Labiaplasty — the procedure that clips off portions of a woman's labia minor (the inner lips of her vulva) so that she looks more like a pristine porn star — is the most common "vaginal rejuvenation" surgery. One Southern California doctor says his most popular procedure is "The Barbie," which whacks out the entire labia minora so that only the outer labia are visible, as smooth as plastic. Where did we go wrong?
Props to Guernica's Kirsten O'Regan, who didn't exactly go under the knife but got creepily close to it for her investigation into labiaplasty. Her consultation with Dr. Ronald Blatt took place in a ominously girly room with pink curtains, plump cushions, and a poster on the wall depicting a female body with the words "Rejuvenate. Repair. Rejoice." Cool, The Stepford Wives is real!
Dr. Blatt showed O'Regan what her vulva would look like without those disgusting inner lips getting in her way — "Basically, if you can imagine it'll be a straight line down from your clitoris," he said. "Nice and tidy." — and when she eventually elected not to mutiliate her body to look like Skipper's older sister, he seemed disappointed (and patronizing):
With my feet wedged into fluffy pink stirrups, Dr. Blatt carefully normalized my request. He reassured me that I am "about our regular" labiaplasty patient (reminiscent of the time my dentist told me I was a perfect candidate for tooth-whitening). When I express doubt at the end of the consultation, wondering aloud if I need the surgery, he shrugs his shoulders and smiles benevolently.
"Whatever makes you happy."
Dr. Blatt, by the way, is less of a vulva-hater than some of his colleagues. Consider Dr. Red Alinsod, a Laguna Beach-based urogynecologist who invented the "Barbie" surgery, which amputates the entire icky labia minora:
This results in a "clamshell" aesthetic: a smooth genital area, the outer labia appearing "sealed" together with no labia minora protrusion. Alinsod tells me he invented the Barbie in 2005. "I had been doing more conservative labiaplasties before then," he says. "But I kept getting patients who wanted almost all of it off. They would come in and say, I want a ‘Barbie.' So I developed a procedure that would give them this comfortable, athletic, petite look, safely."
Why the fuck do women want their vulvas to look like they're made out of plastic? (A minority of women seek out labiaplasty for non-aesthetic reasons, but most do because they're embarrassed or ashamed of their "abnormal" lower lips.) We can blame Brazilian bikini waxes, the mainstream media, and, of course, porn. "Girls are more aware of what they look like now," Alter admits. (And lucky for him!) Blatt's website entices clients by stating that "Some women just want to look ‘prettier' like the women they see in magazines or in films." Ugh.
We can also blame the doctors themselves for perpetuating the "Barbie" ideal. Obviously doctors want their patients to feel self-conscious about their bodies so that they'll pay them for alterations; labiaplasty can cost anywhere from $2,000 to $6,000. "Plastic surgery in private practice is really about money-farming," one anesthesiologist said. Some more number-crunching here:
The American College of Aesthetic Plastic Surgeons recorded 2,140 vaginal rejuvenation surgeries in 2010. The International Society of Aesthetic Plastic Surgeons estimates that 5,200 procedures are performed annually. While this is markedly less than breast augmentation surgeries, over 300,000 of which were performed in 2011, the figures are alarming given the relative newness of vaginal rejuvenation procedures-the first recorded labiaplasty occurred in 1984, but the surgery remained relatively obscure until the late 90s-and the lack of auditing and regulation in the field. According to the American Society for Aesthetic Plastic Surgery, the vaginal rejuvenation industry was worth around $6.8million in 2009. This number is now undoubtedly much higher and does not take into account any procedures performed by gynecologists.
But doctors also help push that desired "look" — an unobtrusive vulva that's becoming "increasingly minimalist" — through the way they discuss women's bodies:
The escalating pathology of the vagina is just one manifestation of a fairly ubiquitous desire to deny natural variations in female anatomy by casting them as aberrations. Alinsod and Alter speak with enthusiastic distaste about female genitalia-"this big, fat pad", "like a golf ball", "she has a fatty majora"-and they don't necessarily consider it a doctor's obligation to advise patients if they are within normal range. Interestingly, a 2011 study in the Journal of Sexual Medicine shows that male physicians are more likely to recommend cosmetic labiaplasty than their female counterparts.
Alinsod told O'Regan that he only considers his patients' mental health "if their requests are unusual." That statement implies that wanting your labia minora amputated is normal. Increasingly, that seems to be the case. The American College of Obstetrics and Gynecology condemns vaginal rejuvenation procedures — back in 2007, it declared that it was "deceptive to give the impression that… any such procedures are accepted and routine surgical practices" — but will that change with the times? Probably. Last year, the Federation of International Gynecologists and Obstetricians included an extended presentation on cosmetic gynecology.
How can we convince our younger sisters and cousins and daughters that it's perfectly okay if your vagina doesn't resemble the porno or plasticized ideal? O'Regan notes some pushback, such as a Tumblr called "Show Your Vagina", which showcases vaginas of all shapes and sizes and colors. Inspiring, yes, but not exactly persuasive enough to remind women bombarded with Photoshopped images of "minimalist" vag that there's no such thing as a perfect vagina. Wait, scratch that: there is such a thing as a perfect vagina. It looks exactly like yours.