Do people having cosmetic surgery on their labia really know what they are doing?
This (then) 41 year old mother of two now has vastly different looking labia minora. These photos above were the pre-op images taken by her surgeon before she had labiaplasty surgery. It’s enough to make you cry, thinking of the emotional pain that drove this person to cut off her normal labia. And they were such a beautiful part of her body.
According to the surgeon’s website she had a 20-year history of being unhappy with her vulva. These before (and-after) photos are being used by the surgeon as part of his advertising programme. The language he uses is extremely pejorative, considering she has completely normal anatomy. He says “She has long and dark labia, redundant lateral prepuce (clitoral hood), excessive and dark perineal skin. All this gives an appearance of an old vulva and vagina. Her labia are very dark and old looking before and then smaller and more youthful afterwards.”
The “after” photo showing her vulva post-op.
Folks it gets a bit more involved from here – referring to scientific/medical papers about the ethics of advertising and marketing tactics and labiaplasty. Please do read on though - this is important.
In their paper, “An analysis of the content and clinical implications of online advertisements for female genital cosmetic surgery” Liao, Taghinejadi, and Creighton state that the ‘before’ photographs used by cosmetic surgeons are consistent with survey findings that most women seeking labiaplasty have labial dimensions that are completely normal. They say “negative connotations for larger labia such as ugliness, odour and irritation are strongly implied in their advertising. Such negative connotations may reinforce ‘pudendal disgust’ that is likely to encourage negative feelings towards the vulva. Negative thoughts and feelings can in turn exacerbate symptom-experience and reporting. The ‘after’ photos promote a suspiciously narrow appearance norm, that is, a smooth-skinned vulva with invisible labia minora. Findings from this study show that these sites employ a variety of techniques which aim to ‘educate’ women about the surgical solutions to potentially unknown defects in their bodies.
In the case of labiaplasty, it has been labelled as condition, designated hypertrophy of the labia minora (the measurement of which was once aimed at linking labial length to lesbianism!), is used to provide an supposed medical warrant for labial reduction. However in a published debate on labiaplasty ethics (Bachmann), it was noted that ‘‘language should be avoided that infers that the labia minora, labia majora, clitoral hood, or the mons pubis are misshaped or ugly and, through surgery, can be ‘restored’ to a more appealing size and shape.’’ However, such language is rife around FGCS [female genital cosmetic surgery]. A key challenge for women’s health professionals and educators is developing a different language for labia minora, which does not implicitly reinforce the perception that there is a normal=desirable state (i.e., ‘‘contained’’) and an undesirable and pathological state (i.e., ‘‘protruding’’).
In “Female Genital Cosmetic Surgery: A Critical Review of Current Knowledge and Contemporary Debates” Virginia Braun, said that women’s accounts that they sought labiaplasty because of perceptions of abnormality and the impact of their labial appearance (or their perception thereof ) on their sex lives. What is certain is that many women seek surgery to address psychological concerns. Psychological concerns are the most important reason for women to have the size of their labia minora reduced, but even after she has been assured that it is simply congenital and that enlargement of the labia minora normally has no clinical significance, many women remain dissatisfied and suffer psychological distress.
Patient choice (autonomy) is most commonly used to ethically justify FGCS, but the concept needs broader analysis. For autonomy to operate, the coercive influences a patient needs to be free from include surgeon practices, and this covers marketing and advertising. What this means is that already emotionally traumatised women are being unduly influenced by commercially driven messages from the cosmetic surgery industry. They are therefore unlikely to be in a position to make informed decisions. Women are only being presented with surgery (labiaplasty, vaginal rejuvenation, g-spot amplification, revirginisation, and the “Barbie” rendering the vulva virtually featureless like a plastic doll’s) by scalpel or laser as the only solution to an emotional or psychological problem.
Liao, Michala and Creighton in (Labial surgery for well women: A review of the literature. 2009) very rightly say, that “where decisions to operate on healthy sex organs are triggered by a perceived defect informed by commercial pressures, where reliable information on risks and benefits is unavailable and where there is no provision of alternatives because there is no concerted effort to develop them, the ethics behind informed consent are vastly compromised.”