The 'Perfect' Porn Vulva: More Women Demanding Cosmetic Genital Surgery

by Rebecca Chalker, Ph.D. ©2013

Alternatively available at:  August 11, 2009

Women are risking their lives to achieve an unrealistic and unnecessary ideal.

Type "labiaplasty," "vaginoplasty" or any of nearly a dozen female genital cosmetic surgeries into any search engine, and a flurry of doctors' Web sites will pop up touting the self-esteem, sexual enhancement, comfort and fashion benefits of female genital cosmetic surgery.

These sites, typically decorated with airbrushed pictures of lovely women in various states of undress or even nude, are replete with before-and-after photos of trimmed-down labia and gushing quotes from satisfied customers.

Many of these sites promise ecstasy-plus: "Laser vaginal reconstruction can accomplish what ever [sic] you desire."

Some patients seem happy with the results.
"When my husband and I had sex, well, it was like nothing I've ever experienced before," a 40-year-old woman reports, six weeks after a three-hour combination labiaplasty, vaginoplasty and clitoral unhooding, costing at low estimate of $15,000 (a high estimate: at least double that). "I had an orgasm probably within three minutes. … I feel like I've found what I had lost ... I feel like I'm 25 again!"

Her surgeon reports this case study as "Strengthening Our Love For Each Other."

Dig a little deeper though, and you find stories tinged with grief and regret about genital "enhancement" surgeries gone wrong.

"Had the surgery 1/07," one woman reports. "Can't say enough [about] how much I regret it. The problems I had it done for can't even compare to the pain and discomfort I'm having now. The surgeon, who has extensive experience, doesn't know why this is happening."

One of the newest wrinkles in the business of sex is the explosion of genital cosmetic surgery.

Not surprisingly, women constitute 90 percent of patients requesting these surgeries. Both physician and popular Internet sites prey on women's sexual insecurities by promoting appearance and alleged sexual benefits, but pay scant attention to the wide range of normal genital appearance, the variability of sexual response and possible harm.

The New View Campaign Working Group on Female Genital Cosmetic Surgery, a project that I participated in, identified unresearched claims made about female genital cosmetic surgery (FGCS) and analyzed how the rhetoric used by the body-modification and sexual-medicine industries has co-opted core feminist concepts of empowerment, self-determination and choice for profit.

Our review of medical, academic and popular literature, and a survey of physicians' promotional materials provides a disturbing picture.

There are nearly a dozen genital "remodeling" procedures.

The most popular by far is labiaplasty, the cutting of one or both sides of the inner lips or labia minora, or removing a V-shaped wedge. As a part of the clitoral system, the inner lips are sexually sensitive, so removal of this densely innervated tissue to get better sex seems, well, counterintuitive.

The next most popular surgery is vaginal tightening: vaginoplastyor vaginal rejuvenation, which involves removal of part of the vaginal lining and tightening tissue and muscles surrounding the vaginal opening.

The question about the development of scar tissue and disruption during future vaginal births is typically left unaddressed.

Reduction of the glans or tip of the clitoris (clitoropexy) for is done for purely aesthetic purposes. The only function of the glans is sexual sensation, so reducing it can in no way enhance sexual pleasure. The protective clitoral hood (or "unhooding") is rarely requested, but is often offered (for additional cost) along with labiaplasty. The idea that reduction or removal may enhance clitoral sensation is pure mythology.

Hymen restoration or repair (hymenoplasty) is done to provide the illusion of virginity when the hymen has been broken through normal activities or intercourse. Some women are having hymenoplasty as a "Valentine's present" to their lovers.

Removal of a tough or "imperforate" hymen for functional reasons, i.e., to make insertion of the penis or sex toys more comfortable, is variously called hymenotomy or hymenectomy.

The wildly controversial "G shot" is an injection of a quarter-sized dollop of human-engineered collagen through the vaginal wall into the urethral sponge, the spongy tissue surrounding the urethra.  Developed and franchised by Dr. David Matlock of Dr. 90210 fame, this procedure must be redone every few months. According to Matlock's Web site, and unpublished data, this injection results in "enhanced sexual arousal and sexual gratification for 87 percent of normal sexually functioning women."

Many women sing the praises of the shot: "After my G shot, I get sexually aroused performing yoga." But comedian Margaret Cho reported no sexual enhancement at all saying that it felt like she was "sitting on a hemorrhoid donut."

Other procedures include pubic mound reduction, reducing or poofing up the outer lips or labia majora and "building up and strengthening" the perineal body.

Regarding the ecstatic reviews, psychologist Carol Tavris notes that "One of the most well-documented findings in sociology is called the 'justification of effort' effect: The more time, effort, money and pain that people invest in a procedure, program, surgery, or other activity, the more motivated they are to justify it.

"How easy would it be for you to find a Marine willing to say that cadet hazing and suffering were unnecessary and brutal?" Or "… to get George Bush to say 'Gee, I guess going to Iraq was a bad decision?' "

All women by far are not enthused. "Perhaps the only rejuvenation going on is the doctor's wallet," an anonymous contributor to the Wall Street Journal blog opined. On Women's Health News, Rachel Walden observed "… spending $3,500 to $20,000 cutting up your hoo-ha isn't going to fix what's wrong with you."

The American College of Obstetricians and Gynecologists noted in 2007 that these "procedures are not medically indicated, and the safety and effectiveness … have not been documented. No adequate studies have been published assessing the long-term satisfaction, safety and complication rates," although the college dropped the ball by failing to institute regulations or sanctions.

The American Society of Plastic Surgeons informally agrees with this policy, but does not have a formal policy of its own.

Women may believe that their doctors are proficient in these techniques, but ob-gyns, family-practice physicians and urologists are promoting and performing these lucrative surgeries with minimal training.

By Matlock's estimation, doctors in all 50 states, and around the world, operate as "franchisees" of his business. Although he has been asked repeatedly for documentation on safety and effectiveness, Matlock has refused to publish any outcome studies, citing his need to "protect [his] intellectual property."

The most reliable evidence of the possible negative after-effects of genital surgeries is reported in follow-up reports on children with intersex conditions. In many cases, labia reduction removes sexually sensitive tissue, may cause lifelong hypersensitivity or numbness, pain on intercourse, infection, adhesions and scarring.

Some doctors acknowledge the downside of these putative enhancement procedures.
"We have seen many unfortunate examples of terrible, scarred, uneven results of labiaplasty from other physicians who have attempted labia-reduction surgery with typically poor results, which are usually permanent," Dr. Robert Roh, a New York City gynecologist, reports on his Web site.

Dr. Red Alinsod, an Orange County, Calif., gynecologist, concurs: "The numbers of patients requiring labiaplasty revisions have dramatically increased over the past several years. It is not a common procedure but one that is steadily on the rise as more surgeons attempt to perform labiaplasty surgery without knowledge of the basic tenets of aesthetic vaginal surgery."

No guidelines for "normal" genital appearance exist. An article in the British Journal of Obstetrics and Gynecology by Jillilan Lloyd and colleagues notes that "Previous work has defined the labia minora as hypertrophic [enlarged or overgrown] … if the maximum distance from the base to edge was [greater than] 4 centimeters." After careful measurement of 50 volunteers ages 18 and 50, these authors report "wide variation in all parameters assessed," with the width of the labia minora varying from 7 to 50 centimeters in width.

Describing protuberant labia minora as "looking like a spaniel's ears," French surgeons reported a high patient satisfaction rate for 98 women who answered a post-operative mail questionnaire.

Although they defined labia minora hypertrophy to be greater than 4 centimeters, they concluded "… we believe that hypertrophy of the labia minora is definitely a mere variant of normal anatomy." The 7 percent dissatisfaction rate was caused by poor aesthetic or functional result, or unrealistic patient expectations. The authors concede that "… 40 percent of the patients did not respond to the questionnaire, or were lost to follow-up, thus giving a potentially lower satisfaction rate."

Normal female genitals are virtually invisible in the popular media, except through pornographic sources. Lloyd and her colleagues note, "With the conspicuous availability of pornography in everyday life, women and their sexual partners are increasingly exposed to idealized, highly selective images of the female genital anatomy."

In 2005, shock-jock Howard Stern went live on the E Channel and found that the frequent appearance of porn stars enhanced ratings. Houston, a popular porn star and strip club dancer, appeared on Stern's show and talked about reducing her labia to look better on film. Carlin Ross, of remembers how Stern milked the topic.

"He could see that the porn stars were good for ratings, and they would bring their labia trophies cast in clear resin like an award and auction them off on Ebay."

Surgeons have also noted the impetus behind this trend. "Some women just want to look 'prettier,' like the women they see in [pornographic] magazines or in films," one New York City ob-gyn says. Another doctor reports that his patients want their vulvas to look like "the playmates of Playboy."

Based at least partially on the porn model and on the invisibility of normal genitals in the media, on Web sites, in chat rooms, and women's magazines, they are establishing a narrow norm and aesthetic ideal.

These negative messages feed a long history of misogynist genital disgust, and misinformation creates an environment of dissatisfaction and a demand for female genital cosmetic surgeries that would fall within the definition of female genital mutilation articulated by the WHO, UNICEF, and UNFPA in 1997:

Female genital mutilation comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons. … In some forms of Type II … only the labia minor are cut.

Women's right to choice is a core feminist concept, but choice made in the vacuum of the deficient discourse on FGCS promotes little more than wishful thinking.

The entrepreneurial medical and media narratives do not provide a useful understanding about the appearance and function of the female genitals, hence, informed consent is impossible.

Sexual attraction, response and pleasure are complex interactions of psychological and physiological processes that change with age, partners and experience, and regardless of the perceived short-term benefits of genital surgeries, reconfiguring the genitals is unlikely to have significant impact on sexual fulfillment.

And it's not just grown women that are drawn to the procedure.

Hosting a chat room on the subject, the Web site elicited this hyperemic query: "i dont think this is normal can i just cut my labia off," and "hello whats [sic] the younest [sic] age you can have labiaplasty sugery?" [sic]

Click here for more information on female genital cosmetic surgery and on the New View Campaign's fall protest.