Activism on the medicalization of sex and female genital cosmetic surgery by the New View Campaign in the United States

Abstract

The New View Campaign is a grassroots initiative begun in 1999 to challenge the over-medicalization of sex in the wake of publicity following the release of Viagra. This paper describes the history of the campaign and its activities, which started with analysing the construction of female sexual dysfunction, and moved on to develop a critical understanding of sexuality as a market for the pharmaceutical industry to exploit. The campaign has also had much to say about a positive model for sexuality, sex education, treatment of sex problems, and sex research. From 2006, we began to look at the new female cosmetic genital surgery industry. In 2008, we wrote letters to many government and medical professional groups expressing our concerns about female cosmetic genital surgery and asking for support. We also organised a demonstration outside the office of a New York surgeon who was doing this surgery and developed a webpage as a resource for students, scholars, journalists and activists. In 2009, we held an event in an art gallery that celebrated artists who support and encourage female sexual diversity. Supporters and colleagues of the campaign have published books and articles, and created visual and training materials, including a project called Vulvagraphics.

Résumé

La campagne New View est une initiative lancée au niveau de la communauté en 1999 pour remettre en question la surmédicalisation de la sexualité, conséquence de la publicité ayant suivi la commercialisation du Viagra. L’article décrit l’histoire de la campagne et ses activités. Nous avons commencé par analyser la construction de la dysfonction sexuelle féminine et sommes ensuite parvenus à une compréhension critique de la sexualité comme marché à exploiter pour l’industrie pharmaceutique. La campagne s’est également exprimée sur un modèle positif pour la sexualité, l’éducation sexuelle, le traitement des problèmes sexuels et la recherche en la matière. Dès 2006, nous nous sommes intéressés à la nouvelle industrie de la chirurgie plastique des organes génitaux féminins. En 2008, nous avons écrit à nombre d’autorités et de groupes professionnels médicaux pour leur faire part de notre inquiétude quant à ce type de chirurgie et demander un appui. Nous avons aussi organisé une manifestation devant le cabinet d’un chirurgien new-yorkais qui pratiquait ces opérations et avons créé un site Internet comme ressource pour les étudiants, les chercheurs, les journalistes et les militants. En 2009, dans une galerie d’art, nous avons fêté les artistes qui soutiennent et encouragent la diversité sexuelle féminine. Les sympathisants et les adhérents de la campagne ont publié des livres et des articles, et ont produit du matériel visuel et formatif, notamment un projet intitulé Vulvagraphics.

Resumen

La campaña New View es una iniciativa de base iniciada en 1999 para cuestionar la sobremedicalización de la sexualidad tras la publicidad después del lanzamiento de Viagra. En este artículo se describe la historia de la campaña y sus actividades, que comenzaron por analizar la construcción de la disfunción sexual femenina y de ahí formularon un entendimiento crítico de la sexualidad como mercado a ser explotado por la industria farmacéutica. La campaña también ha tenido mucho que decir en cuanto a un modelo positivo para la sexualidad, la educación sexual, el tratamiento de problemas sexuales y la investigación sexual. A partir de 2006, empezamos a estudiar la nueva industria de la cirugía cosmética genital femenina. En 2008, escribimos cartas a numerosos grupos de profesionales gubernamentales y médicos para expresar nuestras inquietudes respecto a dicha cirugía y solicitar apoyo. Además, organizamos una demostración fuera del consultorio de un cirujano de Nueva York, quien estaba efectuando esta cirugía y había creado una página Web como recurso para estudiantes, eruditos, periodistas y activistas. En 2009, organizamos un evento en una galería de arte, donde se celebraban a artistas que apoyan y fomentan la diversidad sexual femenina. Los defensores y colegas de la campaña han publicado libros y artículos, y han creado material visual y didáctico, incluso un proyecto llamado Vulvagraphics.

Key Words:

• medicalisation of sex
• female sexual dysfunction
• female cosmetic genital surgery
• advocacy

A tidal wave of publicity followed the 1998 approval of Viagra, a new vascular drug to treat penile erection problems. Within days, journalists started clamouring for a “female Viagra”. Urologists, fresh from their leading role in the Viagra clinical trials and looking for new clinical opportunities, began to speak with authority about women’s sexual problems, to organize conferences on “female sexual dysfunction” and to propose new organizations and journals.¹

The launch of the New View campaign

The New View Campaign (NVC) is a grassroots initiative begun to challenge the over-medicalization of sex in the wake of publicity following the release of Viagra. As a feminist psychologist and sexologist, based in New York, I called for a challenge to this new medicalization and with a grassroots feminist group that came together in 1999, began to organize a critical opposition which became “The New View of Women’s Sexual Problems.”^* The early activities of the Campaign involved analysis of the urology-led trends in research and professional education, which deconstructed their financial, regulatory, and theoretical origins, challenged the construction of female sexual dysfunction, and offered alternative clinical formulations to deal with women’s sexual problems.²³ The New View Campaign (NVC) activities included a website; a manifesto, which was translated and published widely in 2000 (see website); an edited book;⁴ two international conferences – in San Francisco in 2002 and Montreal in 2005 (for reports, see website); a teaching manual;⁵ a listserv; online continuing education courses; and testimony in 2004 before the US Food and Drug Administration’s advisory hearing on the only drug for female sexual dysfunction to come up for approval.

Ten years after the approval of Viagra, the threatened usurpation of sex research and professional education by the urology model has become the dominant, though not uncontested, professional trend. The weak and marginalized field of psychosocial sexology capitulated to the dominant medical model some time ago and abandoned its humanistic heritage.⁶ Non-medical sexology continues to be published, of course, but the lion’s share of funding and public visibility currently goes to a steady stream of urology-led (and pharma-funded) international “sexual medicine” organizations, conferences, texts, guidelines, and new clinics. Notwithstanding, there has been continuing controversy over the legitimacy of female sexual dysfunction nomenclature, medical treatments and epidemiological research, spurred in part by the publications and press coverage of our campaign.⁷⁸

Critical understanding of sexuality as a market

Over the decade the NVC has expanded its critical understanding of these trends to see urologists as agents of a global pharmaceutical industry whose goal is to create and maintain new markets through promoting biomechanical thinking about the self and everyday life. We now understand that the influence of the pharmaceutical industry grows because of favourable governmental regulations regarding advertising and drug approval and is abetted by media collusion and naïveté. We also see how the drugs industry is able to promote its views and products because of favourable professional organization policies regarding corporate conference sponsorship and continuing education. In other words, in ten years our understanding of sexual medicalization has enlarged to include the wider picture of relations among political, corporate, media, educational and professional interests in an era of globalization.⁹ All along, the NVC has incorporated feminist scholarship, warning that the new attention to women’s sexual emancipation around the world can be co-opted by medicalization even as formal patriarchal oppressions recede.¹⁰

The NVC has also examined how contemporary sexuality is a special market. Sex enhancement obviously offers great financial opportunities, but poor sex education and the moral contests involved in public discourse about sexual pleasure have created an ignorant and vulnerable public.¹¹ Sexual drugs sell less well in countries with better sex education policies.

The activities of the campaign became focused on placing “sexual medicine” and female sexual dysfunction in the largest explanatory context. In the process, the campaign itself became an example of resistance to disease-mongering and of feminist health activism that is cited by journalists and pharmaceutical industry critics.^12–14

Taking on female cosmetic genital surgery

Prior to 2006, most of the NVC’s activity was directed at analyzing the role of the pharmaceutical industry in the medicalization of women’s sexual norms and challenging new “female Viagra” products. However, several of us^* began to meet in 2006 to think about the strange new female cosmetic genital surgery (FGCS) industry. We called ourselves the Petals project after Betty Dodson’s favorite term for labia. We decided to prepare a brochure for women, a “consumer guide” wherein we could describe the health, political and gendered issues regarding the surgery and include many of Betty’s genital drawings¹⁵¹⁶ as corrective genital education.

The Petals group developed an outline for the consumer guide and considered connecting the project to the National Organization for Women’s annual “Love Your Body Day” but the project did not go further than tentative planning.

To bone up, I began reading the work of Virginia (Ginny) Braun, a New Zealand psychologist and the most prolific academic feminist writing about FGCS.^* In July 2007, Ginny and I met, coincidentally, at a feminist conference in the UK and I agreed to edit a special issue on the New View Campaign for the journal she co-edits, Feminism and Psychology. I solicited empirical, theoretical and applied pieces and decided to write my own contribution on FGCS.¹⁷¹⁸ Articles ranged from how the NVC has attempted to build bridges between academic and alternative worlds that both rightly claim expertise about sexuality; one on the fact that when women are asked to examine their sexual problems and identify possible causes, they primarily pinpoint sociocultural and relational issues; to one on how the New View approach can be used in both pedagogical and clinical settings with queer and lesbian clients and issues, and one on how the New View lent itself to grassroots empowerment in Thailand. The special issue, with two papers on theory, two on media perspectives, three on applications and three empirical studies, came out in November 2008. The NVC is often stereotyped by its critics as a “just say no to drugs” one-note song. While it is true that we have been consistently critical of the “Viagra for women” products over these years, the campaign has had much to say about a positive model for sexuality, sex education, treatment of sex problems, and sex research. It will be harder to minimize our message after this special issue.

Meanwhile, in August, 2007, the American College of Obstetrics and Gynecology issued a strong statement about FGCS, arguing that the procedures were “not medically indicated, nor is there documentation of their safety and effectiveness.”¹⁹ However, there were no sanctions for surgeons practising or advertising procedures such as labiaplasty, laser vaginal surgery, pubic mound or clitoral surgeries. The statement was an important initiative on the part of a major professional organization, but the lack of implementation shows how unwilling or unable such organizations are to take decisive action against their membership.

In July 2008, a new gynaecology office opened in mid-town New York designed as a “vulva spa”, offering a cafeteria of surgeries, products and services for the perfect vulvas, including the use of labia surgery.²⁰ That summer I met Li-Mei Liao, a clinical psychologist who was part of a group in London studying patients’ FGCS requests and surgical outcomes.²¹ Lih-Mei had convened a 2008 conference in London to discuss “Genital Cutting in a Globalized Age” and had brought together experts on FGCS, female genital mutilation, intersex, transsex, and male circumcision issues.^† Lih-Mei, like Ginny Braun and myself, realized that FGCS should not be discussed in isolation from other forms of medicalization of genital function and construction of genital normalcy, and she organized the conference to promote dialogue. But, again, the conference resulted in no agenda for action.

After reading the New York Times article about the vulva perfection clinic and talking with Lih-Mei, I decided the time was ready for some public activism.

Planning the 2008 demonstration

Much in activism is serendipity. I picked a convenient date for the first planning meeting, and sent two dozen invitations to New York feminists and sexologists. The six people who were able to attend became the core team, and we held eight two-hour planning meetings over ten weeks. The core group became intergenerational and livelier when it was joined by four psychology and gender studies graduate students.

We discussed the conceptual aspects of the FGCS issue (e.g. how do we understand the idea of “choice” in cosmetic surgery?), discursive aspects (e.g. what words should we use to describe the FGCS procedures?; should we use medical terms such as “labiaplasty” and “vaginal rejuvenation” or descriptive words like “cutting” and “amputation”?), and logistical issues (e.g. should we demonstrate in front of a doctor’s office or a government agency such as the Office of Consumer Protection?). We looked for every scrap of prevalence data on FGCS. We contacted friendly gynaecologists to glean anecdotes about harm or regret. One student took photos of all the FGCS surgeons’ office fronts and sidewalks so that we could choose one with space for a demonstration and passing traffic. Ultimately, we decided to hold an outdoor demonstration for two hours on a weekday in front of one of the NY surgeons identified who:

•	was performing FGCS,
•	was advertising online and through the media, claiming sexual benefits from FGCS, and
•	had before-and-after genital photographs on their website.

We chose the building housing the office of Dr Ronald Blatt, who met our criteria.^*

We also decided to develop a webpage as a resource for students, scholars, journalists and activists.^† It included an elaborate chart identifying the New York City FGCS doctors, and hyperlinking to their before and after photos, financing schemes, etc. We would also include quotes from the various doctors’ websites that we judged especially exaggerated and unprofessional.

In addition, we wrote letters to many government and medical professional groups expressing our concerns and asking for support. We received calls back from two of them, the federal consumer education group and the women’s health branch of the National Institutes of Health, but neither one was willing to initiate any investigations.

For the demonstration, we prepared signs and chants, got police permission, and wrote a two-minute piece of street theater entitled “Dr IFFA and the Two Vulvas,” with Dr IFFA standing for Dr Interest Free Financing Available, a reference to the financing schemes FGCS surgeons advertised on their sites. The play featured two very large vulva puppets, one robust and plump (“Miss Before”) and one pale and with stitches (“Miss After”).

The 2008 event^**

The 17th of November 2008 was cold and sunny. We assembled in front of Dr. Blatt’s building where the police had placed some wooden sawhorses as barricades, and taped our colourful signs to the sawhorses. The signs were gradually removed and held aloft by marching protesters as they arrived and joined us. At the peak of our two-hour demonstration there were about 25 marchers, three documentary crews, two print and one web journalist.

We walked in a circle, chanting slogans such as:

•	More research, less marketing
•	Vulvas are beautiful, no two alike
•	Don’t be fooled, cutting has consequences
•	FTC††, end the ads, vulvas need protection
•	Long live long labia
•	Say no to the knife, keep your vulvas free of strife
•	Leave us alone, stop marketing distress
•	Say no to designer vaginas
•	Genital cosmetic surgery, satisfaction not guaranteed
•	Real choice, not consumer choice
•	We want research, we want science, no more ads and no more violence.

Five times we paused for “Dr IFFA and the Two Vulvas”, which got more polished and more exuberant with practice. We handed out over 200 pieces of literature. Most bypassers were bemused; the phrase “genital cosmetic surgery” did not seem to mean much. But when we explained that this meant cutting the labia or clitoris for a smooth uniform look like porn stars, people knew immediately what we meant. “They do that in here?” they asked, grimacing and gesturing towards the building. A man who identified himself as an ophthalmologist insisted that women follow fashion blindly, and that cosmetic surgery was very lucrative for many doctors, but he did agree that advertising by doctors often went too far. Several young men said they liked diverse vulvas. We were very pleased with the article that appeared in Time magazine featuring our demonstration.²²

New View’s first street action, New York City, 17 November 2008

Planning the 2009 event: Vulvagraphics

The 2008 demonstration protested the erasure of female genital diversity by cosmetic genital surgeons and the inadequate regulation and oversight by government and professional groups. After some discussion, we decided to follow this with an event that would focus on celebrating those who support and encourage female sexual diversity – namely, artists. We designed an art-gallery-plus-activism event that would include explicit genital diversity depictions by contemporary artists, and we called the event “Vulvagraphics”. The two-day event would include a discussion with invited panelists, an activist component, a display of books that showed a range of female genitals, an informative webpage,^* and outreach to sexuality blogs and websites.

It was not difficult to find contemporary artists who had created representations of diverse female vulvas, reinforcing our belief that the world of art is more friendly to explicit sexual images than that of health and science. We asked local photographers, videographers and crafts artists to bring their work to the Brooklyn gallery event space. We also included a print of the 1866 painting by Gustave Courbet, “Origin of the World”, because the long history of censorship and condemnation of it highlighted the difficulty society has with the explicit depiction of the female vulva.

We displayed two groups of crafted vulvas, including the work of an International Vulva Knitting Circle that was formed following our 2008 FGCS protest. In addition, members of our planning group created a graphic structure called “The Fitting Room”, which satirized genital cosmetic surgeons’ websites by allowing visitors first to be tempted by reading the outsized claims of the surgeons, then to look through a selection of “after” images, and finally to “try one on” in front of a mirror.

We considered varied types of activism and chose an action in the spirit of the artist-celebration at the heart of the event – an opportunity for participants to create diverse vulvas themselves. We printed Betty Dodson’s vulva drawings^* on pieces of paper. The reverse sides were invitations for the drawings’ recipients to help organize local activism (e.g. a film screening, health education panel, brown bag lecture, knitting circle, etc) to further celebrate female genital diversity. Volunteers used crayons to color in the vulvas and chose a college or university to receive their vulva drawing/letter. This became a popular activity during the two-day event, illuminating the importance of participatory opportunities at feminist action events.

The 2009 event

The event space was set up on the Saturday by volunteers working with the artists; the doors opened at 6pm. To our delight, the four-hour celebration of female genital diversity became a packed-to-the-rafters party. The partner of one of our planning group members acted as a disk jockey with two turntables and a laptop. The music made it festive but not too loud to talk. There was wine and cheese. The weather was a torrential rainstorm and the umbrellas basket near the front door overflowed. It got very hot in the gallery even with open door and windows. People stood around discussing the art and photographing themselves and each other. Scores of vulvas were drawn at the activism table and envelopes addressed. Repeatedly, we observed someone walk in the door, say, “Oh, wow, what is that?” and a quarter-hour later say, “Well, what’s wrong with that, anyway?” or even “That is amazing; they [the vulvas] are so beautiful.”

Midway in the evening we held a little ceremony to recognize the organizers and volunteers and to honor graphic artist and sex coach Betty Dodson. Betty commented that her website, particularly the page we were so pleased with, “The Genital Art Gallery”,^† was currently subject to censorship by new federal regulations requiring a photocopy of a driver’s license from anyone whose genitalia appear online! This provided a graphic illustration of the politics surrounding US displays of genital diversity.

On Sunday, we had a two-hour “brunch salon” of bagels, cream cheese, speakers and discussion. As the convenor of the NVC, I reviewed the history of the campaign’s involvement with FGCS and how the FGCS industry exemplified many discreditable aspects of the medicalization of women’s sexuality. Jon Knowles, Director of Public Information of the Planned Parenthood Federation of America (PPFA), described how printed PPFA materials about puberty did not emphasize genital diversity, although there is a clever online graphic (based on the ubiquitous drawings of Betty Dodson) that does illustrate genital variety.^** He said he was inspired by our event to initiate a new brochure called “You and Your Vulva”. Finally, National Coalition against Censorship Arts Program Director Svetlana Mintcheva discussed arts censorship around the country. Depictions of women’s genitals are illegal to show in public, she told the surprised group, because of the complex current legal definition of “obscenity”. Even pictures of flowers can be and have been removed from a public space if someone complains that they are “suggestive” and “offensive”. Meika Loe, a Colgate University sociologist, who had arranged for a busload of students from her women’s studies class to visit the event, then facilitated the discussion.

The rest of the day saw groups, couples and individuals coming in to check out the event. Again, many photos were taken in front of the displays by visitors, usually using cellphones. Ultimately, over 100 vulvas were crayoned and letters addressed at the activism table.

Conclusion

These two events – a street demonstration and a gallery show-panel-discussion-activism event – injected fun and energy into the New View campaign and offered an entirely different kind of satisfaction and consciousness-raising from academic publications and conference presentations. Interacting with the public is important in feminist activism, and even small groups can plan and carry out events. The total cost of the gallery event was about US$1950 and the street demonstration about US$300. Not least, the bystanders at our street demonstration and the visitors to our gallery event offered commentary on FGCS that informs our understanding and enriches our further work.

Acknowledgements

Planning teams for the events described in this paper included Virginia Braun, Rebecca Chalker, Silvia Fernandez, Nicola Gavey, Amber Hui, Meg Kaplan, Michelle Leve, Rachel Liebert, Meika Loe, Lisa Rubin, Molly Tannenbaum, Leonore Tiefer, Dan Ward and many volunteers and artists.

Notes

* For information on the campaign’s history, a sense of how the issues were viewed over the 2000-2010 decade, our resources and the background pages we have prepared for different events, see: <http://newviewcampaign.org>.

* Betty Dodson: artist, sex educator and “godmother of masturbation” since the 1970s; Becky Chalker: author of The Clitoral Truth; Cydelle Berlin: founder of Nitestar Theater, a sex education programme using drama (see <www.nitestar.org>); and myself.

* Many of Braun‘s papers are on our FGCS website, <www.newviewcampaign.org/fgcs.asp>, especially the resources page, <www.newviewcampaign.org/userfiles/file/Resource%20list%20on%20FGCS.pdf>, e.g. Braun’s articles: <www.psych.auckland.ac.nz/staff/Braun/BraunAbstracts.htm>.

† See: <www.criticalsexology.org.uk/genitalcutting.html>.

* Blatt is “B” in the chart made by Rachel Liebert to describe the surgeons we located: <www.newviewcampaign.org/userfiles/file/New%20York%20City%20genital%20cosmetic%20surgeons%20.pdf>.

† See: <http://newviewcampaign.org/fgcs.asp>.

** Photos from the event are on: <http://newviewcampaign.org/whatsnew_detail.asp?id=6>.

†† The FTC is the US government Food and Trade Commission, whose Consumer Protection Division sanctions misleading advertisements.

* The event webpage is at: <http://newviewcampaign.org/vulvagraphics.asp>, and event photos are at: <http://newviewcampaign.org/whatsnew_detail.asp?id=10>.

* See: <http://newviewcampaign.org/userfiles/file/Dodson_vulvasheet.pdf>.

† See: <http://dodsonandross.com/gallery>.

** See: <www.plannedparenthood.org/teen-talk/body-mind/anatomy/vulva-an-owners-manual-25172.htm>.