Making the Connection: Sexuality and Reproductive Health

In some cities in the United States, cosmetic genital surgery is becoming increasingly available to women with the desire and means to pay for their vagina to be tightened, tucked, or otherwise altered. Critics argue that such surgeries are the medicalized, Westernized version of the female genital mutilation (FGM)1 long associated with Africa, reflecting the same desires for virgin-like "tightness" albeit with typically less medically dire results. Providers argue that that their services are empowering for women, improving their sex lives, and increasing their self-confidence. What is not in dispute is that the market for these elective surgeries is on the increase, and this slow growing trend gives rise to many questions about sexual expectations and physical aesthetics in the U.S. and other industrialized countries.

Cosmetic female genital surgery is the catch-all term for a variety of procedures that surgically alter a woman's vagina and/or labia for non-medical reasons. Procedures now used cosmetically are technically the same surgeries used by doctors to repair damage incurred in childbirth (such as a poorly healed episiotomy) or other physical problems. The most typical procedures are of two general types: those that "tighten" the vaginal canal and those that alter the external appearance of the vulva.

Labiaplasty or Labial Reduction is a cosmetic surgery procedure most commonly performed to reduce the size of a woman's inner labia (labia minora). Although enlargement of the inner labia is considered to be entirely normal, some women believe that a protruding inner labia is aesthetically unappealing. Some research has suggested that women have become more aware of differences in genital appearance due to movies and media. If a woman's labia do not conform to these images, she may feel deformed or abnormal. While some women may in fact choose to have labiaplasty because of functional problems, like physical discomfort or irritation, the majority of women have this procedure for purely aesthetic and psychological reasons.

In most cases, labiaplasty is an outpatient procedure performed under local anesthesia. The procedure involves cutting away a portion of the inner labia. Since the width and length of individual women's labium vary, there is no standard amount removed, and the final size of the labia is left to the decision of the doctor and patient. Although women may have some discomfort following surgery, most women experience no pain or swelling after 2-4 weeks post procedure.

References

¹Roman Rouzier, Christine Louis-Sylvestre, Bernard-Jean Paniel, "Hypertrophy of labia minora: Experience with 163 reductions" American Journal Obstetrics & Gynecology, 182 (Jan 2000): 35-40

²Robert Girling, Mark Salisbury, Robert Ersek., "Vaginal Labioplasty," Plastic & Reconstructive Surgery, 115.6 ( May 2005): 1792-1793

Cosmetic surgeries to tighten the vaginal canal are called laser vaginal rejuvenation (LVR). LVR is typically performed when the wall between the vagina and bladder is weakened or the wall between the rectum and the vagina is weakened, a possible side-effect of natural childbirth that can result in problems such as stress incontinence (losing urine when laughing, coughing, sneezing, etc.). While these repairs are intended for medical purposes, they also may - or may not - result in a vagina that feels "tighter." While tighter may mean "better" sensation during intercourse, marketing for such surgeries often implies that, to be desirable, women should have youthful, pert, tight vaginas.2

The appearance of the vulva can also be changed through designer laser vaginoplasty (DLV). In one form of DLV, labioplasty, a woman's labia minora-or inner lips-are cut and reshaped. Women who seek this procedure often do so because they believe their lips are too large (most often meaning that they protrude beyond the labia majora or outer lips) or asymmetrical.3 DLV is sometimes advertised as addressing "oversized labia minora, a condition that can be embarrassing and uncomfortable."4 In addition to "correcting" "problem" inner labia, other forms of DLV include removing fat from elsewhere in the body and transferring it to the outer labia, providing an "aesthetically enhanced and youthful" look (augmentation labioplasty). On the other hand, women can have unwanted fat from the mons pubis or outer labia removed, which can "alleviate unsightly fatty bulges of this area and produce an aesthetically pleasing contour" (vulvar lipoplasty).

Like other designer items, designer vaginas are a luxury purchase. Basic vaginoplasty can range from $6,500 to $8,500. Package deals, combining more than one procedure, can run in the price range of $10,000. Without medical justification, these procedures constitute elective surgery and are therefore not covered by insurance, though some clinics do offer financing. Dr. David Matlock, an obstetrician-gynecologist in Los Angeles, founded the Laser Vaginal Rejuvenation Institute of Los Angeles in the late 1990s. In 2004 alone, Matlock earned $1.4 million and said the demand is too much for him to handle alone.5

The primary selling points for cosmetic female genital surgery seem to be enhanced sexual gratification and aesthetically pleasing results. Although many women might see the "perfect vagina" as something men have asked for, commentators point out that most men who encounter labia are simply happy to be there, and couldn't care less about perceived size abnormalities or unevenness.6 Vaginal dissatisfaction may in fact have more to do with popular culture than the desire to please a particular individual. Media images often drive concepts of attractiveness and affect self-perception. Some critics have pointed to the rise of pornography as a source of vaginal dissatisfaction: as mainstream fashion magazines, Hollywood films, and television have generated a body of images that reflect and determine what we consider "beautiful" or "the perfect body," so the proliferation of pornography has created a body of images that constitute "the perfect vagina."

Desire and Dollars Equals Designer Vaginas for More and More Women in the United States

References