A Melbourne gynaecologist has been accused of disfiguring a patient who claims she suffers from impaired sexual function, regular infections and psychological trauma following genital surgery.
Dr Serag Youssif has denied the allegations, detailed in documents submitted to the County Court, which allege he removed too much of the woman’s labia minora and “excised tissue attached to the plaintiff’s clitoral hood” during labiaplasty (the surgical reduction of the inner lips of the vulva).
Dr Serag Youssif denies allegations he left a patient disfigured.
The woman, who cannot be named for legal reasons, first met Youssif during a consultation in October 2019 at a Craigieburn clinic, in Melbourne’s outer north.
She says she told Youssif she was unhappy with the appearance of her labia, which also caused significant discomfort.
Youssif said she required the partial excision of her labia minora, which was performed in November 2019, according to the woman’s statement of claim filed in civil court documents in January last year.
Lawyers acting for the 24-year-old accuse Youssif of negligence and breach of contract.
Youssif denies many of the allegations made by his former patient, including that she expressed concern about the appearance of her labia minora.
After the woman complained to the healthcare regulator early last year, the Medical Board of Australia instructed Youssif to undertake further education, including “intensive one-on-one training with a plastic surgeon, gynaecologist, mental health social worker and clinical psychologist regarding best practice”.
He agreed to change his practice to require documentation of pre-operative labia measurements, including photographs, subject to patient consent.
According to his statement of defence, Youssif said he advised the woman there were options to treat the discomfort, including “conservative management and labia reduction surgery”.
“He acted in a manner that was widely accepted in Australia by a significant number of respected practitioners in the field as competent professional practice in the circumstances and was therefore not negligent,” court documents filed on behalf of Youssif said.
The woman’s solicitor, Kathryn Footner from Footner Wren Legal, declined to comment.
Youssif and his lawyer, Edward Smith from Wotton Kearney, also declined to comment.
The case is due to go to trial in March after a failed attempt at mediation in December.
It highlights concerns about a trend in young women seeking genital procedures for aesthetic reasons.
Experts have warned that some clinicians of “dubious qualifications” were redefining normal anatomy to target vulnerable young women, while others say the procedures are now as routine as breast augmentations or nose jobs.
Late last year, The Age revealed an unrelated case in which Melbourne doctor Asarjahu Granot was ordered to pay more than $400,000 to a former patient who was left disfigured and psychologically traumatised by bungled genital surgery.
The procedure performed by Granot, which included vaginoplasty and labiaplasty, caused an abnormal narrowing of her vaginal passage.
It came after Granot settled a lawsuit launched by another former patient, who was 13 years old when she was left disfigured after her labia and clitoral hood were removed at a Malvern East clinic in 2008.
Speaking generally, Professor Gemma Sharp, who leads the Body Image and Eating Disorders Research Program at the University of Queensland, said there had been a surge in court cases related to complications from labiaplasty across Australia.
“Sometimes what will happen is they [a practitioner] do the labia minor reduction and the clitoral hood is left looking quite bulky so they will reduce that as well for aesthetic reasons,” she said.
“But clearly that is full of nerve endings and doing this can result in long-term pain and discomfort and complications.”
Sharp, who spent years researching the psychological predictors of labiaplasty, said the trend was being driven by misinformation about what a normal vulva looked like.
She said increasing numbers of young people felt convinced their genitals were deformed because they did not match the “Barbie doll” ideal.
“Labiaplasty is now considered part of routine practice,” she said. “It’s not an aberration any more, like it was in the past. It’s like a boob job or rhinoplasty, and that just shows how normalised it’s become.”
Experts warn the procedure’s popularity has been fuelled by social media and unrealistic ideas of what female genitalia should look like due to exposure to pornography.
“There are these perceptions ... that male genitalia is meant to be sort of large and grand, and female genitalia is meant to be kind of an absence,” Sharp said.
The number of labiaplasties is not officially recorded in Australia, but research suggests it is one of the fastest growing cosmetic procedures among young people.
Medicare claims for labiaplasty and vulvoplasty more than doubled from 707 in 2002-03 to 1584 in 2013-14.
Most people pay to have a labiaplasty in the private sector, where, unlike in the US, Australia does not require reporting of these statistics.
Medicare will only cover costs if the procedure is to repair genital mutilation or correct an abnormality. In 2016, the Medical Board of Australia advised that girls under 18 have mandatory counselling and a three-month cooling-off period if they sought cosmetic vaginal procedures.
Experts have called for tighter regulations around the procedure and some say Australia should match the UK Royal College of Obstetricians and Gynaecologists’ position that surgery be avoided in patients aged under 18.
Sharp believes patients should be treated case by case and all should undergo mental health consultation.
Plastic surgeon Dr Justine O’Hara said that for women whose labias cause painful pinching, infection, intimacy issues or limit their ability to do physical activities, labiaplasty can vastly improve their lives.
But O’Hara has refused to do the procedure on women when the risk outweighed the benefit, instead referring them to the Victorian Labia Library, a photo gallery of unaltered photos of women’s genitalia, to show them the diversity of what is normal.
“I have definitely refused patients and said, ‘Sorry, but you’re completely normal,’” she said.
O’Hara, who does several labiaplasties a month, has also carried out corrective surgeries for women who had been left with severe complications after having the procedure done by unqualified clinicians.
“I do get very concerned about this,” she said. “They have enormous trouble healing because the person hasn’t left enough tissue.”
She urged anyone considering the procedure to check the credentials of their clinician and encouraged them to seek a qualified and experienced plastic surgeon.
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