Women’s genitals are as diverse as our faces, as you can see in the Labia Library photo gallery. We are accustomed to some faces being accepted as “beautiful”, and know that the standard varies across time and culture. We may be less familiar with the idea that similar judgements are made about the vulva.
The vulva includes the inner lips (labia minora) and outer lips (labia majora), the clitoris, and the vaginal opening. Labia can be long or short, wrinkled or smooth, dark or light. One side is often longer than the other, consistent with the asymmetry of most body parts. The exterior of the clitoris can be pea-sized or as big as a thumb.
Just as some people seek cosmetic surgery on visible parts of their bodies, women have resorted to cosmetic surgery on their genitals to make them resemble an ideal. The Western ideal vulva is represented by the Barbie doll: “a clean slit”.
More than half of GPs surveyed in 2016 reported being consulted by women and girls wanting genital cosmetic surgery.
But what do women see when they search for cosmetic surgery?
Doctors advertise online, offering procedures including labiaplasty to reduce the labia minora, reduction of the clitoral hood, and plumping up of the labia majora.
Our research team wanted to learn what was in popular websites advertising Australian clinics, and analysed 31 websites in 2016. The same or similar websites came up in our search this week.
Websites gave a strong impression that female genitals diverging from the “ideal” need surgery. Although most websites acknowledged that vulvas were naturally diverse, they used language that pathologised any appearance other than a Barbie doll.
Visible labia minora were described as “hypertrophic” (showing excessive growth), which sounds like a medical diagnosis. According to one doctor:
The primary goal of labiaplasty is to reduce the size of the labia by surgically removing excess skin and shaping it into a more youthful and attractive form.
Websites didn’t say why it was better to be youthful than mature in sexuality or sexual organs. “Youthful” implies a yearning for women who are compliant and self-effacing, with no alarming sexual organs and presumably sexual needs.
Websites also emphasised the need to be “feminine”, with a “neat” and “tidy” vulva, conjuring up images of a 1950s housewife. These doctors reinforced the idea of binary sex, in which women must look undeniably female, with no visible clitoris. One website claimed a protruding clitoris “can feel and appear like a very small penis, which can cause deep insecurity and sexual anxiety”.
“Excess, floppy or uneven Labia Minora” justified cosmetic surgery, as did psychological, emotional, and physical discomfort. These were often described as “symptoms” requiring surgery to improve women’s health and well-being. According to one website:
The truth is that relationships, exercise, even dressing can be negatively impacted by a large inner or outer labia.
A typical “patient testimonial” claimed that, after labiaplasty, “Suddenly empowered, I felt more womanly than ever.”
Large labia minora were said to be “unhealthy and unhygienic”. Women were warned that, should “symptoms” be left “untreated”, they would worsen and “contribute to an unpleasant smell developing in the sensitive area”.
Only one website talked about the lack of evidence to support claims about hygiene:
There is no evidence to suggest that labiaplasty surgery can reduce problems with recurrent thrush or address hygiene concerns or problems.
It was also claimed on some sites that women’s sex life would improve because they would no longer be anxious about the way their genitals looked, and because cutting off visible labia minora would make women more attractive:
It will be very apparent to your sexual partner that the external structure of the labia will have been altered visually—namely they’ll be smaller and better aligned. Your sexual partner will clearly notice this change for the better.
Some websites claimed cosmetic surgery had nothing to do with fashion or social pressure and everything to do with individual choice.