This article originally appeared on VICE UK.
A few months ago, 21-year-old Megan* had labiaplasty. She borrowed the money from her mum and, after a consultation at a clinic in London, went ahead with the operation, which, in her case, involved the trimming down of her inner lips (labia minora). The results are great, Megan tells me, and her life has improved. So she was shocked to hear of comments made by Theresa May last week suggesting that some types of labiaplasty could be illegal.
"People are entitled to do whatever they want with their bodies," Megan says. "Until I had the surgery I thought it was normal to be uncomfortable in everyday life. I hated the appearance of my labia, and a lot of things – including sex – were difficult."
However, "designer vagina" operations, the Home Secretary said last week, could technically fall into the same category of crime as female genital mutilation (FGM). May suggested that doctors could be prosecuted for carrying out cosmetic labiaplasty, even if the women they perform the procedures on are over 18 and have given their consent.
Vaginas are considered fair game by the beauty industry; tangled tons of pubes are stripped from them each year, they are vajazzled, dyed, scented, bleached. Since 2001, the number of labiaplasties performed by the NHS has risen five-fold, with more than 2,000 operations carried out in 2010 alone. However, many women have the surgery in private clinics, which aren't required to keep records, so the number is really far higher.
It's heartbreaking that so many women are unhappy. With the boom in labiaplasty it's safe to say there is no longer a single part of our bodies not held up to scrutiny, pathologised, turned to profit. But still, May's comments are likely to jar. The freedom, as an adult, to do as you wish with your body is a key tenet of feminism (think abortion, the right to say no to sex) so making labiaplasty illegal goes against the grain. Likewise, her comparison of labiaplasty to FGM – a major form of child abuse – doesn't, on the surface, seem fair.
Not so, says FGM campaigner and spokesperson for the Foundation for Women's Health Research and Development (FORWARD), Saria Khalifa. "We welcome Theresa May's comments," Khalifa tells me. "There's been very little conversation around the complexities and similarities between female genital cosmetic surgery (FGCS) and FGM. There are parallels."
FGM is classified into four major types. It may include the removal of the clitoris or the fold of skin which surrounds it (type 1), the partial or total removal of the clitoris, labia minora and labia majora (type 2), or the narrowing of the vaginal opening by cutting and repositioning the inner, or outer, labia (infibulation, type 3). Type 4 involves "all other harmful procedures to the female genitalia for non-medical purposes", covering procedures such as piercing, incising, scraping and cauterising.
There are similarities between type 1 and type 2 FGM and some forms of labiaplasty. In the UK, reduction of the labia is the most common operation, but women can also get a vaginal "rejuvenation" (to tighten it up a bit) or get their hymen repaired so they tear and bleed the next time they have sex.
In the US, a growing number of women are asking for the "Barbie", a form of labiaplasty that involves chopping off the entire inside lips and possibly reducing the outer, leaving a flat, doll-like area with little resemblance to most adult women's genitals. Bearing in mind that FGM does not always involve removal of the clitoris, it's hard to see this procedure as vastly different to FGM.
But however grim Barbie vaginas may seem, grown women are choosing them of their own free will. FGM, by comparison, is nearly always carried out on minors. In the UK, 23,000 girls under 15 are thought to be at risk and FGM is, quite rightly, illegal. The UK has been criticised for lagging behind on prosecutions for the procedure and the situation has been called a national scandal.
Age and consent, then, are at the heart of arguments in favour of FGCS. "The difference between this and FGM is that FGM isn't always consensual," Megan says. "With labiaplasty, women have it because they want to and it's often going to make their life better."
However, Khalifa says that consent may not be such a clear dividing line. "There are women over the age of 18 in lots of communities who want FGM done because they feel it's beneficial or think it's more beautiful – that's how they've been raised to view their bodies," she says. "Because it isn't our cultural norm in the UK, it's an idea we can't wrap our heads around. But it's similar to breast implants or a variety of other cosmetic procedures. There is also that pressure in the UK for women to look a certain way.
"There are grey areas around FGM because, how the law currently stands, if a woman over the age of 18 wanted to go through a form of FGM she would legally not be allowed, or the person who did that to her would be prosecuted. There's a slight double standard."
The thinking behind UK law – the Female Genital Mutilation Act 2003 and the Prohibition of Female Genital Mutilation (Scotland) Act 2005 – which makes FGM illegal at any age is that it is impossible to separate genuine personal consent from societal pressure. Indeed. With women between 18 and 25 – those who have grown up most steeped in media images of the perfect vag – the age group most commonly requesting labiaplasty, societal pressure to look a certain way is a real and insidious thing.
Megan is aware of this. "As people, we're shaped by society. It's a no brainer that society plays a big part in what's considered normal," she says.
The Royal College of Obstetricians and Gynaecologists (RCOG) is concerned about the murky area where societal norms and personal choice become impossible to disentangle. At present, FGCS is deemed acceptable when women are distressed by a "perception of abnormality", in which case they'll be classed as needing the surgery for a psychological reason. But perceptions are slippery things.
"The phrase 'distress caused by a perception of abnormality' is open to interpretation, giving rise to some ambiguity around the legal status of some FGCS procedures," says the RCOG.
May's suggestion, that FGCS only be permissible when there is a physical or psychological justification, becomes redundant when definitions are this subjective. Surgery is painful and expensive. People don't go into it lightly.
"No one has plastic surgery for shits and giggles," Megan says. "There is always going to be either a mental or physical reason. You do it because you have either an emotional or physical issue and, more than anything else, that's what you're going to be sorting out."
Khalifa believes that what's needed is a better system in place to offer women requesting FGCS pre-surgery counselling. Studies have shown that many women seeking labiaplasty have labia that fall within normal limits. Take a look at some before and after pictures on any surgery website; the "befores" often look pretty damn ordinary.
David Mills, managing director of the cosmetic surgery firm Moorgate Aesthetics, disagrees. "In most cases of labiaplasty, there's clearly a protrusion of the labia," he says. "Women are often uncomfortable and not able to enjoy normal activities. They're often embarrassed about wearing swimwear and it may affect their personal relationships. If patients have a history of depression or another medical condition that causes concern, we will contact their GP, but I don't recall anyone being turned away for this procedure."
Mills calls Theresa May's comments "draconian" and questions what the difference is between elective surgery on the labia and elective surgery on any other part of the body. Women choose to have their breasts enlarged or their sagging stomach tissue removed, so why not allow them to choose what happens to their labia?
Of course, there is no moral difference between getting breast implants and electing to have your labia reduced with FGCS. The ultimate aim should be that no one feels the pressure to add bits or chop bits from their body, but, in the meantime, women like Megan argue they should be free to do what they want.
The high level of coercion and severe long-term health consequences separate FGM from other elective surgeries, but the similarities should shine a light – again – on how just how steeped we are in dictatorial social norms.
Khalifa believes education is the way forward. "We don't have a system set up for girls to feel comfortable with the way they look," she says. "With FGM, there are very clear parallels not only with female genital cosmetic surgery, but other forms of cosmetic surgery that society dictates to us as women. We need to have more discussion about this."
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