Female genital mutilation in Sub Sahara Africa vs Labiaplasty in America

Female genital mutilation, or circumcision, brings to mind horrific pictures and stories from a world far away and much different than ours. We condemn the practice and donate to organizations that attempt to educate and reform the procedure.  But before we become too self-righteous, I think we need to examine our own culture and ideals about feminine beauty.

A recent encounter with a young Somali patient made me realize how important the culture of your birth can influence your actions even when you live in a different land.  I had seen her for the first time a month earlier when she presented as a new patient with complaints of very painful menses that required her to stay in bed for 2-3 days. As a child of 8, she had vivid memories of undergoing female circumcision.  She is now 24, working and living in the US, but remains culturally Somali. Her exam was significant for an type 3 circumcision with removal of most of the labia and an opening into her vagina that was the size of a Q-tip. The explanation for her painful periods was that menstrual blood was being blocked from leaving her body and was remaining inside the vagina and causing pain due to distention. Intact circumcision is often necessary for a young woman to be considered eligible for marriage as it proves her virginity. Following extensive discussion of the benefits of revising the circumcision, the patient and her mom agreed to the surgery. A week later she called to cancel the surgery. I can only imagine that once she returned home, cultural and familial pressures made her reconsider her decision.

Many of you that have read thus far are thinking how wonderful it is to be able to live in a country where female circumcision is outlawed. However, America has a more subtle form of female genital mutilation – and we pay out of pocket to have it done! Labiaplasty or Barbie minoraplasty refers to removal of part of the labia.  This procedure is being done in gyn and plastic surgery offices and is referred to as a cosmetic procedure. Women’s labias have not changed in the past 50 years, so what is driving this increase in a procedure that was unheard of even 10 years ago. Although I have no scientific research to support my reasons, this is what I have noted in my years in practice.
1. Overall increase in cosmetic surgery utilizing botox and facelifts. If you can enhance everything else, why not “down there”.
2. Fashion trend of tight pants, leggings and thongs. No further explanation needed.
3. Advent of waxing/shaving the entire perineum. This makes labial asymmetry appear more pronounced.

Last week as I was browsing thru an educational journal that I receive, I found 4 listings for courses that teach labiaplasty and other gynecological “enhancements”.  A local plastic surgeon reserves one day a week for labiaplasties and her schedule is full.  What has happened to the female image that we think it necessary to mutilate our bodies for fashion? Is this so much different than what is being done to young girls in Africa? What are we teaching our young women when there is a waxing establishment everywhere you look and teenagers frequent them, not only for eyebrows but for a “Brazilian”. What do I say to a mother who brings in her 17 year old daughter because the mother doesn’t think her labia appear normal? Many questions, but no good answers.

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7 thoughts on “Female genital mutilation in Sub Sahara Africa vs Labiaplasty in America

  1. Jessica Greenblatt says:

    Well said, well said. I was thinking about this very issue while reading Brene Brown’s book “I thought it was just me (but it isn’t)” about women’s shame. The message we tell ourselves, “no one will love me if …” is personally destructive and publicly lucrative.

  2. Kelly says:

    Thank you for this blog post. I just wrote a paper myself in this topic and think it is a shame that the Western world so adamantly rejects this practice. The outlawing of something that is so culturally engrained puts girls and women at greater risk for serious complications from the procedure. Families of girls who have been circumcised will even delay treatment for girls who are hemorrhaging out of fear of being arrested for the crime of having their daughters circumcised. The use of local anesthesia in a medical office would also decrease the negative psychological effects of the procedure and decrease the chance of hemorrhage due to unintentional cuts because of movement during the procedure.

    • I agree that we need to bring this out of the closet and provide more education as well as incentives not to perform the practice. This issue is addressed in one of the chapters of the book “Half the Sky”.

  3. Jen Johnson says:

    The first time I had to insert a foley into an East African patient (and had to use a pediatric size) I was horrified. And I can’t tell you how many labiaplasty cases I’ve seen. Lots of women in America are unhappy with their labias!

    • It is amazing that women with female circumcision don’t have more bladder infections. My response to women who don’t like what they see, “Don’t look down there.”

  4. […] lifelong complications of chronic bladder infections and obstructed labor. But can the practice of labiaplasty (surgical reshaping of the labia) currently popular in the US be considered any less barbaric. It […]

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