“It doesn’t look right,” said forty-two-year-old Carla Westman*. “Like I’m uneven, like one side is larger than the other and as I’ve gotten older, I think one side is stretching. Before I could close my legs and you couldn’t see anything but now one side peeks through just a tiny bit more than the other, and that just bothers me.”
To clarify, Westman, a pharmaceutical rep from Phoenix, Arizona is feeling old. More to the point, she’s blaming her vagina, or labia to be exact. And bizarre as it may sound, she is not necessarily alone.
According to the American Society of Plastic Surgeons, approximately a thousand “vaginal rejuvenations” were performed in 2006 — the most current year for which U.S. statistics have been compiled — up 30 percent from 2005. In the United Kingdom, the number of labiaplasties performed doubled between 2000 and 2005, reaching over eight hundred procedures per year. While these accounts may be nothing to write home about yet, the limited data available (no one database records all instances of Female Genital Cosmetic Surgery) do suggest that the procedures, and the demand for such, are growing exponentially.
“The search term labiaplasty is one of the highest searched things that lead to somebody finding me on the Internet,” confirmed Dr. Scott W. Mosser, a board certified plastic surgeon based in San Francisco, who has been performing labiaplasties for the past four years. But despite the high traffic to his website, Dr. Mosser only performs about a dozen labiaplasties per year, leading him to speculate that people are less than comfortable with the procedure.
Said Dr. Mosser, “When we look at all the other procedures [that I do], the amount of individuals who search them is pretty proportionate to the actual amounts of individuals who come in for a consult. That tells me that labiaplasty may be a little bit in the dark; that women are nervous about it; or maybe it’s an area that’s perceived to be a little bit of taboo.”
What is labiaplasty?
For those still unfamiliar with the procedure, labiaplasty involves the surgical reduction and “beautification” of the labia. Women typically request the procedure for a triad of reasons. These include both visual and physical complaints ranging from discomfort during exercise and vaginal intercourse, to discomfort simply from wearing clothing, in particular when the labia minora get caught between the elastic folds of underwear, to complaints like Westman’s, where women are dissatisfied with a lack of symmetry, discoloration, or the appearance of their labia in general.
Dr. Mosser admits that while there is no true dirtiness to having labia hypertrophy, there does seem to be a psychological desire amongst women to have their genitals look organized or clean. “There is a real trend towards sort of a perception of a clean look, whatever that means, that is associated with youth,” said Dr. Mosser. Nonetheless, he is adamant that anything that is distracting enough to interfere with a person’s quality of life or lifestyle is something that should be addressed.
Is Porn Pushing ‘Ideal Genitals’?
Others, however, are not so convinced.
“Society has changed across the last little while to a context in which cosmetic surgery in general and cosmetic procedures in general have become incredibly normalized,” said Dr. Virginia Braun, a psychologist from the University of Auckland specializing in women’s health and sexuality, and the current co-editor of Feminism and Psychology. “But our knowledge of women’s genital anatomy is still not — we’re not a hundred percent there yet.”
Dr. Braun is one of a handful of doctors and professionals who are adamantly, and radically, opposed to labiaplasties as well as other forms of FGCS like vaginoplasties and hoodectomies. Both vaginoplasties, which involve the “rejuvenation” or tightening of the vagina, and hoodectomies, also called clitoral unhooding, are meant to enhance sexual pleasure (and neither, it bears mentioning, are performed by Dr. Mosser).
To hear Dr. Braun explain it, there is a huge lack of knowledge surrounding genital diversity for women. “Women who have nose jobs or breast enlargements have a huge pool of comparison to draw from. They’ve seen probably thousands of noses every day, and even though we maybe don’t [often] see naked breasts, we certainly know what breasts look like.”
So where are women like Westman, who yearn for their vulvas of yesteryear, drawing their comparisons from? As Dr. Deborah Tolman, a professor of social welfare at Hunter College School of Social Work and author of Dilemmas of Desire: Teenage Girls Talk about Sexuality puts it, “What happened in the last three years to make women’s labias so big that they can’t walk around with them?”
If the accounts from surgeons and the media are to be believed, pornography is a major influence in what women believe is desirable. While women might not be trading notes on their vaginal proportions, they have become increasingly comfortable with mainstream pornography and that leads to one dimensional representations of what vulvas look like. Add to that the phenomenon that is the Brazilian Bikini wax, where all but the smallest trace of pubic hair is removed, and women are getting the HD version of their vulvas outside of a biology class for the first time.
Controlling Women’s Bodies
The phenomenon, argued Dr. Tolman, is just another means of asserting externalized control over women’s sexuality; testament to the profound dearth of education that both women and men have about women’s bodies.
“It is in only such a vacuum that such notions of what are good and right and normal can be insinuated,” she said. “If we have other regularized ways, and by that I mean ongoing knowledge and discussion about what women’s bodies are really like, then it would be much harder for this kind of thing to sneak in and start to look normal.”
Both Dr. Braun and Dr. Tolman speak from a social constructionist perspective, where desire is understood as a learned behavior, and is not something innate or biologically wired. In other words, people learn to desire such procedures. FGCS, said Dr. Tolman, are commodities to be consumed. We learn to become consumers of surgery:
“We don’t want it. I mean we think we want it. It feels like we want it … but I think that the observation that this has only been going on for the last couple of years is testament to how this has not been a ‘forever’ quality of women’s lives.”
Then what with all the women who truly feel as though FGCS will better their quality of life? Are we simply to ignore them? Tell them that they don’t really know, or understand for that matter, what they really want?
“Individual choice is not the only criterion,” argued Dr. Leonore Tiefer, an associate clinical professor of psychiatry at New York University School of Medicine and Albert Einstein College of Medicine. According to Dr. Tiefer, it is the publicity surrounding cosmetic services that generate discontent. For example, medical makeover shows like Dr. 90210 create a context for which women learn to become dissatisfied with their bodies and genitals, and start wondering how they to might benefit from the procedures, which according to the shows’ doctors, promise better sex for both women and their partners.
Said Dr. Tiefer, “I do not condone doctors having free reign to advertise labiaplasty without scientific evidence of its benefits and lack of long-term harm. Nor do I condone doctors having before-and-after photos on their websites because of the lack of popularly-available information about the range of normal labia.”
As one of the foremost critics of “disease-mongering” trends in the medical management of women’s sexual problems, Dr. Tiefer maintains that while the rhetoric of choice and sexual pleasure around FGCS may legitimate and promote the procedures, all FGCS really produce is a generic model of women’s genitalia. Even worse, it pathologizes female genital diversity. So enraged is Dr. Tiefer, that in 2000 she founded The New View Campaign, an organization devoted to stopping all form of FGCS. The group compares FGCS to Female Genital Mutilation (FGM).
Understandably, most people find that comparison shocking. By and large, individuals from outside the specific cultures that perform FGM regard the practice as foreign and incomprehensible. But, points out Dr. Braun, “In both cases, what’s being done is that women’s genitalia are being altered to conform to a certain set of notions and expectations about what genitalia should look like, what they need to look like if they are to be appropriately feminine and appropriately desirable.”
Even the narratives of women who have undergone FGM and FGCS are similar, with women saying things like, “this is important to me to have genitals that look normal, that look appropriate, that are right,” said Dr. Braun. And although there are big differences as well, some of the same sorts of ideas about norms of what bodies should be like, and that woman’s genitals are an appropriate place to intervene, run across both.
Women’s Choice: A Question of Quality of Life
Nonetheless, Dr. Mosser doubts that the woman with labia hypertrophy who is uncomfortable engaging in intercourse, and is uncomfortable walking down the street, and is uncomfortable looking at her naked body in the mirror, would agree with the comparison. That person, said Dr. Mosser, “would consider it not to be an external pressure but a correction of something which will improve her quality of life.”
Either way, women like Westman would do best to get to know their genitals as they are and should be. If nothing else, it’s a whole lot cheaper.
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