Women’s genitals are under the knife, and we need to talk about it

At the age of 16, Courtney, a young woman from the UK, opted to undergo a labiaplasty — a surgical procedure that left her with substantial pain and lifelong scarring. Throughout her early teenage years, she found that due to the size of her labia, she experienced discomfort when sitting, and was bothered by her labia rubbing against her clothes. While she did make the choice to have a labiaplasty in order to ease this pain and irritation, in retrospect, she acknowledges that her decision was undeniably influenced by the beauty standards of a pornified society. The pornography she consumed as a young teenager contributed to intense feelings that her vulva was abnormal. When I spoke to her via Twitter direct message, she told me:

“I’ll never be able to know if I’d have made that same choice in a world free from the influence that porn and body insecurities have had on my brain, and it’s depressing to know how many others have succumbed to that.”

Unfortunately, Courtney’s experience is all too common. Today, labiaplasty is one of the fastest growing cosmetic surgery procedures around the world. Labiaplasty is a procedure undertaken to alter the appearance of female genitalia — most often, this surgery involves a reduction of the labia minora, but also frequently includes a clitoral hood reduction and vaginal “tightening.”

Even to the most objective reader, the statistics on the growth and prevalence of this procedure are alarming.

In the US, a total of 13,266 labiaplasties were performed in 2016, with 23,155 procedures undertaken in Brazil the same year. According to the American Society for Aesthetic Plastic Surgery, labiaplasties have increased in popularity by 217.3 per cent over the past five years. In the UK, doctors have reported seeing girls as young as nine expressing discomfort or dissatisfaction with the appearance of their vulvas. The prevalence of the phenomenon of genital-hating among young women has been acknowledged as a cause for concern by many in the medical profession. In a report produced for the BBC’s Victoria Derbyshire show, gynaecologist Dr. Naomi Crouch said there is “absolutely no scientific evidence to support the practice of labiaplasty” and that “the risk of harm is significant,” particularly for teenage girls who are still developing.

What quickly becomes obvious as you scroll through the websites of doctors offering this procedure is how effectively the risks are masked by claims of “rejuvenation” and “vaginal beautification.” Left unmentioned is the fact there are no training standards for labiaplasty, and neither gynaecologists nor plastic surgeons are trained to do these procedures in residency. Furthermore, detailed surgical anatomy of the vulva and vulvar physiology are missing from plastic surgery literature.

Without any training standards in place, young women opting for these procedures face potentially life-altering risks. Courtney’s surgery resulted in labia minora that were reduced to such an extent that her stitches split open numerous times, leaving her in agonizing pain. Today, even years after her surgery, she has noticeable scarring on her genitals, and occasionally experiences “phantom pain” as a result of the trauma she has endured. Jessica, another young woman I spoke to for this piece, told me her labia minora was removed completely in a botched labiaplasty during which she also suffered a denervated clitoris, eliminating clitoral sensation for life.

Considering the significant risks involved, why are an increasing number of women opting to undergo this procedure?

Labiaplasty is often advertised as a way to improve a woman’s self-confidence and reignite her sex life. Dr. Lina Triana, a plastic surgeon and International Society of Aesthetic Plastic Surgery (ISAPS) board member, presents labiaplasty as a procedure that “empowers women, and helps them achieve a better quality of life through increased comfort and sexual confidence.” It is unclear how carving up women’s perfectly fine and healthy genitals with a scalpel contributes to female empowerment, and research does not back up Triana’s claims. Rather, studies show that claims of achieving a better quality of life are misleading — on the whole, women’s psychological and sexual well-being does not improve after labiaplasty. As we can see in the cases of Courtney, Jessica, and countless others, often the opposite is true.

The female genitals favoured by the mainstream porn market are characterized by small pink labia, often with no visible labia minora. When large labia are shown, they are represented as a fetish — something freakish and dehumanizing. PornHub showcases videos of women with large labia titled, “Latina with Long Hanging Lips on Webcam” and “Hot Coed Masturbates her Huge Flapping Pussy Lips to Orgasm.” In porn, women either fit the mold, or they are dehumanized and fetishized for the ways in which they deviate from that mold.

The growth of the internet has not only led to increased access to pornography, but to medical information, including anatomy textbooks, journal articles, and patient education resources. It has facilitated increased exposure to advertisements for cosmetic surgeries. The trend towards a certain genital appearance has been led by many in the medical community who stand to profit from female insecurity, as well as by those in the porn industry. Clinics perform labiaplasties that aim to give young women the “Barbie” look — genitals that are as tucked away as possible, with labia scarcely visible, and often reducing the clitoral hood and tightening the vaginal passage. Doll-like, minimally-noticeable labia have become the norm to which many women wish to conform.

The female beauty ideal has consistently demanded beauty practices, but there is an important change to note in the nature of these practices. Surgery on the genitals is indicative of a culture that prioritizes the attainment, not just that women look beautiful in public, but in private as well — that their naked body fit the conventional mold. Sexual liberalism and “sex positive” rhetoric evolved with porn culture, as the parts of women’s bodies that were previously covered most of the time became subject to scrutiny. Women were encouraged to expand the scope of their insecurities to include many new ones, convinced their naked bodies looked inadequate when compared to the naked bodies that were suddenly everywhere — from widely distributed pornography watched by their partners to lingerie billboards in their local shopping centre.

Women’s genitals — their most intimate body part — must now conform to the beauty ideal as dictated by our pornified culture. The choice is between being sexually objectified in the way all conventionally desirable women are or being exploited as a fetish, with your insecurities front and centre — only acceptable so long as they can be used to degrade and dehumanize a woman for porn consumers.

Labiaplasties are generally not done for medical reasons, but for superficial reasons. In her 1991 book, Backlash, Susan Faludi argues that for many of these cosmetic surgeons, boosting women’s self-esteem is not the primary motive, writing, “Despite the ads, the doctors were less interested in improving their patients’ sense of control than they were in improving their own control over their patients.”

If we look at labiaplasties specifically, what sort of control is being asserted over women?

In her bestselling book, The Beauty Myth, Naomi Wolf argues that “a cultural fixation on female thinness is not an obsession about female beauty but an obsession about female obedience.” In order to ensure conformity to the ideal, female appetite is demonized. The uncontrolled woman loves food, desires sex, and speaks up about her oppression. She is a threat to the patriarchal status quo. The use of genital beauty ideals and genital surgery to control women can be seen in the same way.

In our woman-hating culture, women are sexually objectified, and this is magnified in the case of porn. However, women are also seen as sexual subjects in a very specific way, in the sense that an unquenchable sexual desire is seen as appealing in women who fit the beauty ideal. Women are encouraged to want sex, but only if they’re conventionally attractive, and only if they want the kind of sex that men want from them. A lack of immediately visible genitalia indicates a female body that conforms to the ideal.

Furthermore, most of the time genitals are seen in the context of sex. A female body with genitalia that do not meet patriarchal, porn-culture — labia that are dark or long or larger than most — represent a refusal to conform. A naked woman with genitals that are not tucked away but clearly visible stands as a symbol of female sexuality that doesn’t exist to please  the male gaze. An attack on women’s genitals is an attack on women’s refusal to conform to male-dictated standards of female sexuality.

“I was in my first ever fully sexually active relationship at the time of my surgery and I can’t help but feel that a lot of my decision making revolved around what I thought my partner desired due to his porn use,” Courtney told me. “I can’t deny that being a young woman in the porn age has damaged me in more ways than just the surgery.”

Whether the primary culprit behind this phenomenon is pornography, cosmetic surgeons, pop culture, or a combination of all three, it is clear that young women and girls are being put at risk in order to meet a narrow idea of what sexiness looks like. Thankfully, there are individuals challenging this genital-shaming.

In 2008, artist Jamie McCartney created “The Great Wall of Vagina” — a nine-metre-long polyptych consisting of 400 plaster casts of vulvas, all unique, arranged into 10 large panels. The plaster casts include the vulvas of women aged 18 to 76. On his website, McCartney says, “For many women their genital appearance is a source of anxiety and I was in a unique position to do something about that.”

In 2018, UK photographer Laura Dodsworth photographed the vulvas of 100 women aged 19 to 101 and talked to them about their relationships with their genitals. The results were published in a book released in February 2019, entitled Womanhood: The Bare Reality. Inspired largely by the trend of young women getting labiaplasties, Dodsworth’s aim was to encourage women to reclaim their bodies from a culture that relies on female self-hatred and self-consciousness.

If we are going to address this crisis for what it is — an assault on female sexuality — then we need a counter-narrative to the one young women are constantly hearing. The potential impact of this trend is harmful and dangerous, as Courtney and Jessica know too well. We need to facilitate an understanding of female sexuality as existing free from male expectations. We need to engage young women in a radical feminist discourse that unpacks their genital hatred and brings the reality of its roots into sharp focus.

Women’s genitals do not need to fit any particular image to be deemed acceptable. Women’s sexual pleasure is not something trivial to be sacrificed on the altar of the pornified ideal. Female sexuality matters, and a certain genital appearance is not a mandatory component of that sexuality.

Keep your labia. Shake off male-dictated sexuality instead.

Jessica Masterson is a writer, single mother, and PhD student at the University of Birmingham. Her research focuses on sexual ethics and sadomasochism. Follow her on Twitter @moongirlmusing.

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