Female Genital Cosmetic Surgery

Deviance, Desire and the Pursuit of Perfection

Camille Nurka

• Publisher: Palgrave Macmillan
• Year: 2018
• Print ISBN: 9783319964898
• eBook ISBN: 9783319964904
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

Examining the fascinating history of female genital cosmetic surgery, Camille Nurka traces the origins of contemporary ideas of genital normality. Over the past twenty years, Western women have become increasingly worried about the aesthetic appearance of their labia minora and are turning to cosmetic surgery to achieve the ideal vulva: a clean slit with no visible protrusion of the inner lips. Long labia minora are described by medical experts as 'hypertrophied, ' a term that implies deformity and the atypical. But how far back does the diagnosis of labial hypertrophy go, and where did it originate? Female Genital Cosmetic Surgery tells the story of the female genitalia from the alien world of ancient Greek gynaecology to the colonial period of exploration and exploitation up to the present day. Bringing together historical, medical, and theoretical documentation and commentary, Nurka uncovers a long tradition of pathologizing female anatomy, a history sure to be of interest to any reader who wishes to know more about how medicine shapes our commonly held ideals.

© The Author(s) 2019

Camille NurkaFemale Genital Cosmetic Surgeryhttps://doi.org/10.1007/978-3-319-96490-4_1

Begin Abstract

1. Introduction: Perfectible Sex

Camille Nurka¹

(1)

Mount Waverley, VIC, Australia

Camille Nurka

End Abstract

In 2015, I came across an online education resource for Australian youth called Somazone. Created by the Australian Drug Foundation, it was set up as a safe space for young people to ask questions about mental health, depression, sex, sexuality, relationships, bullying, abuse, drugs and alcohol. Sadly, this education resource no longer exists. ¹ I had discovered this site in the course of my research on cosmetic labiaplasty. What caught my attention was an anxious question posed by a young woman about her labia minora:

OK, so 16 is the age to experiment, hey. And it’s natural to fool around with your boyfriend if you’re both ready to let yourselves explore each other’s bodies. Well there lies my problem.

I haven’t told anybody. I am a reasonably popular girl who attracts lots of guy’s attention. So I don’t have a problem with guys, or with my body, so everyone thinks.

I am slim and petite but yet I don’t want to let anyone near me for fear of humiliation that my lower region isn’t attractive or appealing. I am ready to have some fun experimenting but I am very ashamed because my labia sticks out and I do not want to be hurt or teased.

I hope someone out there understands what I mean. I want to get a labioplasty but I don’t want my parents to find out and don’t know wether I have to be over 18. I feel guilty not loving my whole body. ²

There are two kinds of painful emotion being expressed here: one is shame and the other is guilt over feeling ashamed. While she worries that a potential sexual partner might find her vagina ugly, she also worries that her body shame is unwarranted or illegitimate. The post prompted a litany of comments by respondents relieved to have the opportunity to express similar feelings of embarrassment, dislike, discomfort, disgust, paranoia, abnormality and unhappiness. But it also generated many body-positive responses from both women and men who reassured her that she was normal and that labia were sexy. These responses, in a safe and moderated online environment, led one commenter to say: ‘I feel so much better reading about this … I have large ones too and didn’t like them but now i’m startin to feel better about them and now i know i’m normal =].’ ³

Somazone was a public health initiative, but not all sex education sites are responsible or ethical. For instance, RealSelf is an online forum that provides information for prospective clients about cosmetic surgery, where surgeons respond to women’s queries about their bodies as a way to generate business. One query-poster from Florida asks: ‘Is it normal for it to lol [look] this way. I’ve been scared to have any sexual relationships because I’m think guys will find it unattractive and I was wondering if I should get surgery?’ ⁴ While one surgeon responds by reassuring her that her labia are normal, he nonetheless suggests that ‘there is a trend to have less prominent labia’ and that for women who are troubled by their labia, ‘a certain surgical procedure exists to help to correct this problem and restore their femininity’. ⁵

What is salient here is the prevalence of a shared sense of sexual shame and fears of abnormality in the anxious and unhappy stories posted by contemporary women about their genitals. The anxiety of inhabiting an abnormal femininity and the fear of heterosexual inadequacy are strikingly present in the accounts of genital shame given by women enquiring about labiaplasty in online forums such as Somazone and RealSelf. These women are likely to find their fears confirmed in the diagnosis of a spurious gynaecological condition known as ‘hypertrophy of the labia minora’, which simply means that the labia are large in size. I call this ‘diagnosis’ spurious because labia minora that bear no signs of malignant organic disorder other than that they are long are not diseased. ‘Hypertrophy’ is a denotative description of a structure and not a clinical pathology, even though it is often presented as a medical diagnosis.

This book charts the history of this diagnosis. It is not a sociological analysis of how women think about and respond to female genital cosmetic surgery, nor does it attempt to provide a theory of female agency that is able to show how contemporary women navigate the pleasures and pains of genital cosmetic surgery. Rather, this book came about because I felt that the development of medical knowledge of the female genitals could provide some answers to the vexing question of where the idea of genital normality comes from. Medicine is, of course, not the only source of sexual knowledge, but it has been overlooked in accounts in the popular media and in academic articles that put the blame for cosmetic labiaplasty primarily on internet pornography. This book sets out the argument that contemporary women’s feelings of genital shame and abnormality need to be located within the broader history of medical gynaecology because of its important role in laying the discursive groundwork for the expression of these anxieties. Although the current phenomenon of female genital cosmetic surgery is embedded in contemporary late-capitalist Western culture, the questions that motivate this book are historical ones: To what extent is the genital shame driving female uptake of labiaplasty surgery strictly contemporary? How far back does the diagnosis of labial hypertrophy go? And where do our ideas about genital normality come from?

What Is Female Genital Cosmetic Surgery?

Female genital cosmetic surgery (hereafter FGCS) refers to a range of surgical procedures that are performed on the vagina and vulva when there is no indication of gynaecological disease. These are essentially aesthetic and restorative procedures that aim to make the genitals look appropriately feminine, to reduce physical and mental discomfort, and to enhance sexual feeling. They include reduction of the labia minora, or labiaplasty; reduction of the clitoral hood (labiaplasty and clitoral hood reduction are often performed together); ‘augmentation’, or enlargement, of the labia majora; vaginal tightening, or vaginal ‘rejuvenation’, and perineoplasty; ‘G-spot amplification’; clitoral reduction; and hymenoplasty, or hymen reconstruction. ⁶ I would also include in this list clitoral reconstruction for women who have had the clitoris excised in ritual cutting practices, otherwise known as FGM (or ‘female genital mutilation’). The most common form of FGCS is labiaplasty, which involves cutting back large and protuberant labia minora so that they are either entirely hidden by or sit flush with the lips of the labia majora. Over the last couple of decades, media reports and anecdotal evidence from cosmetic surgeons have suggested a marked rise in popularity of cosmetic labiaplasty procedures. This has been borne out in the global statistics collected by the International Society of Aesthetic Plastic Surgery (ISAPS), which found that of all the cosmetic surgery procedures in 2016, labiaplasty showed the largest annual increase, rising by 45 per cent since 2015. ⁷

In the medical literature detailing surgical labiaplasty techniques, protuberant labia minora are described as ‘hypertrophied’. A precise definition of ‘hypertrophy’ in the literature is wanting, with labial measurement being anything from 2–5 cm from base to tip as the baseline requirement for diagnosis. ⁸ It may also be accompanied by asymmetry, where one labium is larger than the other. What is clear, however, is that labia minora that protrude to any degree beyond the labia majora can be classed as hypertrophic. German plastic surgeon Stefan Gress has suggested that a height of 2 cm from the interlabial fold could serve as a useful baseline, as this is the point at which ‘the inner vaginal lips generally start to be visible outside the shelter of the labia majora’. ⁹ Surgeons usually also stress that a diagnosis of labial hypertrophy is more dependent upon how a woman feels about her protruding labia than about any specific method of measurement. As Solanki et al. put it: ‘When deciding on the need for surgical intervention the symptoms described by the patient are more important than measurements alone. These issues can be functional, aesthetic and psychological’. ¹⁰ Gress justifies the need for surgery on the grounds that ‘asymmetrical or greatly enlarged labia minora can distort the body image so permanently that the woman’s sex life can be seriously affected. Doctors who empathise with their patients will surely understand their desire for correction’. ¹¹

According to accounts given by cosmetic surgeons in the clinical literature, the main reasons women give for wanting the procedure done involve concerns about aesthetic appearance, fears of abnormality, and problems with physical comfort, hygiene and sexual function. ¹² Goodman found that in at least two studies the majority of patients cited aesthetic reasons for undergoing labiaplasty, followed by discomfort in clothing, entry dyspareunia (or painful penetrative sex) and discomfort with exercise. He concluded that ‘the goal of these procedures is to obtain a more subjectively aesthetically pleasing appearance of the genitalia without adverse sequelae or anatomical distortion’. ¹³ In a 2007 qualitative study by Ros Bramwell, Claire Morland and Anne S. Garden, interviewees who had undergone labiaplasty expressed anxiety about their genital normality and dissatisfaction with their sex lives. They felt defective and abnormal, which, for some, was precipitated or confirmed by the comments of relatives. The women also expressed deeply felt sexual shame in feeling sel...

Table of contents

• Cover
• Front Matter
• 1. Introduction: Perfectible Sex
• 2. Ancient Anatomies
• 3. Galen’s Nymphs
• 4. The Colonial Race Sciences
• 5. Sexual Anthropometry
• 6. Deviant Desires
• 7. Desiring Normality
• 8. Conclusion: DIY Sex
• Back Matter