Labiaplasty is the name given to a range of procedures that aims to reduce and reshape the part of the female external genitalia known as the labia minora. It is important to note that current interest in labiaplasty dates back only a couple of decades.
Unrealistic Ideals Due to Media
Several social researchers have related it to the preceding surge in widespread viewing of pornographic videos and movies by both males and females from childhood onwards, which has aroused a misleading and often rigid perspective on what the ‘normal’ labia should look like. Many pornography consumers are unaware that the photos and other visual media are heavily doctored using virtual means to make the external genitalia appear quite different from what they actually look like.
Thus, the demand for labiaplasty is usually based in the first part on an unrealistic idea of what is normal, both on the part of the client and the doctor who performs the surgery. For instance, many men and women prefer the labia to look neat and tucked away, without realizing that larger labia may actually contribute to sexual arousal and enjoyment of intercourse by both partners.
Few Therapeutic Indications
Labiaplasty has very few true medical indications even though it is a surgical procedure. This raises the question as to whether cosmetic labial surgery ought to be classified with female genital mutilation (FGM).
The definition of FGM under the WHO is any procedure, which includes the partial or total removal of the female external genitalia for non-therapeutic reasons. It is considered a criminal offence to perform, counsel or abet a woman or girl for such an act. Thus, partial removal of the labia eminently qualifies under this heading. Why, then, it is not considered as FGM, is a question in the mind of many dispassionate observers.
Yet some governmental websites continue to offer advice on cosmetic labial surgery, describing it as partial removal or reshaping of the labia. This remains the same whether the motivation is purely cosmetic, purely functional (deemed a highly doubtful entity by most researchers) or a combination of the two. It is noteworthy that one medical journal published a study showing that almost all women underwent the surgery for non-therapeutic aims. Anxiety and suffering due to labia being perceived wrongly as excessively large is not a valid therapeutic indication for surgical treatment.
Though the terms and perhaps the aims are different, it is indisputable that the end-result is the same, so that governmental medical websites promote the same procedure that is condemned by their legal arm. The most common defense against considering labiaplasty as a component of FGM is that it is performed on and at the request of an adult consenting female. This overlooks the fact that lack of consent is not the main issue in FGM but mutilation for non-medical indications is.
Substitute for Mental Health Practices
A third issue is that labiaplasty is being overused as a solution for mental health issues linked to fixed idea about how the labia should appear.
Mental health practices such as encouraging women to correctly perceive a range normality, rather than one fixed image, and to accept themselves fully, rather than strive for the acceptance of others may be more effective than labiaplasty.
The surgeon is here made responsible for the woman’s mental health and the knife is the ultimate panacea for the woman’s loss of identity as a feminine person, rather than identifying the actual cause of mental distress and treating it appropriately.
Lack of Quality Control
One more major issue lies in the complete lack of quality control in this field, relating to:
- Who performs the surgery
- Where the surgery is performed
- How often the surgery is performed
- Predictable long-term outcomes, both physical and mental
- Advertising that takes advantage of socially fostered false expectations and fears rooted in the feminine identity and sexuality, on the part of both males and females
- Minimal follow up and reporting of adverse effects
It is true to say that the indications for labiaplasty are few and exist very rarely, being mostly influenced by misleading or suggestive advertising. Expectations of what is normal need to be revised with reference to the reality of significant variance in female external genitalia. Surgeons should stop attempting to create the perfect labia when there is no standard of ‘perfect’ to go by, but rather a fixed image derived artificially.
Finally, surgery should not be the substitute for personal effort to resolve personal conflicts, nor should it be touted for its commercial and technical viability. Viability is not a synonym for necessity when it comes to an aesthetic genital surgery. It is not ethical medicine to promote a cure for a disease, which does not exist by first convincing healthy people that they suffer from the disease in question.
Advertising which plays on the pseudo-feminine mystique is to be condemned as misleading and treats women only as defective variants of an imaginary ideal, which is to be attained by their cooperation with the ‘expert’ surgeon. This may be considered as simply a multimillion-dollar industry, which thrives on fostering female insecurity.
Reviewed by Yolanda Smith, BPharm