First and foremost, the fact that most women know their vulva as a vagina is incredibly disempowering, with some women being so under-educated and disconnected that they think their pee comes out of their clitoris.
On top of that, the etymology of the vagina- which is the most commonly accepted term (though almost always used incorrectly), is a “sheath for a sword”, which indicates that the vagina is merely a receptacle for something, rather than an organ of its own right. This part of the female body has been reduced in many ways to a space for giving birth and receiving penises, instead of the nerve dense, engorge-able tissue that can bring enormous amounts of pleasure.
This confusion over female genitalia is not a surprise considering the history and current culture of the suppression of female sexuality, which is in my opinion where much the shame women feel around the appearance of their genitals originates. In Medieval times, male anatomist had named the external genitalia of women the “pudendum” which was derived from the Latin word pudere - which means “to make ashamed” - here we can see shame embedded in the language of our genitalia.
It is no wonder considering that in the 19th century, women with prominent (plush) inner labia were seen as deviant or nymphomaniacs who lied about their masturbation habits, as prominent inner labia was a sign of excess female desire. These women were therefore oftentimes victims to genital mutilation by their doctors, and their inner labia and clitoris were removed. Along with this, any part of the female pelvis that did not solely function as a reproductive organ was dismissed from medical literature. The idea of prominent inner labia and excess sexual desire and activity continued to exist with California’s eugenics legislation ruling to sterilize women for having prominent external genitalia, as they were said to be promiscuous.
Much of the anatomical terminology on female pleasure is still missing from literature due to this oppression, as if it is not important. Not only that, plastic surgery textbooks and journals attribute labia minora hypertrophy to masturbation and sexual activity, though there is no evidence to support such an association. With this kind of history, it is not wonder that Education on female anatomy and pleasure arousal and orgasm is not taught in schools.
Ontop of this, female genitalia is not easy to see and females are not given the opportunity to see just how normal they are.
The ignorance and taboo-ness around female anatomy and the normalcy of plush inner labia has been capitalised upon by surgeons who instead of educating potential clients on anatomical variety, instead advertise their services to targeted vulnerable audiences of influenceable girls on TikTok, which only feeds into the shame machine surrounding female sexuality, and we are living in an age where women are experiencing more body image pressure than ever before.
Not only do these surgeons lack in their duty of care to inform their clients that they are totally normal so that these clients can be fully informed in their decision for surgery, they themselves are usually uninformed of the anatomy of the vulva, inner labia and clitoris, which often results in a lack of sensation post operation, and for some women, pain, and many of the women who experience this outcome are never told of these risks. This only occurs due to the fact that labiaplasty is not standardised in the same way that other cosmetic surgeries are, which I believe is because it is such a taboo topic.
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“There is also a lower standard of information integrity in medicine where vulvas are concerned. Claims that labial hypertrophy is caused by masturbation, aging, sexual activity, and excess androgens are repeated and face no pushback despite no evidence supporting them. There is a lack of curiosity about what is true where vulvas are concerned. Research on vulvar anatomy and physiology has been lacking. What does get published doesn’t get disseminated due to lack of interest. There is more medical literature on vulvar aesthetics and vulvar cosmetic surgery than there is on vulvar anatomy and function. While literature on techniques for other cosmetic surgery gives careful consideration to detailed surgical anatomy function, in literature on vulvar cosmetic surgery, detailed anatomy and function are largely disregarded.
Most patients who seek labiaplasty have been exposed to aggressive labiaplasty promotion and advertising. Plastic surgeons advertise labiaplasty as “like a haircut for your genitals.” Protruding labia minora are described as “unfeminine and embarrassing.” Doctors looking to profit from these surgeries have promoted a so called “ideal vulva” that may not actually be preferred. Women’s magazines have typically validated these claims, even while raising alarms. In one study of men’s preferences, men who had heard about labiaplasty were more likely to say they preferred smaller labia minora, indicating the female genital cosmetic surgery industry has driven preferences. Still, most men do not appear to have any such a preference, indicating this is somewhat of a fake beauty standard.
Porn is often referenced as a source of insecurity, but research shows women base their ideas of a “normal vulva” far more on medical sources. Additionally, a perusal of pornographic videos reveals plenty of porn stars with larger labia minora. Porn subreddits that focus on vulvas furthermore indicate no preference for hidden labia minora. Censorship of labia minora in soft-core porn images in Australia (right?) was motivated by a desire to limit explicitness and is not representative of what is or is not attractive. Physiologically, we know the labia minora engorge with arousal and are reflective of estrogen levels, developing during puberty and often atrophying with menopause. From an evolutionary standpoint, removing tissue signaling fertility and arousal makes little sense. That’s why this beauty standard is most aptly explained as a symptom of cultural taboo and profit motive.
It is notable that women seeking labiaplasty in the NHS did not have labia minora significantly larger than their non-seeking counterparts. A Z test for a statistical difference in means from these 2 data sets (same authors, same methodology) fails even at 90% confidence. What this means is that, based on these two samples, it cannot be concluded with any reasonable confidence that women seeking surgery have larger labia minora than women not seeking surgery. 45% of the women seeking surgery in Crouch have labia minora smaller than the mean of the general sample in Lloyd. What separates the population seeking surgery isn’t labia minora size but age (average 23) and virgin status (66%). While expensive experts get older populations, I believe younger women and women with minimal sexual experience are most vulnerable to negative messaging about vulvar aesthetics. https://pubmed.ncbi.nlm.nih.gov/21883873/ https://pubmed.ncbi.nlm.nih.gov/15842291/
Alarmingly RANZCOG’s only statement seeming to pertain to these surgeries does not use the word “vulva.” There is no such thing as “cosmetic vaginal procedures.”
Vulva shaming has a significant impact on female sexual confidence and even female sexual function. The negative messaging of labiaplasty surgeons is not just leading women into surgeries that are often unsafe and lead to loss of sexual sensation among a growing community of victims who have little ability to publicly speak about the harm done to them. It is also harming women not seeking surgery by detrimentally impacting the relationships women and girls have with their vulvas. Girls as young as 12 are talking about wanting to cut off their labia minora with scissors in response to labiaplasty promotion on TikTok. Because women have little exposure to what vulvas look like in the real world due to cultural standards of modesty, women are more vulnerable to messaging that visible labia minora are unattractive. As such, we really need the media to stop framing labiaplasty in such a cavalier way. It may seem like just any other cosmetic procedure. It may be that in theory, but in practice, it is not.
Medium articles I have written on this topic:
Here is a textbook chapter by a woman who promotes labiaplasty on TikTok. https://jessica86.medium.com/dr-cat-begovics-chapter-on-fgcs-ad12acfe7742
Labiaplasty can also be compared to hymenoplasty, which some FGCS surgeons offer using basically the same moral reasoning.
I think it’s important to recognize how all these patterns, from stigma around visible female external genitals, to ignorance rendering women vulnerable to messaging, to neglect of female external genital anatomy in medical literature and curricula, to neglect to establish training standards for these surgeries, to false associations with male hormones (consider how androgens are considered the desire hormones) and sexual activity, to restricted inability to speak out or pursue litigation (consider how lawyers won’t take cases involving complete labia minora amputations while complete breast amputations are a slam dunk) are all rooted in cultural suppression of female sexuality. This fundamental basis seems related to the work you do.
Also, one study found that objective labia minora size was not correlated with women’s physical complaints, and most physical complaints pertained to interference with sexual activity. The authors conclude, based on this, that there should be no objective standard for what constitutes medical indication for labiaplasty. But how exactly is reduction in size a solution to physical complaints if size is not correlated with physical complaints? Also, what does the fact that labia minora are primarily seen as a hindrance to sexual activity really mean? In my opinion, it likely means these women aren’t getting properly aroused before penetration occurs. So surgery is achieving a way to bypass female arousal as a prerequisite for intercourse to occur. This bothers me on a very fundamental level.”