This is one of the most clinically important questions in cosmetic gynaecology, and it is one I take seriously in every consultation.
Hormonal changes — particularly the decline of oestrogen at menopause — produce significant changes in intimate tissue. Vaginal atrophy, thinning of the labial tissue, reduced lubrication, altered sensation, and changes in tissue elasticity are all hormonal in origin. A surgeon who is not also a hormone specialist may not always ask whether the concern a patient is presenting with has a hormonal component that should be addressed before — or instead of — surgery.
In practice, I see cases where:
- A patient presenting for vaginoplasty has vaginal tissue changes that are primarily hormonal — topical oestrogen or systemic HRT produces the functional improvement she was seeking without surgery
- A patient presenting for labiaplasty has tissue atrophy driving her discomfort — hormonal optimisation changes the texture and comfort of the tissue significantly
- A patient who has had previous intimate surgery is healing poorly — because her oestrogen levels are too low to support adequate tissue regeneration
The answer to your question is yes — I do sometimes recommend hormonal intervention instead of, or before, surgery. And I can make that recommendation accurately because I practise both disciplines. That is a clinical advantage most specialists in either field alone cannot offer.
— Dr Maria Papadopoulou, Vice President ESAG, Co-Founder Bader Medical Institute
