Reflections on a new trend in women’s health care

I have recently noticed a few websites offering an interesting combination of women’s health services, with traditional obstetrical and gynecological care alongside such services as esthetic or cosmetic procedures.

As a woman, I must say I found these websites inviting. They project an image of sanctuary, where our physical AND psychological needs are attended to in a warm, esthetically pleasing environment, in contrast to the more factory-like settings that continue to be typical of traditional hospital and outpatient settings.  And as an obstetrician, I am acutely aware of the pressure to attend properly to these complex needs in these environments.

With that said, I find these websites unsettling.

One concern I have is around a potential professional conflict of interest that might come from having the same obstetrician/gynecologist delivering both insured and non-insured services under the same roof.  For example, I worry that women seeking medical advice and counsel concerning sexual health will be influenced (consciously or not) to purchase products, or undergo expensive procedures that are not medically necessary.

I am also concerned about women’s true autonomy and safety in making decisions about these products and services. Women may assume that because these services are offered by the same doctor who provides them with traditional medical obstetrical/gynecological care, that the esthetic/cosmetic products and services meet the same standards of evidence as traditional care. But often the outcomes of esthetic/cosmetic products and services are not studied with the same care we increasingly demand of traditional medical and surgical treatments, particularly in this time of increasing quality and safety standards in our public facilities.

Then there is the issue of “cosmetic” gynecological procedures.   Here it gets even more complicated. The line between cosmetic vaginal surgery and medical vaginal repairs following the rigors of childbirth, aging or constitutional anatomic issues doesn’t appear to be clear. Indeed, there is an intense debate over this very issue in the medical literature. But professional organizations like the American College of Obstetricians and Gynecologists and the  Royal College of Obstetrics and Gynecology express significant concern about the gynecologist’s role in promoting and performing surgeries that alter often normal anatomy to fit a stereotyped image that young women (and men) are increasingly exposed to through pornographic and other media portrayals that have come to define what women’s bodies should look like.

Those performing these procedures often justify them by invoking women’s autonomy. They suggest that women’s demand for these procedures should be answered by providing them by qualified gynecologists, who are by training the most experienced pelvic surgeons.

Maybe so.

Whether a woman undergoes any cosmetic procedure is certainly her individual choice.

But here is the heart of the matter to me: Our role as obstetricians/gynecologists is to provide evidence-informed medical and surgical care, and to advocate for practices that promote healthy physiological transitions in women’s lives. I don’t see how accepting – never mind promoting and benefiting from – a perceived link between overall women’s health, women’s sexual health and societal definitions of physical beauty is compatible with that role.