Nipping and Tucking Your Bits: The New Nose Job?

In Western society, men often learn that they should be keenly aware of their penises (and many even measure their masculinity based on their size and performance), but women often learn little to nothing about their vulvas (i.e., their external genitals). These life-giving pleasure centers are mysterious and wonderful, but they can be a source of confusion and mistrust. Many women (and those with vulvas who do not identify as female) have never even looked at their own vulvas! In Season 2 of Orange is the New Black, the always fabulous Sophia (a post-op trans woman) had to explain to her fellow inmates that there is a hole for pee that is separate from the vagina... As odd as that scenario may sound, many vulva bearing individuals are not educated about their genitalia partly because they grow up believing that they should not explore “down there.”

Not only do some women fear what’s going on “south of the border”, they may also believe that their vulvas are ugly or abnormal. Research has shown that there are many women who experience psychological distress and impaired sexual functioning because they are unhappy with the way their vulvas look. Some avoid sexual contact altogether, and others undergo painful procedures to “fix” what they have between their legs. Where is this shame coming from? And how can it lead to an extreme desire to have their own perfectly functioning bits nipped and tucked?

Unlike those individuals with penises, those with vulvas are rarely exposed to other vulvas, so they cannot develop a realistic comparison group by which to judge their own “naughty bits”. This problem is further complicated by the prominence of one type of vulva in sexually explicit movies and pictures. That’s right, porn. We all know that the average person’s penis size and capabilities are likely not equivalent to what is glorified in pornography, but can the same be said for the appearance of vulvas? Unfortunately not.

Many of the vulvas put on the pornography pussy pedestal feature very small labia minora, so that no folds of skin extend beyond the labia majora. This particular configuration is ideal for pornography because it makes filming sexual acts easier. Other parts of the vulva are easily exposed without those silly inner labia getting in the way.

Pragmatically, it is somewhat understandable that the porn industry would want to capitalize on their “money shot”. Fine. But when a government gets involved and declares that the presence of labia minora in photos and videos “obscene”, that’s another story altogether. In Australia, publicly available depictions (e.g., in newspaper articles or softcore porn magazines) of the labia minora must be “discreet.” It turns out that “discreet” means that the labia minora must be nearly non-existent or hiding between the labia majora when viewed from the front. Peek-a-boo! This practice apparently equates to being “clean” or looking tidy, and companies must digitally alter their material to conform.

So, not only are we seeing “designer vaginas” in pornographic films, we very rarely see an unaltered vulva in other sexual and non-sexual images either… How are we supposed to know what is “normal”? The answer must lie in the medical literature, right? Doctors, after all, are exposed to body parts that the rest of us rarely see, so they must have an idea of what is considered “normal”. However, there are notable variations in what is considered “normal” even within the medical field. “Normal” seems to fluctuate based on whether you’re talking to a gynecologist or a plastic surgeon. Some (typically gynecologists) say 5cm should be the max width of the labia, while others say 3cm (typically plastic surgeons). Some plastic surgeons are even allegedly advising women to look to the pornography industry to help them decide how they want their vulvas to look…

Paired with a paucity of education, varying definitions, and a lack of comfort with asking sexuality-related questions, the previously described patterns of media depictions create the perfect breeding ground for a new trend in plastic surgery – the labiaplasty. If having labia minora that extend past the labia majora is considered dirty, messy, and sexually unappealing, then why not just get rid of the excess?

Now, there are some women who experience functional impairment because of the size of their labia. They might experience irritation, discomfort, or pain during sexual intercourse, while wearing clothing, while exercising, etc. In these cases, the labia are in the way, so it is medically indicated to have surgery to reduce the size of the labia minora.

Regardless of what your definition of “normal” is, research reports indicate that women seeking this type of procedure rarely fall within the “abnormal” range. Indeed, women with healthy, “normal” labia are choosing to have this painful elective surgery that could have negative consequences. This isn’t like having your bangs trimmed, folks. As with any surgery, you could experience any range of complications, ranging from a simple infection and localized pain, to scarring, altered sensation, and the development of long-term chronic pain. Just watching a video of the surgery might even be a good reality check; it was enough to make me queasy...

Indeed, the quest for a “designer vulva” is one of the fastest rising elective surgeries; some have reported that it is in the top 20 of elective cosmetic procedures that are being performed. While it’s true that we have every right to do as we wish with our bodies, it’s extraordinarily important to ensure that we are making an informed choice, and understand the motivations behind that decision. In the medical literature, doctors have spoken out about the importance of educating patients on what is considered “normal”, and encouraging them to think carefully before undergoing such a procedure. Further, while some doctors and researchers claim that undergoing a labiaplasty can result in improvements to psychological well-being and sexual functioning, other studies suggest that such patterns do not occur, or fade with time. Unfortunately, by the time a person reaches the doctor’s office seeking surgery, they have likely made up their mind.

Others, it turns out, try to bypass the doctor’s office altogether. Unfortunately, not everyone has the financial capability to alter their anatomy in order to match their ideal body. I was alarmed to come across a medical report titled “Self-Attempted Labioplasty with Elastic Bands Resulting in Severe Necrosis.” Here’s how it began:

“A 26-year-old … white woman, presented to the emergency department with the chief complaint of genital pain and foul odor on her vulva. The patient reported she had always worried about the size of her labia minora and felt they were larger than they should be, especially after the birth of her last child. She had never discussed this with her medical practitioner and, now, was without insurance. She discussed the size of her labia with a friend who suggested she place a rubber band around the part of her labia that she wanted removed and that part would ‘‘fall off.’’ Three days after placement of the bands, she started to experience increased labial pain and noticed a ‘‘foul smell.’’ After 2 additional days, she was unable to tolerate the pain and the foul odor and presented to the emergency department for evaluation. She reported that the labia felt enlarged and that she had difficulty voiding and was very uncomfortable while wearing clothing.”

Needless to say, the elastic bands did not cause the excess skin to “fall off”. The authors went on to describe the great difficulty they had in removing the elastic bands. Attempts to do so were thwarted by the incredible pain this poor woman was in. The area had to be anesthetized, and the dead tissue had to be surgically removed. Ironically, in the end she got the surgery that she wanted but couldn’t afford. However, she had to go through days of agony before seeking help. In this case, the disastrous combination of misinformation and desperation created this unfortunate situation.

At the end of the day, people have the right to decide what they would like to do with their bodies. All we can ask is that they educate themselves on the possible risks and explore the reasons behind their decisions. My hope in writing this piece is to uncover some of the reasons why so many women (and those with vulvas who don’t identify as female) feel at odds with their genitals. By identifying and combating toxic cultural motivators and presenting alternative viewpoints, perhaps we can encourage folks to get up close and personal with their parts; maybe even learning to love, or at least accept them. That’s the feature of a new line of research coming from our lab; we are running a study this year that will help us understand motivations for labiaplasty.

Luckily, the increase in labiaplasty procedures has been accompanied by an increase in campaigns to encourage people to love their vulvas. The documentary “The Perfect Vagina” follows women as they embark on various ways of becoming more comfortable with their vulvas, either through surgery or self-exploration. The book Read My Lips: A Complete Guide to the Vagina and Vulva is an excellent, research-based guide to a healthy and happy relationship with your vulva. The picture books, Vulva 101, Femalia, and Petals present a series of realistic, naturally varying vulvas. Exposing people to such variety of vulvas can help them realize that not every vulva will look like a porn vulva, and that like flowers, there are many different beautiful variations. Nature’s strength is in its wondrous diversity, and that is reflected in many things—including genitals!

Emma Dargie, Ph.D. Candidate