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Current Sexual Health Reports
Published in: Current Sexual Health Reports 4/2020

Open Access 01-12-2020 | Labioplasty | Sociocultural Issues and Epidemiology (J Abdulcadir & D Bader, Section Editors)

Re-thinking the Zero Tolerance Approach to FGM/C: the Debate Around Female Genital Cosmetic Surgery

Author: Janice Boddy

Published in: Current Sexual Health Reports | Issue 4/2020

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Abstract

Purpose of Review

To examine the ‘zero tolerance’ policy for female genital cutting (FGM/C) in the international health community in light of the growing popularity of FGCS (female genital cosmetic surgery) worldwide.

Recent Findings

‘Traditional’ FGM/C performed in Egypt and Sudan and cosmetic labiaplasty performed in Europe, the Americas, and Antipodes by medically trained gynaecologists and plastic surgeons are based on similar aesthetic logics: labia minora that protrude beyond the labia majora are deemed ugly, masculine, and ‘abnormal’. Drawing on the burgeoning medical, social science, and humanities literature surrounding labiaplasty, the paper documents the narrowing of aesthetic standards governing ‘normal’ genital appearance and finds that, in addition to adult women, thousands of (mainly Caucasian) adolescents have undergone these operations whose long-term health consequences are unknown.

Summary

Western heteronormativity, gender binarism, ageism, and the colonial association of protruding labia minora with animality contribute to body image insecurities and fuel the labiaplasty phenomenon, despite the ethical challenge that the procedures are clearly defined by the WHO as type II (a–c) female genital mutilations.
Footnotes
1
In 2007, Liao and Creighton noted a fivefold increase in the number of labiaplasties being performed in the UK in the past decade under the NHS [17]. In the USA, ASAPS statistics from 2018 show that labiaplasty was among the fastest growing cosmetic surgery procedures, up 53% since 2014, and by 18.3% since 2017 alone [18]. In Australia, annual Medicare claims for labiaplasty more than tripled between 2000 and 2011 [19].
 
2
The modified or intermediate operation was introduced in the 1920s by British nurse midwives who trained local women as medical midwives (see note 1). It entails less cutting of the labia minora and labia majora than before, and a partial infibulation of the labia majora anterior to the urethral orifice [4].
 
3
Related procedures on offer include non-surgical laser labia tightening, labia puffing, clitoral hood reduction, G-Shot® injection, hymenoplasty and hymen restoration, vaginoplasty, and laser hair removal.
 
4
Jafar ([33]:2) notes that California lawmakers introduced a bill in January 2019 to ban non-medically necessary genital surgeries on intersex children and minors until they are able to give informed consent. However, the bill has been stalled owing to objection by The Society of Pediatric Urology, which claims that it would abrogate parental rights.
 
5
A clause in the 2017 revision (and 2020 affirmation) of this opinion reads ‘surgical alteration of the labia that is not necessary to the health of the adolescent, who is younger than 18 years, is a violation of federal criminal law’ referring to the Female Genital Mutilation 18 Act, U.S.C. 116 (2015), a law that was deemed unconstitutional in 2018.
 
6
This begs consideration of male circumcision as a form of traditional gender surgery that is typically exempt from laws against genital mutilation. See Earp, Current Sexual Health Reports, this volume.
 
7
This is not, of course, intended to endorse either form of genital modification, only to note their similar logics.
 
8
More recently, Kreklau et al. examined 657 Caucasian women of varying ages and weights and found average labial width (what would be considered length when standing) of between 13.4 and 14.15 mm, with maximums between 42 and 61 mm ([101]:1658).
 
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Metadata
Title
Re-thinking the Zero Tolerance Approach to FGM/C: the Debate Around Female Genital Cosmetic Surgery
Author
Janice Boddy
Publication date
01-12-2020
Publisher
Springer US
Published in
Current Sexual Health Reports / Issue 4/2020
Print ISSN: 1548-3584
Electronic ISSN: 1548-3592
DOI
https://doi.org/10.1007/s11930-020-00293-1

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