Psychological Issues and Social Mores in Female Genital Aesthetic Surgery: What Is Normal?

Kharen Ichino, Jennifer L. Walden

Key Points

• No consensus exists regarding what constitutes a normal external appearance of the female genitalia.

• The contemporary Western ideal of the “perfect vagina” is often described as hairless and pink with labia minora not projecting beyond the labia majora.1

• Studies show a wide range of sizes for each part of the genitalia, making it difficult to describe normal measurements.²

• Psychological improvements are well described in women who have undergone female aesthetic surgical genital procedures for cosmetic and functional reasons.^3,4

• The highly controversial topic of female genital mutilation (FGM) or female genital cutting (FGC)—excising parts of the female genitals for traditional or religious beliefs—is still practiced in third world countries and is their norm of female genital beauty.⁵

• The beauty norm is completely subjective for each patient and should help to improve psychological, physical, and sexual states, even in cases of aesthetic genital surgery.

As with technology and fashion, the perceptions of beauty are constantly evolving. Well into the 1950s, aesthetic plastic surgery occurred in secret and was considered a taboo subject to even mention.⁶ Today, because of the organization of national plastic surgical societies around the world, millions of cosmetic surgery procedures have been performed. For instance, the American Society for Aesthetic Plastic Surgery (ASAPS), consisting of experienced and well-qualified aesthetic plastic surgeons, has published data suggesting that approximately 16 million cosmetic surgeries were performed in the United States in 2014.⁷ The most popular procedures such as breast augmentation and liposuction are familiar to many and have paralleled the definitions of modern beauty. Labiaplasty, which has been performed since the late 1970s,³ is increasing rapidly in number. Women are not yet as comfortable discussing this procedure openly despite the increase in awareness across all media channels. According to ASAPS, (Cosmetic Surgery National Data Bank Statistics), 8745 women had labiaplasty (excluding vaginal rejuvenation) in 2015 in the United States.⁸ This number may seem small compared with the other popular procedures mentioned, but it has increased by 44% from 2013—evidence of a trend that will probably continue to rise significantly⁹ (P. Banwell, personal communication, 2016). The increasing desire for labiaplasty worldwide begs a few questions: Is there such thing as a “perfect” vagina, and what is considered normal? This chapter addresses the different cultural definitions of female genital beauty and the wide variants of normal. Not only the physical but also the psychological improvements that aesthetic genital surgery can provide will be discussed, as well as the associations and implications of FGM on contemporary society.

The Rise in Labiaplasty: Social Influences

The rise in demand of labiaplasty for aesthetic and functional reasons has increased significantly in Western culture. Labiaplasty has been practiced since the 1970s, when, even then, women thought that the labia minora should not protrude beyond the labia majora for aesthetic and functional satisfaction.3 The gradual increase in this trend is suspected to result from the ease in access of images and information through the Internet, such as the perfectly bare vaginas seen in pornography and photoshopped pictures of celebrities in tight-fitting clothes, lingerie, and swimwear. Snug-fitting clothes like leggings and yoga pants have become fashion trends that lead women to be more cautious about the way their crotch is contoured.¹⁰ Sex talk is more prominent among liberated young women, but their genitals are rarely discussed in detail. Unlike men, even when women are completely naked in front of other women, genital details are usually not exposed. This ambiguity prevents many women from becoming aware of all the size, shape, and color variations; thus images seen in pornography and textbooks are referred to as normal.

In some studies, most women described a pretty vagina to be hairless and pink with the labia minora very small or nonexistent.¹ In a recent documentary written by Lisa Rogers entitled “The Perfect Vagina,”¹ women as young as 16 years of age were concerned with the way their vagina looked. A 16-year-old girl thought that her boyfriend would not be attracted to her after seeing her genitalia, so she decided to have surgery at a relatively early age. In another case, a 21-year-old woman was teased by her own sister for having a “hangy” and verbally teased by her male friends who had never even seen it themselves. She was too embarrassed to present herself in front of medical professionals, so she neglected going to her annual gynecology examinations, which could have led to more serious health problems. In these two cases, views of the opposite sex played a role, yet cultural studies showed that 98% of heterosexual men never care about the appearance of a vagina, in contradiction to what modern Internet pornography leads many to think.¹⁰ Despite the indifference of the opposite sex, some women self-critique by comparing themselves to the images of perfect vaginas.