛同时伴有小阴唇肥大。另外,因为分娩,小阴唇系带被撕裂。所以手术需要解决这些问题!
手术后阴道口明显缩紧,小阴唇也减小明显,阴唇系带的结构也恢复了。
在完成阴道紧缩的同时恢复阴唇系带的形状!
1. Do you use a special no scar technique for Labiaplasty? Some surgeons will just remove the excess tissue and the scars will run down the length of the labia. Will this leave unnatural scarring? Will it be obvious?
问题:你们是否使用一种特殊的,没有疤痕的阴唇整形手术?有些医生仅仅会切除部分多余的阴唇组织,这样疤痕会沿着阴唇走行。这类疤痕是否自然?会不会很明显?
The so-called “scar-less” technique is an absolute fallacy. In this widely talked about technique, what's typically performed is that an inverted triangle is cut on the backside of the labia, roughly in the middle, and the tissue is then retracted, or pulled back, to make the labia smaller. This is usually a twenty-minute procedure and it is called “scar-less” because no one typically is going to see the inside, hidden areas of the labia.
In surgery, when a doctor wants to make something tighter, it's common knowledge that the area is opened horizontally . . . and then closed vertically. In this method of labiaplasty, the point of the triangle cut is near the widest part of the labia—then the tissue is pulled in. The problem with this technique is that it fails to address the three most important issues, or complaints facing patients seeking labiaplasty. They are; 1) dark tissue pigmentation (dark color of the tissue in the problematic area); 2) the thickness of the tissue in the labia, and; 3) the “rugated” (ruffled), uneven edges of the labia. Unfortunately, this technique allows for simply drawing inward the tissue in question, leaving it still visibly (anatomically) present after the surgery. Usually the patient ends up with smaller labia—but with the same dark, thick, ruffled tissue— now amassed in a concentrated area, often making the results appear worse than before.
回答:所谓的“无疤痕技术“完全是谬论。这是一个常规手术,通常在阴唇背侧、中间最宽的部位楔形(倒三角形)切除粘膜组织如下图;再将被保留的阴唇组织向下拉覆盖创面,以缩小阴唇。 这种手术之所以称为“无疤痕”,是因为我们将疤痕隐藏在阴唇基底和内侧。但是这种手术会有三个比较“致命”的弱点:1 保留了阴唇色素沉着最重或比较重的部分;2 保留了阴唇最后的部分;3 保留了阴唇皱褶多的部分。这些是手术方式本身造成的,与医生的技术没有很多关系。所以,对于那些希望有着“粉色”、“平滑”和“更显年轻的”阴唇时,我们只能采用另一种方法。但是另一种方法也有它不可避免的缺点,所以这时需要我们进行仔细的术前讨论。
2. Is it recommended to undertake this type of surgery if I've not had children yet?
问题:如果我没有孩子是否也可以做这类手术?
Absolutely. If large labia bother you either physically, or emotionally . . . then it simply doesn't make any sense to live with these physical or emotional pains. Why would you wait? After labiaplasty, your self-esteem and anatomical form will be corrected.
回答:如果肥大的阴唇无论在身体上,还是在精神上都困扰着你,那么你完全可以实行手术。
3. What kind of anesthesia can be used in labia reduction surgery?
问题:使用什么麻醉?
The surgery can be done with local anesthesia, level two IV sedation, or level three general anesthesia's (anesthesia). Most surgeons prefer IV sedation, or what is commonly known as “twilight sleep”, as it makes postoperative recovery immediate and usually results in none of the discomfort from general anesthesia—typically, post op drowsiness, nausea, vomiting and endotrachial post-surgical effects.
回答:国内通常使用局部麻醉
4. How many visits to your office will be required?
问题:手术后需要几次随访?
Over 90% of cases are from outside the region. Our skilled staff can help facilitate ease of travel and planning. In recognizing the difficulty of travel today, due to increased security, only one trip is ever required. Patients may come in for a post-op exam if they wish, and are encouraged to do so (4-6 weeks after surgery), but it’s not always possible when traveling from out of the area. In those instances, some patients can simply send a photograph of the surgical area for the doctor’s review post-operatively. All routine pre-op tests and blood work are performed by 4PM the day before surgery.
回答:(因为国情不同,这个问题我没有翻译,而是写了自己的要求)通常在手术后7-10天随访,有些病人会在随访时要求拆除缝线(我基本使用的是5-0可吸收缝线,不需要拆除),因为她们对缝线比较敏感。手术后4-6周肿胀基本消除(但是每个人情况不一样),这时根据个人情况来医院随访。手术后3个月基本恢复,这时也根据个人来医院随访。
5. Is it better to have labiaplasty done at an early age if there is a need, or is it better to wait until one gets older?
问题:如果需要做小阴唇缩小手术,那么在年轻时做好,还是年纪大时做好呢?
In almost every case, it’s better to have labiaplasty done when it’s needed. If large labia bother you either physically, or emotionally . . . then it simply doesn't make any sense to live with these physical or emotional pains.
Only five years ago, few patients knew of labiaplasty surgery to correct problematic areas. Today, with a heightened awareness of the problem by both young girls and parents, many are now turning to the surgical methods available to correct these problems. The reasons are that young women today are more physically active and armed with the knowledge that there is a simple, one-hour surgery to correct the problem—thus many women are moving forward with labiaplasty while still young. As far as any medical reason for delaying a labiaplasty, there simply isn't one. Whether or not a young woman decides to have the minimal procedure performed, or not, is up to how she feels about herself. In those cases, women and young girls who have an actual physical problem with their labia—such as large, or asymmetric labia—having labiaplasty performed early can result in an anatomical correction that results in greater patient self-esteem as they mature.
回答:如果肥大的小阴唇无论在生理上,还是在精神上困扰您的话,您没有任何理由拖延治疗的时间。人们开始真正关注这类手术也是近5-6年来(而中国,也就是近2年来)。很多受这个问题困扰的年轻女孩在父母的陪同下开始接受外科治疗(国外没有提到最早可以接受治疗的年龄,我认为应该是女孩发育完后,大概16-18岁,最好是18岁。)
6. Would there be a rough edge on the labia when the labiaplasty is finished and healed?
问题:当小阴唇整形手术完成和愈合后,是否会留下粗糙的轮廓?
Our surgical technique creates a natural appearing and feeling edge with no loss of sensation.
回答:我们会保留正常的外观、轮廓和感觉。
7. Will my sexual partner see or feel any changes resulting from my labiaplasty?
问题:小阴唇手术后,我的老公或者男朋友会看到或感觉到任何的不同吗?
Feeling a change after a labiaplasty largely depends on the degree of labia abnormality to begin with. Simply said, if there is enough labia tissue present before a labiaplasty is performed that interferes with sexual activity, then usually the sexual partner will feel a difference after labiaplasty, because the excess tissue won’t interfere with any sexual act as it might have before.
As well, it will be very apparent to your sexual partner that the external structure of the labia will have been altered visually—namely, they’ll be smaller and better aligned. Your sexual partner will clearly notice this change for the better.
回答:他们应该会感觉到不同的,但,是向好的方面改变。
8. Could labiaplasty cause insensitivity?
问题:小阴唇手术会降低阴唇的敏感性吗?
There is no physiological association for sensory pleasure with the labia—that function is served by the clitoris. The only sensation elicited from labia is pain upon tearing or stretching. Labiaplasty can’t cause a loss of sensitivity when done correctly.
回答:(请看前面我关于小阴唇的解剖介绍)如果手术操作正确,不会影响敏感性。(根据部分临床病例和解剖学理论分析,有可能加强和提高性生活的敏感性)
9. Is the skin around my clitoris involved in the procedure?
问题:阴蒂周围的皱褶皮肤(阴蒂包皮)是否也能在小阴唇手术中处理?
In most instances, no. However, in those cases where women have excessively large labia, the skin around the clitoris is reduced due to the retraction of tissue during the labiaplasty procedure. In some instances, this adjunct tissue removal can result in an increase in clitoral sensation during normal sexual activity.
回答:(请仔细看我关于小阴唇的解剖介绍)。通常肥大的小阴唇会伴有阴蒂周围皮肤过多,在实行小阴唇缩小手术中,阴蒂周围的皮肤会因为牵拉而减少。在某些病例中上述这种情况可以增加阴蒂在性生活中的敏感程度!
10. Is clitoral unhooding as involved a procedure as labiaplasty? And should a woman consider having this procedure done?
问题:在小阴唇手术中是否也包括阴蒂包皮去除术?或者女性应该考虑做这类手术?
Clitoral unhooding (also known as Hoodectomy) is analogous to circumcision in men. It involves reducing the tissue that forms a hood or covering that shields the clitoris. Some surgeons won’t perform this delicate operation because of the innervation (neuron cell density) of the clitoral node is many times more concentrated than in any of the surrounding tissue areas—thus if not done correctly, clitoral unhooding can result in heightened sensation of the node by normal movements, in some cases creating considerable discomfort. However, for surgeons who perform the procedure regularly, clitoral unhooding can result in increased stimulus of the clitoral node and many patients have reported increased sexual climaxes (orgasms). Surgeons who do clitoral unhooding usually have a method of determining the extent of sensitivity of the clitoris before proceeding by testing the area with cold and warm swabs. Patients SHOULD ONLY have this procedure performed by a surgeon who has extensive experience in this area and has performed many clitoral unhoodings.
回答:阴蒂包皮去除手术类似男性包皮环切手术。有些外科医生不愿意实行这种精细手术,因为阴蒂中神经细胞集中的密度远远超过周围组织,因此任何不适当的操作都会导致在正常活动中阴蒂的过度敏感和不适。然而,正确地操作却会使女性在性生活中有很大的受益。
11. I have a 15-year-old daughter with enlarged labia minora and it’s become an issue with her emotionally as she gets older. She is asking about surgery tomake her look more normal. My gynecologist says that it can be done in his office. What is the difference in having this procedure done in his office instead of going to someone who specializes in this procedure?
问题:我15岁的女儿小阴唇肥大,这个问题对她的情绪已经产生了严重的影响,我应该找什么样的医生做这类手术?
Many young women and their parents don’t realize how important it is to seek the surgical advice and experience of a physician who has performed hundreds of labiaplasty procedures . . . until it is too late. Simply loping off tissue, without regard to symmetry, or latent-tissue retraction after healing, can result in disastrous results. Simply remember, ONCE TISSUE IS REMOVED, IT RARELY CAN BE REPLACED . . . IF EVER. While the family gynecologist is trained in gynecological anatomy and physiology; procedures in labiaplasty or vaginoplasty are specialty areas not usually taught during medical training. It is ALWAYS advisable to only proceed with a surgeon skilled in performing numerous labiaplasty or vaginoplasty procedures.
回答:找对这方面手术有经验的医生。
12. Can I have an asymmetrical labia fixed to appear like the other side? If so, is the cost the same as a total labiaplasty?
问题:两侧小阴唇不对称,仅修复单侧,术后两侧形态是否能达到一致?
First, it’s important to understand that people develop fairly anatomically symmetrical. This can be said for eyes, ears, limbs, and of course, labia. So, when one side of the labia develops somewhat asymmetrical (something that commonly occurs) it would be very hard to match the irregular side, to the side that is preferred, because of differences in color, labia thickness, and what is termed “rugation” (the ruffled uneven edges of the labia) that occurs at the labia lip. As far as a cost savings, it’s much more important to have a labiaplasty procedure that results in asymmetrical labia, then save the small amount of money and be unhappy with the end result. If cost is an issue, there are a number of financing options available that we offer, which will allow a good result without compromising patient satisfaction.
回答:单侧小阴唇肥大是很常见的,但是很难通过手术达到两侧形态一致,因为小阴唇的形态、颜色和厚度都很不规则。特别是小阴唇的厚度很难达到两侧完全一样!
14. I have read that after labiaplasty a woman can experience lifelong sexualarousal problems. Is this true?
问题:小阴唇手术是否影响性刺激?
No!! This is a common fallacy and it is completely wrong. The media, which at times misinterprets accurate medical information, commonly helps propagates this rumor as a means of creating controversy or sensationalism. It is well known MEDICAL FACT that the labia have sensory nerve fibers that ONLY transmit pain sensation, when stretched or torn. There is NO SEXUAL STIMULATION ASSOCIATED WITH THE LABIA MINORA.
回答:医学证明--位于小阴唇的神经纤维在小阴唇受到拉伸或撕扯时仅仅传导痛感。小阴唇与性刺激没有关系。
15. Is it possible to inject fat around the vagina?
问题:是否可以在阴道中注射游离脂肪?
Free fat transfer, or FFT is indeed possible, and some surgeons report success with this technique. Unfortunately, transplanted fat acts in varying ways in different patients and it’s largely a matter of technique to achieve good success. Because of this, there is a large amount of evidence that in the majority of cases, fat can be reabsorbed over a period of time and leave the area as it was before.
回答:游离脂肪注射是完全可能的,有些外科医生已经成功报道过这类技术。但只是脂肪很容易被吸收
16. Is there a procedure to make my clitoris larger or more exposed for greater sensitivity?
问题:是否有什么技术可以使阴蒂更大些,或者暴露地更多些以便更加敏感?
The size of the clitoral node (clitoris) cannot be increased and is homologous (the same as the penis). Thus size is unrelated to increased sensitivity.
However, sexual stimulation and arousal from the clitoris can be improved if there is too much tissue covering the clitoral node. In these instances, a clitoral unhooding or Hoodectomy, can remove excess tissue, and result in more sensitivity. However, clitoral unhooding is a very delicate operation and SHOULD ONLY be performed by a surgeon who first has a good method of determining clitoral node sensitivity (usually a surgeon will develop their own personal methods to do this) preoperatively; and has done numerous procedures with a proven record of success.
回答:没有什么手术可以使阴蒂变得更大,但是可以使它更容易暴露。
17. If dissolvable stitches are used when do they typically dissolve?
问题:可吸收缝线被吸收的时间:
Dissolvable sutures are used exclusively in labiaplasty. Depending on the specific type of suture (there are a few different types), and the location of the suture, they typically dissolve at 7 – 21 days (some dissolve in 7-10 days), allowing tissues to heal in the most natural way.
回答:国情不一样,这里写是7-21天,我们国内是3个月。有些病人可以根据个人情况在手术后7-10天内拆除。
18. A fatty mound of tissue bulges out from my pubic region, giving me a more manly appearance in underwear and form-fitting clothes. I’I'm told it’s my mons pubis. Is there a way to liposuction this area?
As women age, this area, the Mons Pubis, tends to gain body mass (fat). Liposuction is possible, but the results are often undesirable and vary too greatly from patient to patient. Much of this is because there is an excess amount of fatty tissue in the general area of the lower abdomen, not just in the Mons Pubis region, and this can lead to additional complications.
19. I ride horses frequently. Can you tell me how long I'd have to refrain from riding?
Depending on the extent of surgery, and how rigorous the riding sessions are, it’s recommended that you refrain from riding for at least three weeks.
20. What types of pre-surgery visits or consultations are necessary? Can they be done in one trip, or will it require two or more?
Most women fly in the day before surgery. At that time, a complete history is taken, including a physical; fluids are drawn for lab analysis; and they’ll be a full review of consent forms and other pre-surgery documents. Also at that time, digital photos will be taken for use in a collaborative session to custom design the “look” that the patient desires.
Typically, patients stay overnight in one of several hotels with which we have working agreements. The surgery is scheduled for the following morning.
Your surgeon will see you the next morning before you depart on your return trip to make sure everything is as it should be. After labiaplasty you can return to work or normal activity in about 3 - 4 days. If you have both labiaplasty and vaginoplasty performed (combo surgery) it’s usually recommended that you don’t return to normal activity for at least 6 - 7 days. We recommend a 6-week postoperative visit, but in many instances this isn't possible. In those instances (90 % of patients are from out of state), a digital photo and follow up phone consult is the norm. The patient shouldn't use Tampex, wear constricting undergarments such as thongs, and refrain from sexual intercourse for at least 6 weeks so the area can heal normally. As with any surgery, complete healing is usually 3 months.
21. How far in advance must I schedule my surgery?
Typically a 72-hour notice to schedule surgery to come in for the pre-surgical consult (see question above concerning visits and pre op procedures). Or, patients may simply schedule their surgery in advance, up to one month away.
22. How soon after my surgery can I resume normal sexual intercourse?
Your surgeon consults with each patient on this topic. Depending on a number of factors including age and extent of surgery, normal sexual relations can usually be resumed in 6 to 8 weeks.
23. What is considered normal labia size?
“Normal” labia size is whatever you choose, based on your own self-esteem. If you’re happy with your existing labia, whether symmetrical, or asymmetrical, and you have no problems with the way they look, then, in your case, “normal” labia is whatever you choose, or accept. The point to remember is that with labiaplasty, you can literally pick and choose the size or shape of your labia, and elect to have they anatomically reformed, if you wish.
24. I would specifically like to know if vaginoplasty and labiaplasty can be done at the same time—and is there a cost savings?
Combination Labiaplasty (reduction beautification) Vaginoplasty (rejuvenation tightening) can be performed at the same time, and the cost is markedly less than the single combined price of having each done separately.
25. Can I send digital pictures to do a phone consultation and then fly down for the preoperative consult before surgery?
Because 90 % of patients come from out of state (often out of the country), your surgeon will have extensive phone and e-mail consultations with you prior to booking a procedure. Part of this process sometimes involves the viewing of a patient’s photos prior to them coming in for a face-to-face consult.
26. I have read that some surgeons do labiaplasty surgery by laser while others use a scalpel. Which is better?
Depending on the individual surgeon’s preference, some use lasers and others use scalpels. Others use Iris Scissors for labiaplasty (the same instrument typically used for eye surgery (Blepharoplasty), and face-lifts (Rhytidectomy). While the laser is fine for long straight incisions it doesn't leave the natural edge that an Iris Scissor does, which makes the labia look normal when the surgery is finished. When working on the labia, and making the correct incisions, in the right areas, there is rarely any apparent visible scarring.
27. I've read about different labiaplasty surgical methods such as laser versus Iris scissors. As I understand it there are differences in the procedure and results. Can you explain this to me?
What labiaplasty surgery is all about is creating or recreating small, beautiful, comfortable labia minora. The bottom line is the outcome . . . the destination, not the journey. First, if a laser was so much better, than why isn't it used for other cosmetic procedures such as facelifts, eyes, ears, breast augmentation, and most other aesthetic procedures. The answer is simple; creating the most naturally appearing end result comes with cosmetic iris scissors. Yes, lasers make nice straight incisions. The problem is, there are few, if any straight lines on the human body. There is no difference in recuperation time. Back to work or school in 3 days. Your surgery generally looks good at 4 weeks and you feel good at 6 weeks. In most cases, the reason a laser is used for labiaplasty is because it’s far quicker a procedure, and easier for the surgeon.