The Quest for the 'Perfect Vagina'

Fixated on her perceived problem, Juliette decided to do something about it – and in July of last year settled on a labiaplasty, a procedure that involved having the skin she was self-conscious about removed entirely.

In having part of her labia amputated, Juliette joined a growing number of women who have had cosmetic surgery on their genitals; either labiaplasties, procedures designed to alter the size or shape of the inner labia, or vaginoplasties (sometimes referred to as "vaginal rejuvenations", not to be confused with the catch-all term for genital cosmetic surgery, "female rejuvenation"), which are operations aimed at strengthening and tightening the vagina area – a vaginal "facelift", if you like.

According to the American Society of Plastic Surgeons, a total of 12,666 labiaplasties were performed globally in 2016. That's a significant 39 percent increase on the previous year, making it the fastest-growing cosmetic procedure in the world.

Unsurprisingly, these female rejuvenations are not without controversy: while some women laud the procedures as life-changing, others cast them as a symptom of a deeply shallow, misogynistic popular culture.

WATCH:

For her part, 32-year-old Bonnie took a leap of faith and invested in a "vaginal rejuvenation" surgery after seeing the procedure on Botched, a TV show about cosmetic surgery gone wrong. "I'd always been self-conscious of my labia," she says. "I didn’t like the way it looked or how it felt in my clothes, and in intimate situations I would keep covered up. [Since having the surgery] I can go to the gym or wear a bathing suit without worrying about a camel toe, and can now wear any underwear I want. Labiaplasty changed my life. I never thought I'd feel confident sexually, and now I do."

Not all of the women who receive this kind of surgery are born with a vagina they want to change; many opt for the procedure after becoming mothers. After childbirth, the vaginal muscles and tissues of the pelvis can sometimes stretch and separate, resulting in a laxity that can lead to a loss of sensation during sex – a common driver for vaginal rejuvenation. Others report feeling self-conscious about the appearance of their vagina after a natural birth.

Mother of two, Kaye, went for "laser vaginal rejuvenation" – which is exactly what it sounds like: a laser-based treatment that helps to fight dryness and firm up the vagina. "I noticed a difference the day after. It made me feel fantastic and sexy again," she says. "I hate that the result of these kind of treatments is called a 'designer vagina'. It's not designer, it's reconstruction. If a man’s penis fell apart after childbirth it wouldn’t be called a 'designer penis'; it would be fixed immediately. But, with women, I feel we're just told to get on with it."

Since those pioneering procedures, the practice of genital cosmetic surgery has progressed exponentially, both in effectiveness and precision.

When Dr Heather Furnas MD performed her first labiaplasty nearly 20 years ago, it was to improve her client's sex life.

"A hospital employee told me his girlfriend wanted one because she was so miserable with the pain and discomfort her labia gave her," says Heather. "I made it clear that it would be my first labiaplasty. I researched the procedure before undertaking the surgery, and she was thrilled with the results. At that time, very little had been written about labiaplasty, and most women had never heard of it."

These days, Dr Furnas is a specialist in the field of vaginal rejuvenation, working with her husband – Dr Francisco Canales MD – out of a practice in California. I ask the pair what, clinically, they look to create during one of their procedures. The answer: flat mons pubis; small, thin, pink inner lips; full outer lips; symmetry; no folds in the clitoral hood; and a tight opening of the vaginal canal.

There you have it: the archetypal "perfect" vagina, apparently.

Of course, it's this sort of classification – and, concurrently, a culture that allows for the idea of a "perfect vagina" – which attracts criticism of female genital cosmetic surgery. While some portray the procedures as revolutionary, others view them as anything but. Plenty of art has been created about the fact that no such thing as an "ideal" or even "average" vagina exists, and many women's sites and magazines have published articles calling on readers to "start loving" their vaginas.

Alice Felice Cara, the founder of women's magazine Running in Heels, is hugely against vaginal rejuvenations.

"In our filtered, facetuned world, the quest for perfection extends to even the most intimate parts of the female anatomy, and it can't be a coincidence that the only time we ever encounter vaginas is in porn films – generally made for men, by men," she says. "It's been 20 years since Eve Ensler's seminal work, The Vagina Monologues, was published, but we seem to have made scant progress. We need to talk about vaginas. We need to put an end to the myth of the perfect vagina."

However, influencing factors are often much more insidious than they are direct. As NHS Consultant Gynaecologist and Laparoscopic Surgeon, Mr Shaheen Khazali MD, points out, the rise of the "designer vagina" (in the purely aesthetic sense) is actually more self-perpetuating than anything – but really needn’t be.

"The main concern is with the lack of understanding that people come in different shapes and sizes, as do their genitalia," he says. "In recent years, for different reasons – particularly in younger girls – there has been a faulty impression of what's normal and what's perfect. Girls compare airbrushed idealist version of perfection with their own bodies. There is no proper scientific evaluation of the external female genitalia. Women and girls are negatively comparing themselves to what they see on the web, or advertisements from clinics which promote these procedures. This commonly gives the impression that the labia needs to be hidden. This is all just wrong: longer labias are just normal vaginal variations – we’re all different."

The procedures are not without risk, either.

"I've seen births complicated by these procedures," says midwife, Lucia. "It all depends on the amount of scar tissue present. The more scar tissue, the more likely things can go wrong. Vaginoplasties can leave women with a lot of scar tissue, and this is not always briefed in full to patients. With cosmetic vaginal procures there are higher incidences of planned and emergency C sections, and other birth interventions, and can make things like episiotomies difficult."

Find a decent surgeon, though, and it’s fairly unlikely you’ll run into these problems.

Those same decent surgeons may well be also undertaking a form of vaginoplasty you're unlikely to find much criticism of: reconstruction for the victims of female genital mutilation (FGM), whose labias have been painfully amputated, traditionally without anaesthetic – a religious or cultural practise found in certain communities across Africa, as well as Asia and the Middle East.

"I reconstructed a Somali woman who had been a victim of female genital mutilation – specifically infundibulation, in which her labia minora and clitoris were completely removed and the genitalia sutured closed," says Dr Heather Furnas. "Only a small hole remained for passage of urine and menses. The entire area was scarred. I cut through the scar, which was about a quarter of an inch thick, and beneath was normal mucosa and her vaginal opening. This was the only such case I have reconstructed."

Regardless of motive, women’s lives can be profoundly affected by female rejuvenation surgeries. There may be no such thing as a "perfect vagina", but there's no blanket response either; the nuances of each individual patient require a nuanced discussion of the issue.

Whether female rejuvenation surgeries become more or less common going forward, one thing is for sure: the world could do with more vagina chat.

@MillyMcMahon / @ErinAniker