III. Labioplasty

The surgery originated in the repair of episiotomy scars or in the construction of more “realistic” genitalia for male to female transsexuals, but has recently evolved into an aesthetic elective surgery (Hodgkinson et al. 414). When I first learned of the procedure of aesthetic vaginal labioplasty, its use for purely aesthetic reasons seemed extreme and expensive for the amount of tissue the doctor actually removes. Labioplasty also echoes the rites of female circumcision “routinely practiced” in cultures other than that of the United States.

Still, it is women who desire this surgery for themselves, and for a range of reasons. One patient of doctor of aptly names plastic surgeon Dr. Gary Alter’s said she became conscious of the “abnormality” of her genitalia when her older sister teased her, and she subsequently felt self-conscious throughout the rest of her growth and development (Alter 289). Other women claim they want to reduce their labia because of their difficulty wearing clothing that is “tight in the crotch” (Hodgkinson et al. 414) or to reduce chafing on labia minora which protrude past the labia majora. While the medical definition of a normal sized labia minora states “a normal labia minora is less than five centimeters as measured horizontally from the midline when placed in lateral traction with minimal tension” (Alter 287), doctors allow the patients to decide for themselves what they feel is “abnormal” (Alter 287).

Unfortunately, it does not take much asymmetry or enlargement at all for women to describe themselves as “abnormal.” If we examine the pre- and post-operative photographs that both Hodgkinson and Alter include, the difference is barely noticeable. To me, an enlarged labia minora would be one which hung down to a woman’s knee, that she would have to roll up to fit into her underwear. The asymmetry and enlargement these women see in themselves is barely noticeable and perfectly natural and not worth the expense or the pain of operation to go through.

The surgical “improvement” of women’s external genitalia, while it removes usually a very small amount of tissue, actually poses several serious risks (Woodman 120). Complications from these surgical procedures can include scarring, difficulty in urination, and injury to nerve endings in the pubic or genital area which could lead to permanent loss of feeling in the area or constant discomfort during sexual intercourse or while sitting or walking (Woodman 122). In addition to complications from surgery, these procedures are also risky legally (Woodman 122). Neither pubic liposuction nor labioplasty have been peer-reviewed or clinically tested (Woodman 122). While plastic surgeons like Gary Alter claim that the procedure is so simple nothing could go wrong, and that his patients have nothing but good results (Alter 290), Judith Seifer of the American Association of Sex Educators urges women to explore their options carefully before they take the risks involved in this kind of surgery; she says she “doesn’t see why women would want to take these sorts of risks” (Woodman 120). Dr. George McClure, another plastic surgeon, sums up the issue this way: “I would do these kinds of procedures only if there was an anatomical problem that precluded safe, enjoyable sex. Doing this surgery for appearance’ sake probably isn’t necessary. The variation in anatomy between women is vast, and I presume that’s the way it was intended to be” (Woodman 122).

As truly enlarged gentialia is very rare among women, the desire for genital surgery exemplifies a larger issue: the drive to have an idealized thin body. If their labia major and mons pubis were fleshier and took up more space, their minora might seem more proportional to them. However, driving for slim, straight, “fat-depleted silhouette” (Hodgkinson et al. 414) burns fat away from all places in they body, including the mons pubis and the labia majora. If women worried less about the amount of fat on their bodies, they would have more fat in the right places, namely on the mons pubis and the labia majora, and the labia minora would be able to be tucked away and would not be so visible and exposed to chafing from clothes, etc.

This leads us to ask the question: “Who is driving this craze for ever-more-exotic plastic procedures—feverishly insecure patients, profit-hungry doctors, or some combination thereof?” (Kamps “Labia Envy”). Louisa Kamps, columnist for the “Mothers Who Think” feature of the electronic magazine Salon, learned of Dr. Gary Alter’s new procedure for aesthetic vaginal labioplasty and conducted an interview with him. She notes that when she spoke with Alter about labioplasty, he seemed convinced there was “something freakish” about his patients (Kamps “Labia Envy”). She reports that he sounded as though he were rationalizing the need for labial reduction in some of his patients: “He says, pointing to slightly asymmetrical labia, ‘You see how this is, er, real large?’” (Kamps “Labia Envy”). Kamps asserts that from looking at the photos she can not see why he would say that they are “real large,” certainly not as large as the previously mentioned medical definition of enlarged labia. Kamps comments on a second set of pre- and post-operative photographs: “The labia in the next photo are more elongated, but by no means strange” (Kamps “Labia Envy”). She points out, after a careful study of the photographs, that in the “before” images, the women’s labia were characteristic; Kamps quips that, “You could have picked [them] out of a lineup” (Kamps “Labia Envy”).

However, in the after photographs the patients’ genitalia look eerily similar (Kamps “Labia Envy”). And even more striking is that the fashionable look Alter creates for his patients’ genitals is slim, symmetrical and straight (Kamps “Labia Envy”). The appearance of these women’s genitalia could also be used as a metaphor for the cultural construction of the female body as a whole. Although external genitalia comes in “a snowflake-like spectrum” (Kamps “Labia Envy”), women feel the need to conform not only to ideals of beauty that people can see, namely the face and the figure, but to ideals of beauty imposed on their most private bodily regions, those hardly ever exposed to any sort of gaze, be it male or female.