Feminists view activism as a complement to scholarship and journalism. Female genital cosmetic surgery (FGCS) scholarship names, analyzes, and deconstructs the various components of a new surgical industry managing women’s bodies. As this book shows, recent scholarship has examined FCGS types, prevalence, justifications, proponents, and enabling factors. FGCS journalism tells individual stories of doctors and patients and offers accurate (sometimes) and misleading (too often) local information. FGCS activism attempts to disrupt the industry.
Many chapters in this book of interdisciplinary FGCS scholarship are likely to be critical of the industry while acknowledging the rights of individual surgery consumers. With any luck these chapters will lay out the scholarly landscape of FCGS: Who, What, When, Where, How, and, above all, Why.
But some of us coming from a feminist viewpoint who are critical of this new industry feel an urgency to go further and to take public action to diminish its impact, even to eradicate its existence. There is no recipe for such activism, or any activism, for that matter, no definitive list of successful or to-be-avoided strategies, and most of us who want to supplement our scholarship with activism are amateurs in the public realm. I came, for example, from a background in academic sex research and clinical sexology, and this chapter will offer my perspective on FGCS activism based on a decade’s (2007–2017) efforts .
Academics have often focused their scholarship on social problems and in recent decades have participated in many types of campus and community advocacy activities. Yet, there is an enduring “chasm” between activists and the academics who research and write about social issues and movements that bespeaks a “creative tension between thinking and action, between theory and practice” that limits academics’ ability to engage in political activism (p. xii) .
Professional codes and traditions of conduct have likewise inhibited doctors, nurses, and lawyers from getting involved in social change activities. Professionals are encouraged to advocate for their clients and patients, but fear of jeopardizing their professional standing, licensure, or employment often discourages professionals’ public advocacy behavior. Over five decades (1960s–2010s) as a sex educator and researcher, a licensed New York psychologist and sex therapist, and a member of many professional organizations, I saw very little attention paid to advocacy in scores of professional conferences – no workshops teaching activism skills, no plenaries describing successful activist campaigns, no lectures highlighting needed areas for advocacy. If activism was mentioned at all, it was informally, when conference attendees discussed their “private lives.” I learned that activism was something some professionals did in their spare time, not as part of their career.
The exception to this was in feminist professional groups such as the Association for Women in Psychology or the Society for Menstrual Cycle Research, where politics was a regular topic of invited lectures and participatory workshops and where activist demonstrations were on occasion even scheduled into the program. Framing one’s career in terms of “scholar-activism” was acceptable, even popular, in these groups, reflecting the goal of social change at the core of feminism.
The FCGS industry is linked to numerous socioeconomic factors and agents as identified in other chapters in this book. Challenges require both short-term and long-term goals and utilization of a wide array of strategies and tactics. I see the FGCS activist agenda as a combination of campaigns to reduce both the demand for and the supply of FCGS insofar as the growth of the industry has come about because of increases in both. Success will require attacking both ends of the problem.
Reducing the demand for FGCS will be accomplished by increasing its negatives and decreasing its positives in the eyes of both consumers and professionals. By “increasing the negatives” I mean raising awareness of harmful consequences and side effects, increasing the financial cost, and stigmatizing consumers as gullible and professionals as exploitative. Raising awareness largely involves disseminating research, opinion pieces, and personal stories through teaching and speaking opportunities along with using commercial and social media.
“Decreasing the positives” of FGCS must also focus both on FCGS practitioners and the public and includes public education campaigns that highlight diverse untreated vulvas and their attractiveness, legal challenges to FGCS advertising, promoting restrictive professional guidelines for genital surgeries, and shaming FGCS practitioners. Obviously, activities such as “shaming” and “stigmatizing” are controversial and not for the faint of heart, but insofar as they are undertaken indirectly, these terms are not used. I thought it advisable, however, to be candid in this chapter about how activists construe their strategies.
The effectiveness of such activist efforts should be measured by demonstrating increasingly negative public attitudes toward FGCS and reduced FGCS availability and utilization. Documenting these types of changes is not easy, however. An ideal study would conduct a baseline survey prior to any action and then collect results on the same or a similar survey afterwards. While there have been a few FGCS attitude surveys, they are limited by the circumstances of collection, sample used, and questions asked , and I do not know of any repeated measures evaluating the effectiveness of FGCS activist campaigns. Future activism should consider incorporating before-and-after survey elements to document attitude changes.
Measuring the decline in FGCS utilization is also difficult. Journalism often presents statistics on the prevalence of FGCS procedures, from the American Society of Plastic Surgeons, for example , and articles in recent years have pointed to increasing numbers as a sign of the growing popularity of FGCS. However, methods of collecting such data and the clarity of classifications are confusing and controversial, and while we see many numbers floating around and lots more media attention to FGCS it is premature to conclude that prevalence is on the rise.
Activist projects focusing on FGCS vary greatly based on duration, style, focus, structure, and membership. Some involve direct action; some have a longer-term focus on changing public and professional attitudes. Some are stand-alone projects; some emerge from women’s health or sexuality organizations. Some are one-person initiatives; some have large teams of participants. We know about most of them only because of media coverage. I would venture that college campus and women’s health organization activist initiatives are numerous. As the media attention to FGCS grows, resistance also grows and activism becomes more salient and acceptable.
The largest group of activist projects I have identified are “vulva-positive” campaigns that celebrate the diversity of the vulva and explicitly accentuate its attractiveness. They aim to decrease the positives of FGCS by reducing genital disgust and dissatisfaction. In March, 2016, for example, I learned of a small sewing project in the United Kingdom. Julia Williams had been holding workshops to design patchwork vaginas out of fabric, fur, and glitter to promote body confidence and raise awareness of genital mutilation. “The artist and mum-of-two started the movement as a response to the growing trend for women to undergo labiaplasty or ‘designer vagina’ operations” . I found out about this project accidentally online and believe there are many more. Here are some I have followed.
In 2008, British sculptor Jamie McCartney made plaster casts of hundreds of women’s vulvas, and created an artwork he called “The Great Wall of Vagina” . Initially shocking, a decade later it is now clear that McCartney’s work was the beginning of a wave of vulva-positive art. The “Great Wall” has been widely exhibited and you can learn about a dozen spinoff projects on its website. A project called “Extremes” specifically speaks to FGCS activism:
EXTREMES – Another way to demonstrate human diversity is to concentrate on extremes or on certain themes. Thus we are also seeking women who fit into these categories: If you have particularly LARGE or SMALL LABIA or CLITORIS or you have anything you consider or know is UNUSUAL down there like multiple piercings, hypertrophia, hyperelasticity, childbirth changes etc and are willing to anonymously share it with the world then do get in touch. For many women, modeling for these works has been a real catharsis that alleviates personal anxieties. Once you cross that Rubicon you are free! (capitals in the original) 
Playwright Eve Ensler wrote and performed a one-woman play called The Vagina Monologues in New York in 1996 . Among other topics, this piece celebrated women’s genitalia. Despite criticisms of some of its politics, it has continued to be hugely popular and performed on college campuses and in communities around the world. In 1998, Ensler began a larger activist initiative called “V-Day,” focused on eradicating violence against women, bankrolled by the sizeable profits from performances of The Vagina Monologues. Without explicit mention of FGCS, V-Day activities have promoted positive body and genital imagery and language, and challenged female genital mutilation (FGM, sometimes called female genital cutting [FGC]).
Nick Karras is a sex educator and photographer who created a video (2005) and a book (2012) of diverse vulva portraits called The Petals Project . The anti-FGCS component is made explicit by a quote he places prominently on his website:
Why didn’t people tell me about this before I had my labia plasti? I used to really hate the appearance of my inner lips. I was delighted when I originally heard about the labia plasti, so I jumped on it. Yes, they are smaller now and I was pretty happy about it. When I saw this book at my friend’s house, I was astonished. This might sound ridiculous, but I really never knew how almost everyone had somewhat large inner lips. After looking at the pictures, I now feel like a circumcised male … it was beautiful as is. It’s too late for me, but I hope this book gets to the hands of women around the world who think that having a full labia is not pretty!
Stacy, California. (all spelling as in original)
A similar film called The Centrefold Project has been showing internationally at women’s film festivals and I would guess there are many other similar projects of photography and affirmation. If Jamie McCartney is right, making these films affects participants as well as viewers, destigmatising and demystifying their own “lady bits.”
The Muffia is a UK performance art collective of Katie O’Brien and Sinead King, who began making political statements about women’s bodies on the streets of London and Manchester in 2008 . They wore furry/hairy pubic muffs (pubic hair wigs known as “merkins”) outside their clothes as they walked around, using their bodies as billboards to deliver body liberation messages. While not explicitly about labia or cosmetic surgery, their demonstrations draw attention to being proud “down there,” and thus count as a form of FGCS activism.
An exhibition of vulva art pieces by dozens of prominent artists was shown in 2010 at a New York art gallery . A beautiful catalog was published. Reviews were positive, although generally concurring that the “shock value” of this kind of display would have been greater thirty years earlier. Such art shows (and there are others) presumably increase women’s positive feelings toward vulva diversity and their own genitalia, albeit without ever mentioning FGCS.
Women complained to the UK Advertising Standards Authority about an ad for labiaplasty in the Metro newspaper, calling it “irresponsible” and objecting that the description of labiaplasty as achieving “a more natural appearance” implied that presurgery labia might be thought “unnatural” in appearance .
Australian investigative television exposed how pornography magazines utilize graphic artists to trim depictions of women’s labia to conform to no-genital-details censorship publishing rules. The Hungry Beast produced an astonishing video in 2010 showing the similarity of what the graphic artists do to what surgeons do in FGCS, thereby in both cases reducing the types of vulvas to one standard tiny style . Exposing this kind of media trickery presumably increases a negative opinion of FGCS by associating it with deceptive practices.
I will leave it to others in this book to document the gradual increase in restrictive FGCS guidelines developed by various medical groups, only noting that our activism (see later) always included sending letters to such organizations. Though we never received any acknowledgment, it is plausible that our voice helped shift professional judgments.
The New View Campaign originated in 2000 to challenge the medicalization of sexuality seen in new dysfunction diagnoses, new biomedical workups for sexual distress, new dysfunction drugs, and the overall incursion of pharmaceutical industry money and medical practitioners into sex research and therapies . We engaged in scholarship such as conferences and publications and activism such as online petitions, op-eds, and public testimony at the U.S. Food and Drug Administration (FDA).
In 2008, we learned of a development in gynecology that seemed tailor-made for our analysis and activism: FGCS. Like the movement of ambitious urologists looking to make a name for themselves in a newly created field of “Female Sexual Dysfunction,” a self-identified group of “cosmetogynecologists” was emerging to advertise various FGCS surgical procedures to beautify and “normalize” the vulva. The idea struck us as dangerous to women and designed to exploit women’s sexual insecurities and lack of anatomical information. FGCS seemed uncannily similar to the pharmaceutical industry’s promoting drugs as the best way to help women’s sexual response problems.
Our FGCS activism took place over a four-year period, 2008–2011, involving many different activities and a changing cadre of activists, and as with most amateur activism it evolved as opportunities arose and our analysis expanded.
Our involvement with FGCS began as a result of a 2008 New York Times article about a new “pelvic fitness” clinic that referred to “cosmetogynecology” [15,16]. Our small New York City antimedicalization study group decided to research this new industry and to plan some sort of activism. We didn’t have a plan of action but our experience with the pharmaceutical industry gave us some directions. The work was done by a core group of five (primarily NYC graduate students in critical psychology) and about a dozen additional helpers and demonstration participants drawn from my feminist friends and colleagues. All of our actions and research are shown on an extensive webpage we created .
We identified eight New York City cosmetogynecologists who advertised FGCS procedures online and made a chart of information from their websites (e.g., the types of procedures on offer, whether they were franchisees of entrepreneurial California surgeon David Matlock who promoted FGCS as a business, if they showed before-and-after photos, etc.). We documented the “exaggerated and misleading claims” made on the websites. We wrote ten letters to US government officials and agencies (e.g., Federal Trade Commission Office of Consumer Affairs [FTC]) and professional organizations (e.g., American College of Obstetrics and Gynecology [ACOG]) protesting the unregulated advertising and claimsmaking we observed. We did not receive a single reply.
Pretending to be prospective patients, we visited the clinics and chose one with a location that seemed appropriate for a street demonstration. We sent a press release to hundreds of media outlets announcing our action to demand attention to the effects of unregulated surgical procedures on women’s labia and vaginas. We obtained more than fifty endorsers of our demonstration and posted their names online. We scheduled an afternoon of sign-making at The New School University and prepared costumes for our guerrilla theater piece. We notified the police of our planned demonstration and they set up sawhorses to confine our march to a limited part of the sidewalk.
Our two-hour street demonstration in November (chilly but sunny) consisted in walking in a circle on the sidewalk outside the office building housing Dr. Ronald Blatt’s FGCS office chanting slogans and carrying colorful signs reading, for example, “Long Live Long Labia,” “Stop Marketing Discontent” and “More Research Less Marketing” (see Figures 10.1 and 10.2). Three members of our group repeatedly performed a guerrilla theater piece titled “Dr. IFFA and the Two Labias” highlighting the seductive interest-free financing (IFFA) policies of cosmetogynecology doctors. We compiled still photos into a one-minute video. Our demonstration was covered in TIME magazine  as well as being written up by demonstration members in various publications and blogs.