A cosmetic surgical
procedure to alter women's genitals is rising in popularity thanks in
part to the porn industry, even as many questions loom about unknown
medical and social consequences.

Labiaplasty
involves “trimming” or reshaping the labia minora, usually to
make them smaller or more symmetrical.

Labiaplasty is the
second-fastest growing form of cosmetic surgery, according to the
American
Society for Aesthetic Plastic Surgery. The procedure was
performed 5,070 times in 2013, a 44 percent increase over 2012. It's
difficult to determine how many were performed prior to 2012; that
was the first year ASAPS tabulated the surgery in its annual
statistics.

101
Vagina, an art exhibition and book, began touring North America April
5. Part of its mission is to counteract the negative body image
accompanying the rise of labiaplasty and other cosmetic surgeries.
Photo courtesy of 101
Vagina.

Too Little Research

Labiaplasty is not new. It
and other vaginal procedures have been used historically as forms of
reconstructive surgery. It was, however, performed mainly when deemed
medically necessary by the American College of Obstetricians and
Gynecologists for conditions such as labia hypertrophy (a type of
overgrowth), congenital conditions, or chronic irritation.

It is only within the last
few years labiaplasty has been adopted – and advertised - by the
cosmetic surgery community. And little formal training exists. Dr.
Sean Rice, a Toronto-based plastic surgeon, told CBC News that he
learned the procedure from conferences.

Research on labiaplasty is
even less developed. Almost no studies have been done looking at
long-term outcomes or complications, and a number of the studies that
have been done focus
mainly on patient satisfaction measures. In fact, when
researchers at the University College London Elizabeth Garrett
Anderson Institute of Women’s Health in the U.K. attempted
in 2009 to conduct a systematic review of the literature, what
they were able to find was “extremely rudimentary and precluded the
use of the recommended methodology.” Even the rubric for patient
satisfaction of extant studies “mostly reflected anecdotes or were
based on providers questioning recipients as to how they felt about
the intervention after it had taken place.”

The fact that labiaplasty
is an elective surgery combined with the absence of research has led
several major medical organizations to oppose the procedure,
including the ACOG and the Society
of Obstetricians and Gynecologists of Canada.

Some have gone farther,
arguing that the desire for aesthetic vaginal surgeries is eerily
reminiscent of the female genital mutilation crisis in other
countries. One of the key factors the World
Health Organization uses in defining FGM is its lack of health
benefits – a feature FGM shares with many labiaplasties.

Nor does labiaplasty
always produce satisfactory results. One case report from the
Aesthetic
Surgery Journal describes two women who sought corrective surgery
after their labiaplasties because of deformities in their clitoral
hoods they said had not been present prior to the procedure.

Porn's Unique Role

An important difference
between labiaplasty and FGM is the matter of consent. But consent may
not be free of societal considerations. The WHO points out that FGM
tends to be perpetuated by cultural tradition where it is practiced,
noting that “social pressure to conform to what others do and have
been doing is a strong motivation to perpetuate the practice.”

Plastic surgeons certainly
do their work with greater precision and care than is exhibited in
most FGM rituals. And there is definitely less social pressure in
North America regarding vaginal aesthetics.

But that could be
changing, thanks in part to the increased availability of
pornography. Reviews on sites such as RealSelf.com
seem to confirm the correlation: Jennygirl
wrote, for instance, "Now
I look like a Playboy model down there."

Adult
entertainer Andre Shakti told the CBC her exposure to porn made her
insecure about her own labia. Though she doesn't want labiaplasty
anymore, she had considered it for years. "I was basing the
idea of typical on what I’d seen in porn because I didn’t know
differently. When I found out about the surgery at 19, it was always
there at the back of my mind, ‘when I can afford it, I’ll do
it,'” she said.

Celebrities
such as Sharon
Osbourne have also admitted having vaginal surgery recently,
adding to its cultural currency.

Plastic surgeons are using
these pressures to conform in their own advertising. The Manhattan
Center for Vaginal Surgery proclaims “Neatness Counts.” Even EHow
has jumped on the bandwagon with an
article explaining how men can suggest labiaplasty to their spouses.

The porn industry, of
course, is not directly advocating women get aesthetic vaginal
surgeries. To some extent, what is considered attractive in
pornography is merely a reflection of broader cultural trends.

However, porn has a unique
role in defining modern cultural perceptions of vaginal aesthetics:
there are few other outlets in which men or women can actually see
what another person's vagina looks like.

And porn is increasingly
becoming a predominant venue for vaginal comparison, especially among
teens and young adults.

It has only been in the
last decade that streaming and downloading videos and pictures could
be done with ease. According to statistics compiled by the advocacy
group Family
Safe Media, 90 percent of 8-to-16 year olds have viewed porn
online, and 80 percent of 15-to-17 year olds have had “multiple
hard core exposures.” Many of these viewers develop expectations
about sex – including aesthetics – long before having it.

There is extensive
literature detailing various ways in which media exposure influence
body image, but little work has been done specifically to
investigate media effects on conceptions of female genitalia. In
2013, one
experiment out of Australia’s University of Queensland School
of Psychology suggested that images of altered vaginas could indeed
influence women's beliefs about what's normal.

Three groups of women were
shown images of modified vaginas, unmodified vaginas, or no images.
Then all were shown images of a mix of modified and unmodified
vaginas. The control group was 18 percent less likely to rate the
modified vulvas as normal than those who initially saw the altered
vaginas, and 13 percent less likely to rate them as society's ideal.

If labiaplasty is being
spurred by exposure to an unrealistic ideal, how does one counteract
it?

One effort is being headed
by photographer Philip Werner, whose book and art project, 101
Vagina, seeks to break down “the
taboo around vaginas and body image shame generally.”

The reach of the fine arts
and the medical communities is limited, though, and societal
restrictions on sexually explicit material in popular media outlets
will continue to make porn the de facto source for vaginal
comparisons.

For the moment,
opportunities for women to be exposed to realistic examples of other
vaginas remain few and far between. On this point, the promoters of
labiaplasty have the advantage.