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.

The comments section is closed.

  • Ritika Goel says:

    Thanks for the great piece, Nan. As a physician and a woman, your words resonate so well with me. It is very concerning for providers to be working in both the public and private sector in this manner, as the trust patients have of their healthcare providers is based entirely on the notion that the provider is *only* operating in the best interest of the patient and has nothing to gain personally. Going through pregnancy and childbirth is a special and vulnerable time for young women, and to have the individual who has led you through this process then suggest you might want to “get your vulva done” is just horrifying. Not to mention the notion of physicians colluding in sexism. Great post!

  • Trina Bottos says:

    %featured%I agree that there is a potential conflict of interest when the trusted physician that cares for patients in medical situations also offers cosmetic procedures to the same patients.%featured% I know of a busy female family doctor in one under serviced area who works in family medicine a limited number of days a week and works in her private “skin-care clinic doing Botox injections and other cosmetic skin care treatments for fee the other days. She advertises her optional treatments as a way to “feel good” about yourself. I know that positive self-image can contribute to psychological health but there are other ways to enhance self image without resorting to cosmetic procedures. I also know that Med school tuition is high but the education Doctors receive is also subsidized by taxpayers and I wonder about the ethics of them using their education to supplement the already generous remuneration they receive in their medical practice by offering cosmetic procedures for additional remuneration. As for cosmetic gynecological procedures I share Doctor Okun’s misgivings and feel that the avalanche of internet pornography is fueling the demand. Social pressures impinge on individual freedom in subtle ways and I wonder how truly “free” those who choose to undergo cosmetic surgery are.

  • Judy Glennie says:

    Agree that this is a concern, and the potential impact on access to medical services makes it even more so. Re: the latter, I’ve observed/experienced such situations by some who practice in the dermatology field, where access for real medical dermatology needs are given lower priority than cosmetic dermatology appointments. As a health care professional, I know this isn’t appropriate and will push the system to give me access to those willing to provide medical dermatology care as a priority. But what about patients who don’t/won’t question the system? The same applies to the scenario above. Seems to me that clear separation of services is critical, so that patients understand the concept of medical need vs. cosmetic options. Thanks for raising this important practical and ethical issue.

  • Sarah G says:

    I couldn’t agree more. This just takes a step too far.

  • karen okun says:

    I am curious to see what is posted in response to this article. Increasingly there are less and less parts of my body which i am able to freely observe in the mirror and not reflect that there is some larger than life image of what it is supposed to look like. The fact that my vagina is now included in this debate irks me, to say the least. To say that women have a right to ‘choose’ to have such alterations oversimplifies the path they may have travelled to arrive at that choice.
    Where did the ‘new image’ and expectations of the vagina come from? How did cafe conversation about ‘getting your vulva done’ become as common as ‘getting your lips done’? As Dr. Okun mentions above, the porn industry and other portrayals of the human body in the media reflect a rather limited version of ourselves in our naked state. If women’s choices are based in disatisfaction with who they already are, then i, for one, cannot see that as a movement toward autonomy. There needs to be far more discussion on this current issue.

    • Jacquie Snoek says:

      Hear hear!! Thank you for making two excellent points… The conflict of interest when offering both insured and uninsured services … And how we are being influenced bynthe porn industry…doctors should not be offering such “cosmetic” procedures as it only reinforces the barbie ideal….


Nan Okun


Nan Okun is an obstetrician/gynecologist at Mt. Sinai Hospital and an associate professor at the University of Toronto.

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