The Perfect Vagina

Cosmetic Surgery in the Twenty-First Century

Lindy McDougall

• Publisher: Indiana University Press
• Year: 2021
• Print ISBN: 9780253056122
• eBook ISBN: 9780253056146
• Topic: Sozialwissenschaften
• Subtopic: Menschliche Sexualität in der Psychologie

In the West, a specific ideal for female genitalia has emerged: one of absence, a "clean slit, " attained through the removal of pubic hair and, increasingly, through female genital cosmetic surgery known as FGCS.

In The Perfect Vagina: Cosmetic Surgery in the Twenty-First Century, Lindy McDougall provides an ethnographic account of women who choose FGCS in Australia and the physicians who perform these procedures, both in Australia and globally, while also examining the environment in which surgeons and women come together. Physicians have a vested interest in establishing this surgery as valid medical intervention, despite majority medical opinion explicitly acknowledging that a wide range of genital variation is normal. McDougall offers a nuanced picture of why and how these procedures are performed and draws parallels between FGCS and anthropological discussions of female genital circumcision (cutting). Using the neologism biomagical, she argues that cosmetic surgery functions as both ritual and sacrifice due to its promise of transformation while simultaneously submitting the body to the risks and pain of surgery, thus exposing biomedicine as an increasingly cultural and commercial pursuit.

The Perfect Vagina highlights the complexities involved with FGCS, its role in Western beauty culture, and the creation and control of body image in countries where self-care is valorized and medicine is increasingly harnessed for enhancement as well as health.

ONE

MELTING SNOWFLAKES

Toward a Clean Slit

FEMALE GENITAL AESTHETICS HAS ARISEN as a topic of discussion in the media, as the following excerpt from an article that appeared in Sirens magazine attests.

Even enviably beautiful women are totally freaked out by their vaginas. Maybe that means labia are the great equalizer. Or maybe it means we all need some serious help.

The problem with this variety of anxiety, though, is that it’s tough to assuage. Guys have grappled with genital insecurity since penises were invented, but at least there’s a yardstick by which they can measure their adequacy—literally, a yardstick. Bigger is better, the end. . . . With this dilemma, I don’t know where I stand: What is the ideal here?

It’s tough to find a standard, realistically speaking, not only because we don’t spend a lot of time staring into other women’s vaginas, but also because labia vary about as much as snowflakes. (Armstrong 2008, par. 6–8.)

Sirens magazine (now titled Sexy Feminist) claims to be an alternative online women’s magazine that intellectualizes the topics found in standard women’s magazines in fresh ways. According to the article, both female and male genitalia vary substantially, but some female genitalia are increasingly considered more aesthetically pleasing than others. Traditionally, it has been assumed that men are more concerned than women about the appearance of their genitalia; aesthetically, or at least functionally, bigger is presumed to be better. Conversely, for women, modesty and cleanliness have been the genital ideal. The physicality of women’s genitalia has not been exposed to public scrutiny. However, some women are now more anxious about the appearance of their genitalia, and contrary to Jennifer Armstrong’s (2008) words quoted above, they are now more likely to see other female genitalia because of the mainstreaming of the sex industry and increased exposure to nudity in magazines, in movies, and on the internet. This has occurred at the same time as fashions and a gym and beach culture (where female genitalia are expected to be out of sight while encased in tight fabric) are driving a certain aesthetic ideal.

The increasingly specific and visible female genital ideal is that of the clean slit (Weil Davis 2002) or single crease, a term used in the Australian pornographic magazine industry (Drysdale 2010). Although many women may not aspire to this ideal, it is the aesthetic most frequently encountered in the media. In Being and Nothingness, published in 1943, Sartre commented, “The obscenity of the female sex is that of everything that gapes open” (quoted in Greer 2000, 39). The clean-slit ideal seeks to rectify this image of female genitalia. The ideal is one of absence, a smooth exterior with no flesh protruding and with skin folds completely contained: this can be attained through the removal of pubic hair and, increasingly, through surgery. The clean-slit ideal has been largely created by the media, which generates contradictory messages for women. The popular press, backed by medical opinion, acknowledge that a wide range of variation is normal, but by showing only altered, minimalist vulvas, the implicit message is that women should be worried if their genitalia do not match up to this exacting ideal. The clean-slit aesthetic represents desirable femininity as it is portrayed in the visual media, and genital cosmetic surgery allows the women who choose it to assuage their genital anxiety and increase their self-esteem. The tidy minimalist look is also endorsed as desirable by practicing doctors who profess to understand women’s genital anxieties and why they seek surgery. In an environment where bodies are generally seen as malleable and perfectible, striving to achieve a more perfect body is normalized, even valorized. Whether this acceptance extends to female genital cosmetic surgery is more uncertain.

THE CLEAN SLIT

In I’ll Show You Mine, a photo study of women’s vulvas, compiled by Wrenna Robertson, a Canadian editor, one participant wrote:

A few years ago, I looked up labiaplasty on the web. I’d become very self-conscious about the size of my labia minora after being with female sex partners and seeing their vulvas up close and personal. Like the porn actors I had seen, their labia minora were nicely tucked into a centerfold and hidden between their labia majora, like a letter perfectly folded and slipped into an envelope. My labia minora most certainly were not folded perfectly; they were crumpled and protruding obnoxiously from between my legs. What was the point of an envelope being held, licked, and sealed if it couldn’t contain a letter? (Robertson 2011, 39)

Robertson’s aim in this publication is to relieve women of genital anxiety by showing genital diversity. Accompanying each image is text written by the woman whose vulva is shown, explaining her relationship with her genitalia. A number of similar books exist, but the women participating in my study were more likely to obtain information on vulval morphology from the internet.¹

As the above quotation from Robertson demonstrates, the genital ideal for women is minimalistic; the labia minora should be symmetrical and not protrude past the labia majora (Weil Davis 2002). Using Robertson’s analogy, the letter fits neatly within the envelope. There must be no gaping; the vulva should be flat and closed tight. A slit is a long, straight, narrow opening or cut, an aperture. It is also an obscene term for female genitalia (Princeton University 2013b). When it comes to contemporary genital appearance in the West, however, the term slit takes on a more positive resonance. The ideal echoes that of the model female body, which is represented as tall, straight, and slender, voluptuous only in the “right” places.

Before and after photographs of genitalia found on cosmetic surgery websites confirm this aesthetic ideal. One surgeon in the United States, Dr. Red Alinsod (who has trained several Australian surgeons), has labeled his most minimalist vulval look the “Barbie,” which results in “a ‘clamshell’ aesthetic: a smooth genital area with the outer labia appearing ‘sealed’ together with no labia minora protrusion at all” (O’Regan 2013, 3), reflecting the iconic American doll’s lack of genital detail. According to Alinsod, “I had been doing more conservative labiaplasties but I kept getting patients who wanted almost all of it off. They would come in and say, I want a ‘Barbie.’ So I developed a procedure that would give them this comfortable, athletic, petite look, safely” (O’Regan 2013, 3).

How a vulva can look “comfortable” and “athletic” is perplexing, although the Barbie look certainly appears to be a prepubescent, smooth, and plastic aesthetic. This surgeon’s website describes three vulval looks: the Rim, the most conservative choice, which Alinsod suggests is the look most commonly achieved with labiaplasty worldwide; the Barbie, which is complete excision of any protruding labia minora and the aesthetic most frequently requested by Dr. Alinsod’s patients, particularly those on the West Coast of the United States; and the Hybrid, a recent addition to this aesthetic selection, which is a combination of the Rim and the Barbie, giving “a very fine, petite, natural looking hint of a rim around the vaginal opening” (Alinsod 2013). Just a few years ago, the options were the Rim and the Barbie, and this third choice reflects current trends to continually “improve” labiaplasty techniques to produce a particular aesthetic result. However, although aesthetic choices may vary marginally, the overall aim is for minimization of skin folds, and Alinsod is obviously proud of his ability to offer alternatives to the Rim.

All surgery has risks, and given that the labia minora serve a purpose, excising them may alter sensation and function. The labia minora are rich in nerve endings, blood vessels, and estrogen receptors and therefore add to pleasure and sensation during sexual arousal. They also keep the entrance to the vagina moist, and they direct the urine stream (Battaglia et al. 2013; Dobbeleir, van Landuyt, and Monstrey 2011; Puppo 2013; Schober et al. 2010; Yang et al. 2005). According to Justine Schober et al. (2010), labia minora become engorged during sexual arousal, making them important for sexual response. Labiaplasty, therefore, removes tissue that makes an important contribution to sensory sexual arousal.

Despite the body of medical literature describing the physiology of the labia minora, a gynecologist who specializes in female genital cosmetic surgery and who has been trained by a leading proponent of the practice in the United States responded with conviction when I asked him about the function of the labia minora, “Oh no, there are no pleasure receptors in the labia, none at all.” In contrast, when I questioned plastic surgeons about labia minora, they routinely assured me that they did indeed contain nerve endings that function for both pleasure and pain and that these may be compromised in the search for the “comfortable, athletic, petite look” of the Barbie aesthetic. However, because of their surgical skills, doctors performing female genital cosmetic surgery believe they can minimize risk.

Barbie

Referring to images of vulvas in Playboy magazine, Carlin Ross, who with Betty Dodson runs a sex-positive educational website, observes, “Here’s the formula: not one woman has pubic hair, not one woman has visible labia. Their sex organ is just a slit and they all look alike. Even their outer lips are tight and barely visible. It’s like they took a Barbie doll and drew a line down the middle of her crotch and, voila, it’s a vulva. They don’t look anything like the vulvas I see in the Bodysex groups” (Ross 2012, par. 2).

Ross’s critique of the clean slit is understood through her use of a Barbie-doll analogy. It comes as no surprise that ideal female genitalia are often described in terms of a Barbie-doll aesthetic given that Barbie is modeled on the supposed pinnacle of (hyperreal) Western femininity (Baudrillard 1994). Unlike the original doll, Barbie often now comes with molded underpants, so she has become more modest and, although her vulva is flat and lacks detail, her (lack of) genitalia are now more difficult to critique as a result. Photographs of Barbie dolls are sometimes used as educational tools in women’s and teenagers’ magazines in Australia, such as Cosmopolitan and Dolly, where articles have appeared with body parts labeled as requiring health checks or as sites for cosmetic surgical intervention.

Figure 1.1. “12 Health Checks to Do While You’re Naked,” published in Issue 447 of the Australian edition of Cosmopolitan, Bauer Media Pty Ltd, October 2010, pp. 198–99. Reproduced with permission from Bauer Media Pty Ltd.

The use of Barbie as an educational tool in a section titled “Body Love” (see fig. 1.1) is provocative; any parallel drawn between Barbie’s physique and real bodies carries the assumption that women should compare their bodies with this plastic, extremely unrealistic ideal. While Barbie is bereft of much anatomical detail, including the vulva (labeled in fig. 1.1 as “Vagina”), Barbie-related anxieties tend to cluster around specific markers of idealized femininity—breast size, waist-to-hip ratio, slenderness, and smooth genitalia. As Jacqueline Urla and Jennifer Terry (1995, 13) suggest, “Because Barbie’s body is statistically deviant compared to most women, the doll has functioned to underscore the predicament of femininity: no female body is ever appropriate” without intervention. Indeed, “the female body has increasingly become, like Barbie herself, a form of cultural plastic,” and the vulva has now succumbed to this plasticity (Urla and Terry 1995, 13).

Cleanliness

When associated with the notion of a clean slit, the word clean primarily refers to a visual aesthetic of neatness and tidiness. However, given the historical construction of female genitalia as smelly, dirty, and leaky, the ideal for women also extends to keeping their genitalia as clean and sweet-smelling as possible. Cleanliness, particularly female bodily cleanliness, is valued. Women, predominantly young women, frequently ask in women’s magazines and on the internet about feminine hygiene. “Do I smell and can people tell?” is a major topic (Teens Health 2008). As most women’s health sites attest, the smell of vaginas can vary significantly. However, this is not always reassuring for women, as the following illustrates.

My vagina stinks!?!!??!?!?!?

Yeah. My vagina stinks. I don’t know why. I talked to my doc on the phone and I have an appointment in 4 days. BUT I have a date TOMORROW with this really awesome guy, and I’ve tried shaving, putting lotion or baby powder. NOTHING HELPS. I even tried Vagisil. Doesn’t work either. I can’t postpone the date. I already did that last week. Ugghh I’m so embarrassed! Please make my vagina not stink. (Abbie K 2009)

While a malodorous vagina may indicate an infection requiring treatment, the number of young women asking these questions coincides with a resurgence of feminine hygiene products in pharmacies and supermarkets, supported by advertisements in magazines and on television. Chemist Direct, an Australian online retailer, listed thirty-four feminine hygiene products on a particular day in 2013, including washes, sprays, and a recently introduced product, wipes. The advertisements suggest that women’s genitalia are naturally offensive, despite the vagina being a self-cleaning organ requiring nothing but water for upkeep (Herbenick and Schick 2011). A market exists for feminine hygiene products because of culturally mediated female genital insecurity. One 2013 advertisement for feminine wipes, published in Issue 47 of the Australian Cosmopolitan (2013, 99), declared, “Hooray for a fresh Hoo-ha. With Libra Get Fresh Wipes. They’re not only compact and super discreet, they’re also gentle enough to use all over. Slip some in your handbag so you don’t get caught out.” The implication here is that women should not only be vigilant about policing their feminine odor but also discreet in doing so. By implying that women need this product, Libra is perpetuating the notion that female genitalia are dirty, shameful, and in need of management.

Older women are also concerned about hygiene. One fifty-two-year-old woman I interviewed said that having a labiaplasty has solved her concerns with hygiene:

Ann: I like to smell nice and fresh as much as I possibly can. Before, by the end of the day, I would always find I was very fastidious. I always carried little wipes, little feminine hygiene wipey things. I don’t want to smell. I don’t want to be talking to someone—well, to be honest, it’s offensive. I don’t like to smell fishy or yucky or have any sort of odor. But I must say since I’ve had this done—like, you know, I sort of go for a wee or something late in the afternoon and I go, “Oh! I don’t have that pungent smell.” Whether that is because my labia were trapping extra bits that I never actually got to properly or not, I don’t know.

Hygiene issues such as toilet paper sticking to the labia after micturition or difficulties maintaining personal cleanliness during menstruation are reasons some women give for considering labiaplasty. However, most surgeons I spoke with dismissed the suggestion that surgery could resolve hygiene issues or reduce the incidence of recurrent yeast infections (candidiasis); rather, they emphasized discomfort, aesthetics, and self-esteem as reasons for surgery. Beauticians, on the other hand, do emphasize the importance of cleanliness and neatness as a major advantage of Brazilian waxing. “Girls just prefer it without hair. It is a hygiene thing,” one commented. Neatness is linked to cleanliness, control of one’s environment, and, increasingly, one’s body. Historically grounded negative portrayals of female genitalia are thus perpetuated in the media and in society more widely, and the anxiety they generate in women sells products and services (such as waxing, depilatory products, vaginal deodorants, and wipes).

Liminality, Containment, and Absence

The ideal of the clean slit extends beyond aesthetics to include cleanliness and bodily control, a form of containment of marginal zones (Douglas 1966). The “mysterious” liminal nature of female genitalia threatens order. Unlike male bodies, “the vagina sports moist, textured tissues like bodily insides while it is accessible from the outside without an incision” (Kapsalis 1997, 19). Women’s bodies are always in need of control to ensure there is no leakage of menstrual fluid, no secretions, and no odors—signs of this liminality and abjection (Kristeva 1982). To these leaky feminine attributes has been added the more material labia. Unruly, large, and protruding labia minora are abject, despite their (until now, in the West) permanence on the body.

To the dangers and allures of what’s hidden about the vagina, now is added the “too muchness” of labial tissue. In their heterogeneous dappling and their moist curves, labia mark the lack of tidy differentiation between inside and outside and that’s just too much. One effect of this procedure is to reduce this sense of a “marginal” site between exterior and interior corporeality. . . . This indeterminacy, actually a function of the labia’s protective role, may be part of their association with excess. (Weil Davis 2002, 15)

Female genital cosmetic surgery addresses genital excess. For many women seeking cosmetic surgery, excess is desirable for breasts but not for labia. The clean slit, as an ideal, renders the genital area less problematic (visually) by demarcating the boundary between the “fetishized gloss of the outer dermis and the wet, mushy darkness of the inside” (Weil Davis 2002, 15) through the removal of excess tissue (and hair), thus making this marginal zone more distinct. Elizabeth Grosz asks, “Can it be that in the West, in our time, the female body has been constructed not only as lack or absence but with more complexity, as a ...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Acknowledgments
• Prologue: Mandy’s Story
• Introduction: Vulnerable Vulvas
• 1. Melting Snowflakes: Toward a Clean Slit
• 2. Normativity and the Contradictory Nature of Normal
• 3. Seeking Vulval Perfection
• 4. Vulva Las Vegas: Science, Magic (a Gamble), or More of the Same?
• 5. Autonomy, Risk, Desire, and Magic
• Appendices
• References
• Index
• About the Author