Size Matters

Dr.Vitasna Ketglang was interviewed by Arusa Pisuthipan

Bangkok Post on June 19, 2005

For some women, Vaginal Repair is a life- saver – and even a marriage saver.

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For physicians, a challenge can sometimes lead to the ability to better Mother Nature. —Facial rejuvenation with Botox injections can stop natural signs of old age. Liposuction or a tummy tuck can counter the accumulation of what we take in. A sex change operation can allow a person to belong to a different gender.

What about the reshaping of a woman’s private parts?

In a world full of ironies, it is puzzling that while men want their pivotal organ to be as big as possible, women want theirs to be small. Outrageous as it may sound, a seemingly unnecessary operation has become increasingly popular among Thai women.

Posterior Vaginal Repair surgery is the method that surgeons use to re-shape a woman’s inner vagina, especially for women who have given birth several times – Mother Nature leaves havoc in her wake.

After the second or the third delivery or after years of sexual intercourse, the vaginal muscles can become loose. The inner vagina itself will also enlarge. This can result to unsatisfactory sexual intercourse.

It may generate ridicule or laughter, but for a lot of couples, it’s as serious as any marital issue and no laughing matter. Left unattended, it can affect a relationship or bring about family disharmony.

Dr. Vitasna Ketglang, a Certified Specialist in Obstetrics and Gynecology, admits that seven years ago, before she started performing posterior vaginal repair surgery, she used to believe that this surgery was not essential for her patients, as it was not done for vital medical purposes. “At first I didn’t recognize the importance of Posterior Vaginal Repair surgery. It’s like say, Rhinoplasty or a nose job, if you don’t do it, you still can breathe. It’s not a matter of medical necessity or requirement. Rather it’s a matter of patient satisfaction.” Dr. Vitasna said.

Aside from the Posterior Repair Surgery, Hymenoplasty is another form of Vaginal Repair. This procedure aims mainly at restoring “virginity” through the reconstruction of the Hymen. For women who still consider the thin existence of the Hymen as a symbol of virginity or place a high value on female chastity, this type of surgery can be a savior – they can feel “like a virgin” again.

“Posterior Repair Surgery and Hymenoplasty are two different treatments.  While the Posterior Repair fixes the inside of the vagina, Hymenoplasty only fixes the Hymen. The replacement of the Hymen is highly popular among the women particularly from Latin America and Middle Eastern. But I don’t recommend it.  I don’t think patients should pay too much attention as to whether or not this vaginal membrane is still intact”, the physician says.

With the Posterior Repair, there are two types to consider; the type that enhances sexual pleasure and the other one for posterior vaginal prolapse. This latter is done on the basis of medical indication. Among Thais, the number of patients who seek the first type of treatment is far higher than the latter.

Dr. Vitasna herself has been involved in Posterior Repair Surgery for almost seven years. So far she has performed about 6,000 of them. The gynecologist believes that demand for this surgical procedure has leveled off. “Five or six years ago, I did around 70 vaginal repairs per month. Is that a lot?” she asked. “Now since we have more specialists in this area, I normally do about 30 repairs per month.” Dr. Vitasna adds that for her, an honest doctor-patient discussion is important before the operation is scheduled.

“These days, I have longer discussions with my patients who want me to do the surgery for them. If they are determined to undergo the procedure and have a clear understanding of sexual problems and understand how the treatment will help, then I will help them.”

Most of Dr. Vitasna’s patients are middle-class women who generally have complaints regarding sexual performance. Most are over 35 years and have been through child- birth a couple of times. Some of the patients don’t have children but have been married for many years. When the vaginal muscles become loose, they no longer experience pleasure during intercourse. Others complain of too much vaginal fluid (lubricant) during sexual intercourse.

“All of my patients check in feeling down about themselves. I mean they are worried about their sexual pleasure and performance. Some of them are anxious that they might have a problem with their partner or even a marital breakdown. Some say that their partners complain about their unsatisfactory sexual abilities. It may sound like the men are taking advantage of women but I think it’s a problem that could be fixed.”

Dr. Vitasna recommends that women who consider undergoing the surgery discuss the matter with their partners first. It will help the relationship in the long run, particularly after the fix.

According to the gynecologist, the pre-operative and post-operative procedures are quite similar to other types of surgeries. That is to say, all patients are required to have blood tests, a vaginal check as well as a check for any underlying disease. If there are no abnormal findings, the patient is deemed a suitable candidate for the surgery.

Generally, the patient can go straight home after all the procedures are completed, though it is advisable that they spend a night at the hospital to receive continuous care. A follow-up check up is needed a week later to make sure that no infection is found.

Even though this kind of surgery is widely known among women, most patients want to remain anonymous and want to have their medical information treated as extremely confidential. Patients come in with no name on their medical records and remain anonymous. To Dr. Vitasna, Posterior Vaginal Repair is a practice that goes against the law of nature. At first, she could not understand why people, especially women, paid such attention to the size of their vaginas.

“I used to think that it was such a small problem until later when I saw my patients and I developed more of an understanding. All the questions in my mind were swept aside. I became more open-minded. I know that this problem can later cause family or marriage rift and I know that most patients are very worried. That’s why I help them.”

Is it smart to mess with Mother Nature?

“I can’t give a precise answer as to whether or not this surgery is necessary. I can’t say to my patients that if your partner does not love you because of the size of your vagina, just get away from him. The only thing I can do is to try to understand the problem and help. For me, it’s not about right or wrong. It’s about if we see a problem and think that we can fix it, why not?”