Designer Vaginas: Is Female Circumcision Coming Out of the Closet?

By Gbemisola Olujobi

As a circumcised and sexually fulfilled African woman, when I consider the fuss that female circumcision has attracted to Africa over the years and the wind of labiaplasties and genital rejuvenations currently sweeping across Europe and America, I cannot help but ask in the words of Dr. Deborah Tolman, professor of social welfare at Hunter College School of Social Work, “What happened in the last three years to make [these] women’s labias so big that they can’t walk around with them?”

I was watching an episode of “Dr. 90210” on E! Entertainment Television recently. A young American woman was getting a labiaplasty and clitoral hood reduction. She said her labia “didn’t look nice” and her clitoral hood was “uncomfortable,” especially when she was having sex. I didn’t know what to think.

I was circumcised (read labiaplasty and clitoral hood reduction) when I was 9 days old, in line with the tradition of the Yoruba of western Nigeria. And thanks to the “enlightenment” of Euro-American NGOs, I grew up lamenting what I thought was my irreparable loss and thinking I would definitely have been better off with my genitals intact. Imagine my confusion at the spectacle before me on television.

I have since seen more labiaplasties and clitoral hood reductions on “Dr. 90210.” I am an avid fan of the show and confess to being totally smitten with the effervescent Dr. Robert Rey. But the more of these procedures I see, the more I ... well, wonder. What are labiaplasty and clitoral hood reduction if not female circumcision?

Female circumcision, also known as female genital cutting (FGC) or the more demonized female genital mutilation (FGM), is defined by the World Health Organization as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons.”

FGC is practiced throughout the world, but seems to be more widely practiced in Africa than anywhere else. Not all ethnic groups in Africa practice female circumcision, though it is found in 28 of the continent’s 53 countries.

The WHO identifies three broad types of female circumcision. Type I circumcision is the partial or total removal of the clitoris and/or the prepuce or clitoral hood. Type II circumcision is “partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. Type III circumcision involves narrowing of the vaginal orifice with creation of a covering seal by cutting and repositioning the labia minora and/or the labia majora, with or without excision of the clitoris. This type of circumcision is also known as infibulation or pharaonic circumcision. It is the most extensive form of FGM, and accounts for about 10 percent of all FGM procedures identified in Africa.

And what are labiaplasty, clitoral hood reduction, vaginoplasty and the other procedures classified as female genital cosmetic surgery? Labiaplasty is plastic surgery of the labia majora and/or the labia minora, which are the external folds of skin surrounding the structures of the vulva. The procedure involves reducing the size of one or both sets of labia. Clitoral hood reduction is an operation which repositions the protruding clitoris and reduces the length and projection of the clitoral hood. Vaginoplasty is the surgical modification of the female vagina. The most frequent vaginoplasty procedure is the narrowing of the vaginal opening to make it firmer.

These operations involve cutting that includes full or partial amputation of the labia or clitoris, as well as procedures to narrow or tighten the vagina—all hallmarks of circumcision and infibulation.

Now, from what I understand, some Euro-American women are becoming so disturbed by the appearance of their genitalia that they are asking plastic surgeons to modify them. But how did this new worry start? Or, as professor Tolman puts it, “What happened in the last three years to make [these] women’s labias so big that they can’t walk around with them?”

Physicians and mainstream mass media report that the widespread viewing of pornography has increased demand for labiaplasty. As more people see the shortened labia of pornographic actresses, they are getting the idea that trim genitals are the ideal. Human sexuality expert Bonnie Zylbergold argues in an article that women are getting the HD version of their vulvas outside a biology class for the first time. And “while women might not be trading notes on their vaginal proportions,” says Zylbergold, “they have become increasingly comfortable with mainstream pornography and that leads to one dimensional representations of what vulvas look like.”

Just as the phenomenon of Playboy magazine in the 1950s spread the craze for breast enlargements in the ’60s and ’70s, an increasing number of women are going to plastic surgeons with pictures of spread-eagled models in magazines such as Playboy and Penthouse and saying, “I want those clit and lips,” very much as some women have been ordering Angelina Jolie’s mouth and Jennifer Lopez’s butt in surgeons’ “supermarkets.”

Call it “labia envy,” says New York writer Louisa Kamps. A host of plastic surgeons are aggressively offering women relief from this new form of envy.

Kamps quotes Dr. Gary Alter, a Beverly Hills plastic surgeon, as saying: “Some women have this feeling they’re not that pretty down there. If you really think you’re deformed, you’re going to be less open to a sexual relationship. Before, it was the dark ages, because nobody really cared, or knew, what it looked like. But now, with Penthouse and all these magazines that show vaginas—I mean, they really show it—you have women, not just men, looking. And they start making aesthetic judgments.”

Many surgeons are against these procedures and some have even called the doctors who perform them “fraudulent.” Among those who disagree with that criticism is Dr. Scott W. Mosser, a board-certified plastic surgeon based in San Francisco who has been performing labiaplasties for the past four years. He insists that anything that is distracting enough to interfere with a person’s quality of life or lifestyle is something that should be addressed.

Sex expert Zylbergold asks, “What’s with all the women who truly feel as though FGCS [female genital cosmetic surgery] will better their quality of life? Are we simply to ignore them? Tell them that they don’t really know, or understand for that matter, what they really want?”

One woman who responded to a post on labiaplasty at colbertnation.com wrote: “I used to talk about this [surgery] all the time. There are times I still want to do it. My right inner labium is larger than the left, even larger than the outer labia (it looks like a tongue sticking out). It’s bothered me my whole sexual life and I always used to talk about getting it removed so it looks more symmetrical. Not to mention it sometimes gets stuck during intercourse and is painful every now and then. I even threaten to do it myself. I can see why some women might want to get it done, and I feel if that’s the way they want it, fine. Porn might have something to do with it, but I think there are women out there who want to get it for their own satisfaction.”

Researcher Karen Roberts McNamara reports that accounts of this medical trend in mainstream media quote doctors and patients alike as describing the new beauty standard for the vulva as “neat” and “clean.” McNamara cites a Boston Globe article in which a 25-year-old student from California, a patient of Dr. David Matlock, describes her postsurgery genitalia as “cleaner” and “more hygienic.”

Acclaimed champion of what he calls “vaginal rejuvenation,” Dr. Matlock proffers what he considers to be the definition of vulvar beauty as a “nice, clean look.” He claims that his laser rejuvenation will “effectively enhance the vaginal muscle tone, strength and control, decrease the internal and external vaginal diameters, as well as build up and strengthen the perineal body.”

Now, unless something really drastic happens to make women like the one at the ColbertNation site accept their asymmetrical and protruding genitalia and ignore the Matlocks and Alters, labiaplasty and clitoral hood reductions (call them clit and lip jobs, if you will) may yet become the staples that nose and boob jobs have metamorphosed into.

According to the California Surgical Institute, labiaplasty has become more common. In the United Kingdom, the number of labiaplasties doubled between 2000 and 2005. And in Germany, as psychologist Borken Ada Hagen and gynecologist Heribert Kentenich report in the journal Obstetrics and Gynecology, labiaplasty (known there as labienreduktion) has become the third leading cosmetic plastic surgery—right after face-lifts and breast augmentation.

Patient satisfaction has also been significant. A recent two-year study on 407 labiaplasty patients between the ages of 13 and 63 indicates that they appear to be happy with the procedure. Dr. Alter, the Beverly Hills plastic surgeon and urologist, performed a procedure known as the Alter V technique on all 407 women.

According to an article on the study, printed in the December 2008 issue of Plastic and Reconstructive Surgery, 98 percent of the patients reported they would have the surgery again. Seventy percent reported increased self-esteem, while 71 percent claimed to have improved sex lives. The study found only 4 percent of subjects reporting complications.

So where does this leave Africans who have been hounded for years by Euro-American NGOs and donor agencies to abandon “the barbaric and primitive practice” known as female circumcision?

Could it be that some ancient Africans saw flesh and blood versions of these before-and-after photos and decided, long before what is now known as cosmetic surgery came into being, that women would be better served with something close to what is now being called the “Toronto Trim.”

The term comes from Toronto plastic surgeon Robert Stubbs, by way of health reporter Krista Foss. Stubbs has done more than 205 labia minora shortenings on women aged 14 to 60. His style of trimming the hood of the clitoris as well as the lips of the vagina has been nicknamed the Toronto Trim.

The appropriately named Dr. Stubbs reports that these trims are not done on women who experience pain from their labia. Rather, they are done for cosmetic reasons. “Women don’t want to compete with men with something large between their legs. They want something small, neat and tidy and tucked up out of the way.” Again with the “neat and tidy.”

Linda, a woman in her mid-20s, said her labia minora had always bothered her. “It was physically uncomfortable, and I didn’t find it very aesthetically pleasing,” she said. She went to Stubbs and got a Toronto Trim for $4,500.

Patricia, a 32-year-old mother of two from New York City who had her labia shortened, also had worried that “it was all hanging.” So she looked for a surgeon, who fixed it, and she says “it’s nice and it’s neat now.”

Bernard Stern, the Florida doctor who performed Patricia’s labiaplasty, says he has operated on all kinds of women, including Las Vegas showgirls, exotic dancers, a Playmate of the Year, doctors, nurses, midwives, attorneys, professional athletes, marathoners, junior Olympians, equestrians, Pilates instructors and personal trainers. His patients have included an 82-year-old and a 16-year-old, as well as a 19-year-old and her 40-year-old mother.

Stern claims that most of his patients could not live with their genitals. “Quite honestly, most of the people that come in here have stuff that’s just unbelievable. There’s no doubt, I mean [the labia are] totally uneven, one side’s huge, the other’s not. ... For some of them, this is a life-changing procedure.”

According to the surgeon, “The women feel undesirable or unpretty. Even if nobody sees it, they see it.” Stern also claims that for many, a labiaplasty or vaginal tightening can “save their marriage.”

Now, my grandmother performed these “procedures” all her life. As early as 5 a.m., mothers would line up in our backyard with their baby sons and daughters to be circumcised by her expert hands. Among the Yoruba of Nigeria, circumcision is done in early infancy.

Grandma took special care and pride with female babies. She would do her job deftly and pass the screaming baby to her mother saying, “Your daughter has been beautified.” The satisfied mother would then go back home and cook a celebratory chicken feast to mark the occasion. For some reason, no such feasts were cooked to mark a male baby’s circumcision.

So, how is my grandmother different from these board-certified plastic surgeons and urologists?

I cannot defend the circumcision knives Grandma inherited from her grandmother as being sterile. I also cannot claim that the palm oil she used to soothe the circumcision wound, the lime juice she used to “sanitize” the circumcision site, and the snail slime she swore would make the wound heal properly were up to WHO standards. But when I read the reports of labiaplasty patients, I cannot help but have a proud smile on my face when I recall my grandmother’s declarations after every baby girl’s circumcision: “She has been beautified and made clean.” How could she have known that this was going to be the refrain of board-certified surgeons in Europe and America after “beautifying” their women patients?

As it turns out, the reasons given for female circumcision on the one hand and female genital cosmetic surgery on the other are not totally different. Practitioners of female circumcision couch its functions in culture and religious obligation. According to professor Aisha Samad Matias, they usually say things like “It makes you clean, beautiful, better, sweet-smelling,” or “You will be able to marry, be presentable to your husband, able to satisfy and keep your husband, able to conceive and bear children.”

These reasons are not far from those given by women in Euro-America who seek the “nice, clean and neat” ideal of vulvar beauty through labiaplasties and clitoral hood reductions.

According to Dr. Virginia Braun, a psychologist at the University of Auckland who specializes in women’s health and sexuality, the narratives of women who have undergone FGM and FGCS are similar. In both cases, Braun argues, women say, “It is important to me to have genitals that look normal, that look appropriate, that are right.”

The big difference between female circumcision and FGCS hovers around self-consent and voluntarism. A great fuss is made about the rights of female circumcision “victims” by activists who see it as a form of child abuse or gender oppression. Writer Ifeyinwa Iweriebor, however, argues that this misrepresentation totally occludes the essential truth: that circumcision is not performed on girls (or on boys) to oppress them or do them any harm. For the practitioners, the procedure is carried out for the noblest of reasons, the best of intentions and in good faith. Maybe all those taboos surrounding female circumcision in African cultures were formulated as a way of ensuring that women went through this painful process to achieve the “nice clean slit” that is now being marketed by Euro-American plastic surgeons.

At the end of the day, it looks like female circumcision and FGCS are done for very much the same reasons. According to Simone Davis, professor and gender theorist at Mount Holyoke College in Massachusetts, among the key motivating factors raised by African women who favor female genital surgeries are beautification, transcendence of shame and the desire to conform. These clearly matter as well to American women seeking cosmetic surgery on their labia, says Davis.

And according to McNamara, although most plastic surgeons usually insist that the women they treat seek the procedure to enhance their own sexual satisfaction, some concede that many women have a consultation at the urging of their husbands, boyfriends or partners who want increased sensation for themselves.

These procedures—vaginoplasty, labiaplasty, hymenoplasty, female circumcision or genital mutilation—all have one thing in common. In McNamara’s words, they “highlight the constructedness of the sexed female subject because her body requires constant maintenance to adhere to gender requirements.”

The good news for labiaplasty patients (read victims) is that though they may regard female circumcision as foreign and incomprehensible, what they are doing is altering their genitalia to conform to a certain set of notions and expectations about what genitalia should look like if they are to be appropriately feminine and desirable.

Remember Dr. Alter? He says, “With Penthouse and all these magazines that show vaginas—I mean, they really show it—you have women, not just men, looking. And they start making aesthetic judgments.”

Such aesthetic judgments are the moving force behind the disciplinary pressures of Western beauty standards. Think of anorexia, bulimia, “a cracker a day” diets, gastric bypass surgery, lap-band surgery and other such horrors. These things are done “voluntarily” and with “self-consent” by people who have been pushed to the wall by societal ideals about what a woman’s body should look like.

So why has the West been demonizing “Africans and their barbaric culture of female circumcision” all these years? In actual fact, according to Davis, one could regard Western female consumers who consent to the procedures and even finance them to be even more oppressed and bound by normative gender than their African counterparts, because there is no actual external policing. In this case, she argues, American women are reminiscent of philosopher Michel Foucault’s “docile bodies,” who, on their own, fill the role of enforcers of their own subjection under the matrix of gender.

Davis quotes Soraya Mire, a Somali filmmaker, as saying, “In America, women pay money that is theirs, and no one else’s, to go to a doctor who cuts them up. ... Western women cut themselves up voluntarily.”

Somalia is a hotspot of infibulation and an action spot for Western anti-circumcision activists. Many Somali women and girls, as well as women and girls from other parts of Africa, have fled their homelands and gone into exile in Europe and America to escape circumcision and infibulation.

Imagine Mire’s confusion, and mine as well. Imagine the indignation of millions of Africans who have been forced to abandon this rite of passage only to wake up one day and find out that Euro-American women are sneaking, behind our backs, to circumcise themselves and their daughters. One of Florida surgeon Bernard Stern’s patients was a 19-year-old whose 40-year-old mother had her labiaplasty six months after she had hers.

This truly is a strange world!

Collage: eonline.com / andrewbostom.org / drrobertrey.com