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Translated by Audrey Morabito
The overwhelming majority of studies on female genital cosmetic surgery focus on cis women. Thus, the term "woman" will be favoured within this article. However, the author would like to point out that some people with a vagina and/or a vulva may not identify with this gender.
During a college sociology class, I vaguely remember a spontaneous debate that erupted on the subject of female genital cutting/mutilation. By that, I mean the “different procedures that involve the cutting of female genitalia and permanently mutilating the sexual organs of young females for non-medical reasons.” (Ontario Human Rights Commission, 2000). This includes the partial or total excision of the clitoral hood, the clitoris, the labia as well as infibulation or any other practice such as incision, stretching, spilling of corrosive materials, piercing the clitoris or neighbouring tissues such as the vestibule or the vagina itself (ONU, 1997).
Believe it or not, some students in the class were in favour of this practice, arguing that it is about respecting the culture, customs and traditions of others. Others have argued that female genital mutilation is an extremely important rite of passage for some peoples: “It’s like high school grad ball for us”.
I’m sorry, but if prom consisted of removing a part of my body (a rather pleasant part as well) and that this operation had the potential danger of having disastrous physical (World Health Organization, 1997) and psychological consequences (OHRC, 2000), I would have, undoubtedly, skipped my turn.
I consoled myself by rationalizing that it wasn’t the majority that was in favour of this practice during this class debate. I told myself that it was the view of maybe three or four “attention-seekers” that wanted to show that they stood out with their heterodox opinions. Then, following recent news, I realized I was putting my head-in-the-sand.
You have probably seen the ads for women’s genital rejuvenation in Sherbrooke and the debates that ensued. This is a phenomenon that I was vaguely aware of. I was naive to believe that only a very small minority of women had this procedure done. I believed that the majority of them must be porn actors who wanted to conform to a certain ideal: beautiful, well-defined pink labia, hairless and flawless. No, it is an increasingly common and popular intervention (Cihantimur & Herold, 2013; Creighton, 2014), especially amongst young women between the ages of 20 and 30 years old (Ashong & Batta, 2013).
When I saw these billboards, I asked myself how were these genital cosmetic procedures different from female genital mutilation in other parts of the world. This is a line of questioning that was also brought forth by Dr. Laberge in an interview with Paul Arcand. The more I think about it, the more I have the impression that these are two very similar phenomena.
The Perfect Labia
Why have we concluded that there is such a thing as the perfect labia? Probably for the same reason we impose ideals and beauty standards for every other part of our bodies (Ashong & Batta, 2013).
However, if no two noses are the same, then why would there be two identical vulvas?
The porn industry is indeed getting its consumers accustomed to seeing, if I may say so, a fairly limited vulvae standard. These vulvas are very similar, often pink and hairless, with labia majora completely covering the labia minora (Creighton, 2014; Iglesia, 2014). The reality is, however, that there is a large vulvovaginal variety (for those who are more visual, you can view the work of artist Jamie McCartney, The Great Wall of Vagina).
On the other hand, the clinics that promote these types of surgical interventions to rejuvenate the vulva and the vagina’s appearance, also implicitly promote this vulvovaginal standard (McPencow & Guess, 2012). These clinics affirm, in their ads, that surgery is the direct answer to the sexual and psychosocial problems of their clients (Liao et al., 2012) even though this is far from being supported by scientific literature (McPencow & Guess, 2012). With all this pressure to reach this standard of the perfect vulva, the one promoted by pornography but also by society (Iglesia, 2014), it is not a surprise that more and more young women have this irrepressible urge to undertake “panty renovations”.
Five Original Ways to Renovate Your Vulva
Many interventions exist to, supposedly, refresh your vulva and vagina. Some, mistakenly, regroup them under the term genital rejuvenation. In 2007, the members of the American College of Obstetricians and Gynecologists (ACOG) objected to this term, because it goes against nomenclature standards regarding medical procedures (American College of Obstetricians and Gynecologists, 2007; Rosenbaum, 2007). The term advocated by the ACOG is female genital cosmetic surgery (FGCS) (Goodman, 2009; Mirzabeigi et al., 2011). This term encompasses all the different techniques used to modify the physical appearance (shape, length, size) of the vagina or the external genitalia for aesthetic purposes only (McPencow & Guess, 2012; Sheldon & Wilkinson, 1998).
This term is divided into five distinct categories (Goodman et al., 2010):
1) Labiaplasty consists of reducing the size of the labia or correcting “irregularities” (e.g. labia asymmetry) (Ashong & Batta, 2013; Goodman, 2009; McPencow & Guess, 2012).
2) Vaginoplasty (perineoplasty) consists of making the vaginal vestibule narrower (Gress, 2007).
3) Clitoral unhooding consists of the partial or complete removal of the clitoral hood (Goodman et al., 2010).
4) Hymenoplasty consists of reconstructing the hymen, often to increase the likelihood of tears and bleeding during coitus (Goodman et al., 2009).
5) The amplification of the G-spot with collagen (Ashong & Batta, 2013; McPencow & Guess, 2012).
Other procedures are sometimes included in this list such as liposuction or fat injections in the mons pubis or the labia majora (Ashong & Batta, 2013) or lightening of the labia by laser (Cihantimur & Herold, 2013).
It is important to note that all the surgeries mentioned in this article are purely cosmetic or for aesthetic reasons (McPencow & Guess, 2012) and not for functionality. For example, functional surgeries may be used when irregularities make it difficult for the organ to function as expected (Parmer, 2009).
So-called aesthetic surgeries, but corresponding to a treatment that can be used, for example, during vaginal agenesis, are not included in this FGCS list. The interventions used for reconstruction following cancer, trauma or pelvic organ prolapse, for example, are also not considered as FGCS (ACOG, 2007; McPencow & Guess, 2012).
I would like to point out that I also exclude functional FGCS (Goodman, 2009; Parmer, 2009), such as labiaplasty to resolve a marked and disabling discomfort.
Next Step: Two Labias for the Price of One!
Over the past two decades, the use of FGCS’ has been increasing worldwide (McPencow & Guess, 2012). In the United States, in one year alone, the procedures that qualify as “vaginal rejuvenation” have increased by 30% (Braun, 2000). The ad campaign of Dr. Élise Bernier in Sherbrooke is not an isolated case; from the United States to Nigeria, the trend is increasing (Ashong & Batta, 2013). You can easily find several very appealing deals to get your lips redone on the websites of these cosmetic clinics.
However, there is a lack of reliable information (Tiefer, 2010) and credible scientific studies that could help shed light on this phenomenon that is gaining in popularity (Goodman, 2009; McPencow & Guess, 2012).
What are the actual risks and advantages?
What is the exact prevalence of this type of surgery?
What is the satisfaction rate of the patients in the long run?
What are the social and medical consequences of this phenomenon?
There are many other unanswered questions.
The ad campaigns about these types of interventions are often false or unfounded (Liao, 2012; McPencow & Guess, 2012). They promise all sorts of benefits (such as better self-esteem) that are not proven (Ashong & Batta, 2013; Creighton, 2014; Liao et al., 2012; McPencow & Guess, 2012). Hello misrepresentation… This is without speaking to the fact that the benefits are largely put forth but that the risks with this type of surgery are rarely addressed. The ones that are mentioned are often the most minimal risks. However, female genital cosmetic surgeries have a way higher risk potential than what the cosmetic surgery clinics let on (McPencow & Guess, 2012)... Which results in an ill-informed population that perceives genital rejuvenation (FGCS) erroneously (McPencow & Guess, 2012).
Birds of a Feather Flock Together
Cosmetic surgery clinics specialized in FGCS promise that these interventions are performed gently and without significant pain. Then why on earth compare them to the practice of genital mutilation? Because even though this isn’t on the same spectrum, there is a parallel to make. In my opinion, stripping the bean (clitoral unhooding) or shrinking the stoop (infibulation) resembles mutilation because in all cases we do it to conform to societal and cultural norms as well as the current sociological standards (UN, 1997). And in any case, there can be serious consequences. Severe pain, dyspareunia, vulvodynia, hemorrhaging, poorly healed scars, keloids, infections and tears are all common complications linked to female genital mutilation and FGCS surgeries (Ashong & Batta, 2013; UN, 1997). Even though these often-disastrous consequences are a lot less frequent during cosmetic surgery, this reality exists (Braun, 2010; Creighton, 2014). An article published in 2004 on Scandinavian laws on penal sanctions for female genital mutilation, states that there is not enough proof to conclude that FCGS surgeries are different from female genital mutilation. In light of this information, the article concludes that both these types of interventions must be considered in the same way (therefore both liable to criminal charges) (Essen & Johnsdotter, 2004).
Come Who May
One of the reasons that female genital mutilation is practiced in some countries is to suppress female sexual pleasure (OHRC, 2009; UN, 1997) by removing the external part of the clitoris or closing the vestibule (OHRC, 2000; Essen & Johnsdotter, 2004). No need to state all the appalling consequences that this may have.
For FGCS cosmetic surgeries, they proclaim the opposite. Thanks to the intervention, the patient’s sexual pleasure will increase (Cihantimur & Herold, 2012; Goodman et al., 2010) in particular because of a greater sense of self-esteem (Goodman, 2009). Because, obviously, the length and symmetry of our labia are directly proportional to the way we feel about ourselves… In the same vein, sexual pleasure would also be enhanced if we removed layers of skin that cover our “golden button”. The goal of this intervention is to expose the tissues with extremely sensitive nerve endings to render them more accessible (Cihantimur & Herold, 2013).
At first glance, we can observe a significant difference between genital mutilations and FGCS. Except that sometimes after surgery, the sensations don’t feel as they had before (hyposensitivity) or that they are exacerbated to the point that they are painful (hypersensitivity) (Ashong & Batta, 2013; Goodman et al., 2010).
The initial approach may be very different but unfortunately, the results may be the same.
What to Think of it?
In my humble opinion, the scientific community must take responsibility and denounce the misinformation concerning FGCS surgeries. They should invest time and resources into research whose goal is to draw a portrait of the actual situation (Essen & Johnsdotter, 2004) and to put in place guidelines for this relatively new practice (Goodman, 2009).
Furthermore, allowing this type of campaign, as we were able to see in Sherbrooke (which invokes low self-esteem as a symptom), we create a feeling that there is a problem that we have to remedy, a problem we didn’t even know existed. We have a collective duty to uphold: to denounce the irony of the situation. On the one hand, we try to fight against female genital mutilation and on the other hand, we offer cosmetic procedures to alter the natural appearance of female genitalia (Ashong & Batta, 2013). Although I do not directly condemn cosmetic genital surgeries because they can be functional and greatly improve the quality of life of women who experience pain, discomfort or even vulvovaginal disabilities (Cihantimur & Herold, 2013; Iglesia, 2014), I believe we should question the way we market them. As the great comedian, Mélanie Couture would say; “Viva la vulva”.
The body diversity that we constantly advocate for also applies to what’s in our panties!
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Ashong, C.A., & Batta, H.E. (2013). Sensationalising the Female Pudenda: An Examination of Public Communication of Aesthetic Genital Surgery. Global Journal of Health Science, 5(2), 153-165. https://doi.org/10.5539/gjhs.v5n2p153
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