Questioning The Ads For Below-The-Waist Surgery

Not surprisingly, the headline about “designer vagina” procedures in a press release this week from BMJ Open, an online publication of the esteemed BMJ (formerly the British Medical Journal) caught my eye — and stopped my coffee cup in midair.

It appears that women are flocking to surgeons for things like “vaginal rejuvenation,” “G-spot amplification,” “revirgination” and “labiaplasty.” According to the BMJ authors, a team from University College Hospital in London, vaginal cosmetic surgery is a growing thing for women who “simply don’t like the way their genitals look.”

Good Lord.

These women are apparently concerned about the visibility of vaginal labia through tight clothing (I must be getting old. Why not just wear looser clothing?). Or, as the BMJ authors put it, they want their labia to look “sleeker” and “more appealing.” The women in question seem to have an “awareness – courtesy of a partner or magazine pictures – of larger than normal labia.” (What kind of partners would say….oh, well.)

There is an actual point, beyond sheer prurient interest, to the authors’ concerns. They are worried, with good reason as I discovered, that Internet ads touting these vaginal cosmetic procedures are of “poor” quality. That is, they often contain inaccurate and misleading information. (Are we surprised?)

So, I put my coffee cup down and did what the authors did: I Googled their search term, female genital cosmetic surgery, and sure enough, up popped endless ads shamelessly appealing to, or dare I say, “creating,” female genital insecurities. For the record, I get that some older women who’ve had multiple babies may have urinary incontinence or other legitimate complications of childbirth - or even plain aging – and might want to have things tightened up a bit. Vaginas, like the rest of our bodies, can get droopy with time.

But young women and girls worried that they don’t look right? First, it was that women’s breasts were too small – or too big. Now, it’s genitals, too? In truth, there’s as much variation in labia length as in many other physical characteristics.

What really gets me about all this is that these made-up genital insecurities make a mockery of the real, and serious, issue of female genital mutilation in developing countries. In our supposedly modern societies, women are persuaded that they don’t “look” right and are choosing surgery they probably don’t need, while girls in Africa are still forced into genital mutilation.

[module align="right" width="half" type="pull-quote"]It doesn’t take a genius to question the wisdom of all this unnecessary female genital cosmetic surgery, but I called one anyway.[/module]

In reality, “Designer vaginoplasty” and “G-spot amplification” are, as the American College of Obstetricians and Gynecologists put it in a 2007 statement, “not medically indicated, and the safety and effectiveness of these procedures have not been documented.”

Which is pretty much what the British researchers concluded.

It doesn’t take a genius to question the wisdom of all this unnecessary female genital cosmetic surgery, but I called one anyway, Dr. Nawal Nour, director of the Ambulatory Obstetrics Practice at Brigham and Women’s Hospital.

Nour won a MacArthur Foundation “genius” award in 2003 for her work on repairing the surgical and emotional damage done to women through female genital mutilation. In fact, she has devoted her entire life to treating the medical complications and legal issues surrounding female genital mutilation and founded the African Women’s Health Center in Boston.

She feels that female genital surgeries, with proper counseling, may make sense if women “have truly physiological complications after childbirth” or when there are other “medical indications to perform some of these surgeries.”

But she is appalled that “more and more girls and women are thinking that they are abnormal,” and that the definition of what is considered “normal” for the length of labia has been getting smaller and smaller.

In the U.S., Nour said, it has been illegal since 1996 for surgeons to knowingly excise, that is, to surgically remove, all or part of the labia in someone under 18. As part of a survey, she called a number of surgeons and asked if they would do it anyway in girls this young. Many said yes, she said, “even though under the law that is considered genital mutilation.”

“Genital mutilation” or “female genital cosmetic surgery.” It’s a fine line, indeed. And tragic, by whatever name you call it.

Judy Foreman, a health reporter in Boston, just completed a book about chronic pain: “A Nation in Pain: Healing Our Biggest Health Problem.”