Cosmetic Surgery Heads South

Why some women are turning to surgery on a false quest for genital perfection

by Melody Thomas

Breast implants, liposuction, rhinoplasty, tummy-tucks, face-lifts, and butt-implants – the message regarding body image today is one that says “Hey! If you don’t like it, get rid of it (assuming you can pay for it).” And it seems no region of the body is safe, the same message is being more and more aggressively targeted at women’s genitals.

The first recorded Labiaplasty procedure, where a woman’s labia minora are trimmed, was recorded in 1984. But it wasn’t until the late 90’s and 2000’s, when numbers began to increase on clinical reports and profit-hungry surgeons with media-savvy PA’s started pushing stories into the glossy media, that the “designer vagina” entered the public domain. More and more, women were asked to add one more anxiety to the ever-growing list. Not only did they need to worry their thighs were fat, breasts saggy, faces wrinkled and tummies pudgy – now they had to be anxious about their pink bits too.

I say pink bits and genitals because the search for the designer vagina isn’t limited to the vagina (which somewhat insultingly means “sheath for a sword” in Latin), nor even the vulva (which has varying definitions, but usually refers to the external or visible parts of a woman’s genitals) – the perineum and pubic mound are also parts that can now be ‘touched up’ by a surgeon or gynaecologist. As well as labiaplasty a woman can treat herself to a vaginal rejuventaion (or “tightening”), “G-spot amplification,” labia majora “augmentations”, pubic liposuction, clitoral hood reduction, hymen “reconstruction” and perineum rejuvenation. When it comes to Female Genital Cosmetic Surgery (FGCS) in the 21st century, a woman’s just spoiled for choice.

Figuring out how many women are seeking these operations, and how they’re feeling about the results, is near impossible. There is little research available on the topic. What is available often comes straight from the offices of surgeons themselves – and reports written by those with a fiscal interest in maintaining their reputation are not easily trusted. What these clinical case-reports do tell us is that labiaplasty is the most popular procedure of the lot, and that patient satisfaction and surgery success is high.

An increase in specialty clinics and data from other sources does support the proposition that labiaplasty is the most popular FGCS procedure. Data from the American Society of Plastic Surgeons indicated a 30% increase in “vaginal rejuvenation” from 2005-2006, but the reality will be more, as surgeries performed by gynaecologists are not focused on in these samples. That overall patient satisfaction is less well supported. Some studies report that only 30% of patients even receive an in-person follow-up at two weeks and only 41% via a written questionnaire. There is no consideration given to how experiences may be different for those who were don’t respond (which evidence suggests is the case) and the Internet abounds with FGCS horror-stories. In addition, surgeons report seeing and attempting to fix botched labiaplasties, with one Californian surgeon even specialising primarily in “labiaplasty revision”.

Dr. Virginia Braun (pictured left) is a lecturer in the Department of Psychology at The University of Auckland who examines the influence of culture and society on the individual. FGCS and the socio-cultural and psychological ramifications of this practice on someone’s experience as a woman is one of her primary areas of interest.

When I ask Dr Braun whether this practice is getting enough coverage in the media, she tells me “it’s a yes and no discussion.” Dr Braun believes that to some degree the huge amount of media coverage given to the issue is disproportionate to the actual amount of surgery undertaken, although it certainly appears to be getting more popular and there’s nothing to suggest this growth will slow down or reverse. But no, Dr Braun also believes there is little public discussion of the underlying issue of genital diversity, and in some cases this aspect is completely missing from the dialogue.

For example, the success of these surgeries lies heavily in maintaining a belief that there is such thing as “abnormal” genitals. “Hypertrophy of the labia minora” is one label that is applied far too liberally by magazines, websites and in self-diagnosis by women themselves. What it refers to is labia minora that extend out beyond the labia majora (sorry to spell it out, but this means inner ‘lips’ that push out past the outer ‘lips’). The thing is, there is no agreed-upon measurement at which ‘hypertrophy of the labia minora’ should become something to worry about. What most doctors would say is that if something is causing you great discomfort then surgery may be an option, but what surgeon websites and most glossy magazine articles are saying is that anyone with slightly protruding labia minora has something potentially wrong with them and would be wise to consider ‘corrective’ surgery.

What’s missing from the dialogue is any discussion on the extreme diversity of female genitals. A study that measured the genitals of 50 sequential genealogical patients in terms of everything from size and colour to shape and texture showed ridiculous amounts of diversity, including labia minora measuring from base to tip anywhere between 7 and 50mm. Dr Braun says ‘Hypertrophy of the labia minora’ has been bought into the discussion with no justification for its use and no real consistency of definition except that labia minora are being judged “too big”. What women are calling hypertrophy is in fact completely normal variation. This effect is exacerbated further by the copious amounts of “before and after” surgery shots available online. Here, pages of “good” (see identical) vulva are juxtaposed with “bad” (see different) vulva, which almost every woman is likely to see herself in.

What else is missing from the dialogue, and one of Dr Braun’s major concerns, is that this is a psychological issue and not a dysfunction of the body – and an immediate surgical solution is being offered without initial exploration into other ways to help you feel differently about your vulva. How women feel about their genitals is an issue no different than that of basic body image. For comparison’s sake, being offered FGCS for genitalia-related anxiety is like walking into a doctor’s office feeling anxious about your (normal) weight and being offered liposuction. And the way it’s framed by these surgeons is that poor women suffering the distress of ‘large’ labia is perfectly natural. While it is understandable giving the context, the suffering itself is not natural. Perhaps the worst part is that research hasn’t been conducted to show whether these operations can at all alleviate the anxieties that drive these women to such desperate measures – despite drastic claims by surgeons of the live-changing nature of the operations.

When I asked Dr Braun about the role of porn in women’s feelings towards their own genitals she was hesitant to point the finger, stating that “porn is an easy culprit – but it does have a role.” Like with the lengthening of legs, smoothing of wrinkles and boosting of breasts done with Photoshop these days, airbrushing is used heavily in porn. One magazine editor went as far as to say that if they don’t like a model’s genitals they just cut them out and replace them with another woman’s! Certainly women are exposed to these images more and more often, and the genitals of porn stars in magazines are often of the neatly tucked, ‘barbie-look’ that is reflected in those post-surgery shots online and not at all in the natural genital variation of real-life. Because porn depicts what is “sexually desirable” it is natural for women to feel disheartened when their own genitalia don’t match up. For those who would agree against porn’s role, consider the almost comic evidence that, like taking a cutout of a celebrity into the hairdresser, most women bring Playboy into the surgeon’s office when seeking FGCS.

Like research into its prevalence, research into other contributing factors for the growing trend towards FGCS is scarce. One theory is that moves towards a now almost mandatory hairless (or at least partly-hairless) vulva have turned the genital region into an area where women should be doing something. Sexual Health workers are reporting numbers of women with natural pubic hair to be as low as 1 in 20, and like a nicely trimmed bikini line – a nicely packaged vulva has become a woman’s responsibility – another area where she mustn’t ‘let herself go’. Some theories put oral sex as a contributor – asserting that the increase in popularity of this quite visual sexual act makes appearance more of a concern. And then of course, there’s the long and documented history of cultural shame and a narrative of unpleasantness around female genitalia.

It goes way back to Freud’s notion that women were inferior beings envious of the penis, and back even further than that, but that shame still exists today. Everyone who’s lived beyond adolescence can spout of a handful of derogatory names for vulva, and you’ve probably heard as many jokes mentioning flaps or fish or some other reference to their general undesirability. That kind of context is fertile ground for the uptake of surgery to relive anxiety.

When all sides of the debate have been weighed (which we can’t even really begin to do here)- there’s always going to be someone who jumps up and argues that these operations are, after all, a woman’s personal choice. But given the context in which women are growing up, it is most often not, as Dr Braun puts it, “a choice among equal options”. When women are growing up with feelings of shame and even disgust attached to their genitals, with images and narrative medicalising and pathologising natural diversity, with no media discussion around the psychology behind the issues and not a lot of alternative options on how to deal with them being offered up – they are already being propelled more towards one option than the other. Dr Braun uses a body-hair study as an example, where students were asked to let all body hair grow for 12 weeks while keeping diaries. The data was jaw-dropping in terms of the abundance of comments made by family, friends, siblings and partners. What the students agreed upon overwhelmingly was that this decision they’d made all on their own (to shave and wax their body hair) was not in fact a choice among equal options. It was a choice between “one very powerful and normative choice and one very different and un-normative choice.”

It’s hard to know which way the pendulum will swing on the issue of FGCS. Their popularity has been compared to that of “breast implants 30 years ago,” but what that comment fails to take into account is that 30 years ago cosmetic surgery was a relatively foreign concept, and FGCS is coming-of-age at a time when cosmetic surgery is accepted to the point where there are whole reality TV series on just that topic. The uptake of these surgeries is likely to move a lot faster. This will potentially be combated by a few other factors.

Recently, the American College of Obstetricians and Gynaecologists and the Royal Australian and NZ College of Obstetricians and Gynaecologists both issued public statements against FGCS, and many prominent surgeons and gynaecologists are following suit. Feminist groups are campaigning for an increase in narrative around female genital diversity, through groups like the vulva knitting circle (http://www.facebook.com/group.php?gid=38913383315) and the new view campaign (http://www.fsd-alert.org/). More than a couple of (often flower-themed) books have even been published depicting vulva in all their un-retouched, full-colour glory like Heart of the Flower (http://www.heartoftheflower.com/) and Petals (https://nickkarras.com/Home_Page.html). They make for slightly uncomfortable reading, but they certainly hammer home the message of natural genital diversity.

At an individual level the biggest change can probably come from opening up the lines of communication on this traditionally embarrassing subject. You might not all feel comfortable enough to get out the hand-mirror with a group of friends, but so much of the anxiety about women’s genitals is in worrying about what’s normal. Women need to know that variation is what’s normal, and that the concept of identical genitals is really very weird.

ENDS