Region

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Plastic Surgery, Universidad del Valle Plastic Surgery, Cali, Valle del Cauca, Colombia

Keywords

Venus mountPubic regionGenital fat cushionGenital areaGenital aesthetics

Bulky or not bulky; what is best?

The pubic region has been a very important area of our sexuality. Early in the renascence period where nudity was introduced into the world of art, the pubic region—also known as Venus Mons or mons pubis —was the lowest artists would represent of a woman’s genitalia, showing it as a symbol of female sexuality.

Today, we take for granted the many options for genital and vaginal rejuvenation procedures available, we are most focused on what labia looks like or how to tighten vaginas, but the truth is that pubic region is an important aspect, not only for genitalia aesthetics but also for healthy sexual intercourse.

Though unnatural, not having any hair on the genital region is very common nowadays. Methods such us waxing or laser the area are the most commonly used. When waxing and during laser treatments, the area is exposed to heat, which repeatedly can cause loss of fatty pubic tissue, which is a feature of this particular area. During sexual intercourse, the pubic region endures pressure; therefore, it needs to have a fatty-like buffer to protect women from direct bone friction or potential pain. After regular waxing, of the area, the skin can also be stretched, becoming loose in time, and with gravity force ptosis will appear, making it less appealing and again and maybe painful during sexual intercourse.

Another reason for pubic region to become loose is when patients lose a lot of weight—this is especially true for massive weight loss patients.

Anatomy

The pubic region is located anteriorly to pubic bone , and is also called mons pubis. Characteristically, the area has an important amount of fatty tissue, which not only gives a turgid and appealing contour but also serves as bone protection to friction during sexual intercourse.

On its posterior aspect, the skin prolongs into forming labia majora, one on each side of the vaginal opening; these are cutaneous folds also featured by fatty tissue abundance.

After a C section, the superior aspect of pubic area ends up with a scar that oftentimes imbricates into an annoying fold.

Women may also feel unhappy with their pubic region after having a tummy tuck, since sometimes, the upward stretch is excessive, pulling mons pubis, labia majora and minora, and even the clitoris itself up, leaving behind not only an unnatural looking area but making it uncomfortable to wear tight pants or having sexual intercourse.

These findings, frequently referred to by patients, are important to always keep in mind when planning a mons pubis pexy.

Assessment

It is important to understand what bothers your patients down there, so the first step must always be to listen to your patient.

Oftentimes when a patient is unhappy with her pubic region, she may feel the same about her labia majora, so make sure to listen well in order to put together the best treatment plan for your patient; in many cases you will need to correct both: mons pubis and labia majora excess or atrophy.

What Will the Patient Tell Me?

Too much fat:

“I do not feel comfortable when wearing tight pants because my mons pubis shows too much.”
“I am embarrassed to wear a bathing suit, because I feel like everybody will be looking at my big pubic region.”
“This problem is limiting my life, I can only wear loose clothes and do not like them!”

Too much loose skin:

“I don’t like that my pubic region looks saggy when I’m standing.”
“I don’t like what it looks like down there, it looks old, how can I make it look younger?”
“I think my pubic region started to get loose and flabby, after years of waxing.”
“After I lost so much weight my pubic area is loose and empty.”
“I don’t like what I see when I am standing, can we do something about it?”
Strange appearance:
“I don’t like how this scar (C section) disturbs my contour.”
“After the C section I ended up with this hideous fold on my belly.”
“I do not know how, but something happened after the tummy tuck, and it looks funny down there.”
“I think the doctor may have stretched up too much during tummy tuck, so my genital region is pulled up and I do not like it.”

Feeling uncomfortable and/or painful:

“After the tummy tuck my clitoris ended up being too high and it can be uncomfortable at times.”
“I feel this intense pressure during sexual intercourse, I even feel pain on my pubic bone, so I’m not enjoying it anymore!”
“‘My area’ feels deflated, what can be done?”

What to Look for in My Patient?

First of all, we need to recognize what’s bothering our patient; is it excess skin or excess fatty tissue, a strange appearance, or too little fatty tissue?”

The treatment plan will vary importantly, not only according to your findings as specialist but to patient’s feels and wants. Some women are just afraid to end up with a bulky area after treatment; some may ask you to “debulk” the area, when for a fact there isn’t that much excess; some will ask for a pexy; and some will be afraid of it; therefore, when dealing with the pubic area, it is very important to put a treatment plan together according to what she wants or not.

We’ll have four main groups of patients and of course their many combinations as well: