Rapid advances in the field of surgery have not only made it possible for people to get better from life-threatening conditions but also change the way they look. A recent trend in women’s surgery is modifying the female genitalia, sometimes for clinical reasons but increasingly for cosmetic purposes.
The most common type of female genital cosmetic surgery is perhaps Labiaplasty, in which the size of the labia minora is reduced. It can be a treatment for women who have concerns with hygiene, difficulties during sexual intercourse or discomfort when exercising, but some women and sometimes even girls in their teens are opting for this surgery because of concerns about the way their genitalia look. These include operations to make the external appearance more "attractive" as they are influenced by images from popular culture and the pornography industry. Doctors point out that just like noses and chins come in various shapes and all are normal, so is the genitalia. However the root of such misapprehension lies in the popular notion that there is just one type of ‘neat’ genital appearance, the type to be found prominently depicted in pornography. In extreme cases the demand for labiaplasty on the part of the woman patient can be linked to body dysmorphic disorder, which causes significant anxieties about body image.
In Britain, Labiaplasties on the NHS have risen fivefold in the past 10 years1. Statistics show that more than 2,000 labiaplasty operations were performed in 2010 on the NHS. Many more are carried out by private clinics but there are no figures available on these procedures, although the Royal College of Obstetricians and Gynaecologists says "the practice of labiaplasty is now widespread".
In the US, female genital cosmetic surgery is as yet a small segment of the plastic surgery market, but it is rapidly growing, with thousands of women estimated to undergo such procedures every year2. That growth comes despite a warning from the American College of Obstetricians and Gynecologists (ACOG), in a 2007 notice to member physicians, that strongly questioned the medical validity and safety of female genital cosmetic surgery.
Also known as "vaginal rejuvenation", vaginoplasty is the surgical repair of vaginal laxity to make the vagina tighter. Cosmetic surgery clinics claim that the vaginoplasty procedure can restore vaginal contour and tightness, which is sometimes lost after successive childbearing. But many doctors believe that there is little evidence that the results of such surgery are any better than doing simple pelvic floor muscle exercises. More than 2,140 U.S. women underwent "vaginal rejuvenation" last year, according to the American Society for Aesthetic Plastic Surgery. The International Society of Aesthetic Plastic Surgeons put the U.S. total at nearly 5,200 in 2010. Experts note such figures do not include the many procedures done by gynecologists. While in the US, such procedures can cost between $2,500 and $12,000 and are usually not covered by insurance, in the UK, they carry a price tag of around £3,000.
Also known as hymenorrhaphy, hymenoplasty is a kind of cosmetic procedure which surgically restores the hymen in a woman’s body. The new hymen can be a membrane without blood supply like a gelatin capsule or a vaginal flap with blood supply and hence capable of bleeding after the next episode of vaginal sexual intercourse. Because of the desirability of virgins, in many traditional cultures, hymenoplasty is a growing trend. Girls who may have engaged in pre-marital sex or even worked as sex workers are ready to come under the surgeon’s knife to eliminate suspicions about their sexual past from their future marital partners. Hymenoplasty is in fact one more instance where newer technology has been appropriated to continue and even reinforce traditional norms and sexual codes. Though there is no doubt about the fact that hymenoplasty is increasingly becoming a popular cosmetic procedure – as evident from the plethora of internet advertising – there are still no official statistics on the number of hymenplasty procedures performed in countries like India where traditional notions about marriage and virginal brides still dominate. This is a direct result of the secrecy associated with the procedure since women who undergo it are unwilling to share details for fear of it getting to the ears of potential marital partners. Apart from India, hymenoloasty is practiced in many African cultures, some orthodox Catholic cultures and certainly all Islamic cultures. That hymenoplasty is performed to restore the virginity of women in order to better their marital prospects in other cultures too is evident from news reports3 like the one which talks about the trend in Georgia, an East European country. Though here too no official numbers exist, top doctors say that they perform five to seven such operations per month.
In western societies of Europe and the US, most of the women opting for hymenoplasty belong to traditional cultures in Asia, Africa and the Middle East. An increasing number of Muslim women in Europe are undergoing hymenoplasty4 so that their future marital partners are not able to detect that they have had sex in the past. As Europe’s Muslim population grows, many young Muslim women are caught between the freedoms that European society affords and the strict morality of their traditional culture. The issue has been particularly charged in France, where a renewed and fierce debate emerged around the importance of a woman’s virginity in the aftermath of the revelation in 2008 that a court in Lille, in northern France, had annulled the 2006 marriage of two French Muslims because the groom found his bride was not the virgin she had claimed to be. While feminists as well as some lawyers and doctors warned that the court’s acceptance of the centrality of virginity in marriage would encourage more Frenchwomen from Arab and African Muslim backgrounds to have their hymens restored, those advocating multiculturalism say it is a matter of individual choice.
At the same time, women of African and Arab origin are not the only ones going for hymenoplasty in the West. On the opposite spectrum of social mores are those who wish to go under the surgeon’s knife as a way of gifting their virginity to their partners on wedding anniversaries and Valentine’s Days. Indeed these women are coming back to countries where hymenoplasty is performed chiefly to save an unmarried woman’s and her family’s honor. A recent news report5 notes the trend in medical tourism; “ With more and more women from US and UK shopping for cosmetic procedures in Indian hospitals, along with breast upliftment and liposuction, we are now increasingly getting inquiries about hymenoplasty which tops the list as a unique anniversary gift," says Dr Bijal Parikh, consultant cosmetic surgeon in Apollo. Apparently the choice makes financial sense too since a Hymenoplasty costs anywhere between Rs 1-2.5 lakh in US and UK while the same is done in India for Rs 10,000-20,000. So whether for cultural or financial reasons, hymenoplasty is one of the most common genital surgeries among women.
Apart from these three types of genital surgeries, there are others like "G-spot amplification," which involves injecting the area in the front wall of the vagina with collagen or another filler to enhance sexual gratification. Unlike the previous three, this is more in the grey area, since no controlled studies have been done, or are likely to be done, to show whether it has any effect on greater sexual fulfillment for women.
Hyped up online advertising
One major reason for the popularity of genital cosmetic surgeries among women has been the ease and accessibility of advertising on the internet. In a report6 published online in Obstetrics & Gynecology, researchers called for guidelines in genital cosmetic surgery to be drawn up after finding major gaps in the breadth, accuracy, and quality of the clinical information provided among the first five British and American websites which popped up on Google for the procedure. The report found that among the clinics offering various genital cosmetic surgeries, as many Half of the sites promised increased sexual pleasure, when doctors agree that there is no certain evidence on the matter. Also the sites appear to prey on unnecessary and oftentimes unfounded fears about appearance of female genitals, reinforcing negative feelings towards the vagina also known as ‘pudendal disgust.’ For example, three websites claimed that labial surgery would improve odor, irritation, and curb the risk of infections, while all the sites played up concerns on the appearance of a woman’s genitals including the visibility of the vaginal labia through tight clothing and a larger than normal labia, a concern often brought up through a partner or magazine pictures. Other sites recommended labial reduction to promote a “youthful vulval appearance,” and promises of reshaping the labia to make it “sleeker,” and “more appealing.” while advertisement for hymenoplasty assured that the patient would bleed on her wedding night and be able to “keep her head high.” Belying the fears played upon by such sites, a study published in the International Journal of Obstetrics and Gynecology found that of 33 women seeking labial reduction procedures in the UK, all of them had normal-sized labia minora, with an average width of 27mm on the right, and 25 mm on the left.
The rising popularity of genital cosmetic surgery has come under fire from critics who say the trend is the latest service aimed at women pursuing an impossible ideal of physical perfection, hyped by Internet pornography and advertising by surgeons who may not explain all the risks, such as infections, scarring, pain and the loss of the very sensations – like clitoral sensitivity – some patients seek to enhance. Surgeons say many patients have been influenced by images of the waxed, buffed or surgically altered genitals of porn actresses. Such images and aspirations are not only unrealistic but most importantly gloss over that female sexual response is driven more by psychological factors rather than genital appearance. Women who derive validation from their abilities, personalities and relationships will have happy sex lives, no matter what they look like down south.
- BBC News - 'Designer vagina surgery not to be carried out on NHS'
- Reuters - U.S. gynecologists alarmed by plastic surgery trend
- GlobalPost - Georgian women seek virginity restoration
- The New York Times - In Europe, Debate Over Islam and Virginity
- The Times of India - Get under the knife, be a virgin again!
- New York Daily News - Women who seek 'vaginal rejuvenation' procedures cautioned to beware of misinformation pervading the internet about procedures