Q:
I’ve read it’s becoming a trend for women to get surgery to reduce their inner pussy lips. I think that’s awful! What’s behind this?

A:
First, let me say that I agree. It’s awful. I’m against labiaplasty (surgically altering the inner lips of the vulva, called the labia minora) done purely for cosmetic reasons.

That’s not a minority view where I come from. I’ve heard a lot of expert opinion on the issue, and it’s overwhelmingly against this kind of cosmetic genital surgery. Risks include loss of feeling due to nerve damage, painful scarring, and infections. The benefits are in the eye of the beholder, at best.

Many experts chalk up the desire for surgically trimmed labia to women’s ignorance of their anatomy. Explanations tend to follow one (but sometimes both) of these arguments:

1. A woman who wants this surgery typically believes her labia are abnormal. She thinks so because she hasn’t seen many other examples. That’s because she rarely looks at close-up, detailed images of vulvas. So, if you show her numerous pictures of vulvas, she might appreciate the snowflake-like diversity among them. Then she might embrace her vulva’s specialness and leave her labia alone.

2. Women want labiaplasty because they think their parts should match what they see in porn, despite their awareness that the vulvas depicted in porn often conform to an unnatural ideal—neat, hairless slits.

In a recent Medscape.com interview, a prominent gynecologist and reconstructive surgeon, Dr. Cheryl B. Iglesia, said, “The trend toward pubic hair removal gives people a clearer view of the genital area. Many of the images in the media, and certainly on the internet and in pornography, feature no pubic hair, and the external genitalia appear to be uniform, almost Barbie-like.”

Therefore, exposure to close-up, detailed images of vulvas doesn’t discourage labiaplasty, but drives women toward the procedure.

I don’t buy either argument. First, anyone who seriously considers having bits of her labia sliced off, just for looks, doesn’t care about normal variation in anatomy. She’s either profoundly unhappy with her labia, or very cavalier about going under the knife (and perhaps has had a lot of other cosmetic work done).

The “because of porn” argument could only make sense to someone who hasn’t seen a lot of porn.

In the same Medscape interview, Dr. Iglesia implicates this very magazine in connection with cosmetic labiaplasty. Asked how health professionals could help women and girls feel okay about their genitals, she answers, “Displaying contrasting images of normal vulvar anatomy would be useful.”

Agreed. But then Dr. Iglesia goes on to say, “What sells right now in such publications as Playboy and Penthouse and in internet pornography are prepubescent images. I hope that larger labia and pubic hair return as fads.”

I would like to invite the doctor to use our montage of images displaying normal vulvar anatomy, all of which were drawn from Penthouse pictorials published in the past year.

Dr. Iglesia’s own research contradicts her claim that porn makes women want to alter their labia. She contributed to a study in which 360 women aged 18 to 72 rated the appearance of different vulvas. Regardless of their age, personal hair-removal habits, and where they learned what vulvas look like, most women were satisfied with their own vulva, and deemed hairy and shaved vulvas to be equally “normal.” When asked to pick the most attractive vulva, most women chose one that was hairless, with symmetrical inner lips that did not stick out past the outer lips, a small clitoris, and a clitoral hood that didn’t protrude past the outer lips. The researchers claim that these traits are “all consistently seen in pornography.”

Nevertheless, the study showed that preferring a bald, trim vulva had no bearing on women’s interest in surgically altering their own vulvas. Women who expressed interest in surgery tended to be older. According to the study’s authors, giving birth and hormonal changes during menopause cause changes in the appearance of the vulva. They write, “Therefore, restoration of prior appearance and anatomy, rather than a distorted vulvar perception, may be the source of this difference.”

I won’t sit quietly and let people blame porn for every fucked-up thing women do. At the same time, I’m glad that experts like Dr. Iglesia are speaking out against unnecessary genital surgery. I don’t want to see women harmed by a craze for “designer genitalia.” But I think it’s too early to sound a general alarm.

The American Society for Aesthetic Plastic Surgery reports that, last year, a total of 3,521 “vaginal rejuvenation” procedures were done in the United States—including labia lopping and other nips and tucks to the vagina and vulva. That was up from 2,142 procedures in 2011.

You could say that labia-reduction surgery affects thousands of women and is growing at a rate of 64 percent per year. Or you could say that very few women get this surgery. It accounted for only 0.2 percent of the 1.69 million cosmetic surgeries done nationwide in 2012.

In the same year, plastic surgeons did more than 330,000 breast implants, 156,000 tummy tucks, 153,000 eyelid lifts, and 112,000 breast reductions.

Labiaplasty isn’t popular now, and I bet it won’t ever be. It’s one thing to follow the latest fad and get intimate waxing, vajazzling, tattoos, or piercings. But it’s quite another to opt for having bits of your genitals sliced or burned off. There must be a ceiling on how many women in a given year will go for that. I expect it’s pretty low.

Whether you’re looking for tips to improve your performance between the sheets, answers to a question or two, or help with an issue you can’t take to even your most trusted friend, our expert can help. It’s time to get schooled.

Have a question for Martin Downs…submit them to: sexed@ffn.com.

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