The Perfect Vagina

Presented by Lisa Rogers, Channel 4 TV, UK, 17 August 2008

The Perfect Vagina is a documentary that was filmed in the UK and broadcast on 17 August 2008 by one of Britain's main commercial television channels, Channel 4. The film is about female genital cosmetic surgery, which is described by Virginia Braun as surgery on women's genitals that is mainly for aesthetic reasons and is not a reconstructive, gender reassignment, or otherwise medically necessary procedure.¹ This documentary was part of a series of programmes on women's issues, which also covered mothers sharing breastmilk and whether brothels should be legalised in the UK. Channel 4 approached presenter Lisa Rogers to ask if she would be interested in working on this programme. She decided to do it after a conversation with her doctor, which convinced her that dissatisfaction with vulva appearance is widespread.²

Rogers takes the viewer with her through a series of interviews, with the aim of discouraging female viewers from believing female genital cosmetic surgery is ever necessary. She follows the experiences of a woman having her labia trimmed, as well as interviewing surgeons, women considering surgery on their labia, a bikini-line waxer, a gynaecologist, her own mother, husband and male friends, and some workmen decorating her house – all in all a broad variety of people with a range of views on female genitals and genital cosmetic surgery.

The cosmetic surgeons who were interviewed presented female genital cosmetic surgery as a question of choice, offering freedom to women to change their bodies as they wish so as to increase their confidence and make themselves happier:

“There's no one can force anyone to go for surgery. The way we treat patients, if it affects them psychologically and we help them, why not? If the excess skin is there, you want to trim it, you trim it.” (Dr Magdy Hend)

Surgery on the genitals was not presented as a special case by these surgeons but was instead likened to any other form of cosmetic surgery. The women considering or undergoing cosmetic surgery to their genitals had a similar viewpoint. They downplayed the seriousness and the risks of undergoing the surgery and focused on their negative feelings about the appearance of their genitals. The women's perspectives did differ a little from that of the surgeons in their emphasis on the physical aspects of their “problem”. The surgeons spoke more about choice and body image, whereas the women seeking surgery talked about physical genital appearance and the resulting feelings:

“See, I don't think it's attractive at all. I don't like these bits, basically. I look at it and I think, ugh, it just looks like a cauliflower, and I don't want to have a cauliflower, I want something prettier.” (Reagan)

A number of the women interviewed in the programme commented on the increasing popularity of waxing pubic hair and connected this to the contemporary increase in female genital cosmetic surgery. One viewpoint aired was that pubic hair waxing amongst women causes the vulva to be more visible and so women consider surgery to improve the appearance of their now-visible genitals. According to the bikini-line waxer, the trend for removing all or most of the pubic hair through waxing was popularised in the 1990s by television shows aimed at women, such as Sex and the City. The uro-gynaecologist interviewed drew the following parallel between female genital cosmetic surgery and other beautifying rituals:

“There's been a huge trend towards bikini waxing, doing things with your pubic hair as well as the hair on your head, and so if you can have cosmetic surgery on your face, you can also have cosmetic surgery to your genitals.” (Prof Linda Cardozo)

Lisa Rogers, her mother and her mother's friends make the argument that the fashion for removing pubic hair has increased the visibility of female genitals and therefore made the appearance of the vulva more of an issue. The suggestion is made that this visibility leads to more insecurity in women about exposing their bodies to their male partner, and that this insecurity is compounded by a lack of access to images showing how diverse vulval appearance naturally is. Prof Cardozo thought women knew what was popular but not what was normal. Lisa Rogers was shocked by the homogeneity of the appearance of vulvas in pornographic magazines, i.e. almost not visible. And one of the women who discussed her desire for surgery described watching pornographic films with her husband and feeling that her vulva was unattractive as a result:

“All I think about then is, why are we watching this, is it because he wants this image of perfection, and would it be better, would I be sexier if I nipped this bit off and tucked that bit in?” (Kelly)

It is common for youth and beauty to be conflated in the world of cosmetic surgery and, according to this documentary, female genital cosmetic surgery is no different. Prof Cardozo suggests that the “ideal” vulva that women want is similar in appearance to the vulva of a young girl. A number of the women who reported disliking the appearance of their genitals, including Lisa Rogers herself, talked about the negative effects of age on the vulva, though none of the genital cosmetic surgeries discussed specifically targeted the effects of age.

Lisa Rogers' husband and her male friends said they had been unaware that genital appearance was a cause of insecurity for women. These men said they had not considered genital appearance as an issue, though one commented that the amount of pubic hair a woman has and the smell of her genitals did matter to him. The painters and decorators working on Lisa Rogers' home said that for them the attractiveness of a woman's genitals is important. She responded with both anger and dismay to hear this, as she thought women feel insecure precisely because of men making judgemental comments like that.

It was not clear from this documentary whether this is a heterosexual issue only. There was no discussion of other sexualities and the impact on women's body confidence. The documentary focused on two possible causes of women seeking genital cosmetic surgery: lack of exposure to the normal diversity of genital appearance in women, and anxiety about the opinions of potential male partners about the vulva. Do lesbian and bisexual women experience this issue in the same way or not? And what about women living in countries where communal nudity is more common than it is in the UK, would the lack of “knowing what is normal” be different? For a lesbian woman, concerns about how attractive her partner finds her genitals could obviously still arise, but the partner's judgement of her genital appearance will not be contending simultaneously with gender power imbalances and her partner would also have a vulva that can be “judged”.

What is “normal” female genital appearance?

In this documentary, “normal” female genital appearance seems to mean a diversity in size, shape and colour of parts of the vulva, though the limits to this diversity are not described. The question of how different someone's genitals would need to be for them no longer to be considered normal is not asked or answered. I would suggest that “female genitals” is already very much a catch-all term and that if the person to whom the genitals belong identifies as female, then their genitals must be normal female genitals. “Normality” encompasses diversity which makes sense in the context of the broad variation in other parts of the body in size, presence, shape and colour. Alternatively, people may cite particular criteria for a body part being a “normal” example of that body part. For example, a foot may be expected to have five toes, while a foot that has six toes is still accepted as a foot but not a “normal” foot. If this is an accepted definition, then the documentary suggests that “normal” vulvas consist of inner and outer labia, a vagina, a clitoris and a clitoral hood, though perceptions of normality of size and shape would also be subject to limitations, just as height and weight are.

Why do young women today feel insecure about the normality of their genital appearance?

This documentary was prompted by the recent rapid increase in women undergoing female genital cosmetic surgery in the UK.³ The question is, why do young women today feel insecure about the normality of their genital appearance, their labia in particular? The most popular cosmetic surgery on women's genitals is trimming of the inner labia, to make them smaller (labiaplasty), usually so that they are concealed by the outer labia.³ Long inner labia are unlikely to be hidden by any amount of pubic hair, suggesting that the increase in labiaplasty is probably not for this reason. However, the fact that woman are removing their pubic hair suggests that the genitals have become less private and more public, lending them the status of a body part that can be measured against beauty standards. Wolf argues in The Beauty Myth⁴ that the most frequent cosmetic procedures are performed on the areas of women's bodies most associated with “femaleness”: thighs, stomach, buttocks, and breasts. This has now gone further, to include the vulva, that most female of body parts.

The question remains: why are long labia seen as a negative thing, why the removal of pubic hair that exposes genitals that must then be hidden, and why isn't big beautiful. As an example of how beauty standards are relative to culture, Wolf points out that Maori society traditionally considers fat labia to be more beautiful than thin ones.⁴ In the USA and the UK today, small is considered beautiful, as is youthfulness. Labia trimming (and pubic hair removal) limit a woman's sexuality metaphorically by making her genitals smaller and more child-like, and limit her sexuality physically by cutting away sensitive tissue, which can leave scarring that may be unresponsive to touch.⁵ Research that has investigated outcomes for women suggests that post-operative pain during intercourse is normal for up to approximately one month, though two of 98 patients required further surgery to correct this.⁶ A qualitative study has suggested that women's expectations of surgery overestimate the positive effects it will have on their lives.⁷

Braun argues that much of the success of female genital cosmetic surgery is because its promoters created the problem – that the privacy of this part of the body can foster anxiety, playing on the long-standing cultural taboo surrounding female sexuality – which was then sold to women alongside the solution of surgery.¹ The problem of unattractive labia (long, uneven, extended) is easily solved by surgery, because the trimming of this tissue is a relatively simple procedure, provided the woman is not overly concerned about any resulting loss of sensation.⁵

Wolf argues that the rigidity and scope of beauty standards is increasing alongside feminist progress, as an attempt to maintain the oppression of women,⁴ while Braun argues that the creation of a market for female genital cosmetic surgery is for providers' financial gain rather than a solution to a pre-existing, unresolved problem.¹ These arguments together suggest that female genital cosmetic surgery is being successfully marketed because our society systematically prescribes standards for women's bodies that inhibit their satisfaction in everyday life. According to Wolf, leaving women's appetites unfulfilled maintains their focus on smaller problems and saps their energy for pursuits such as financial gain or political activism.⁴ This places female genital cosmetic surgery as a Western equivalent to female genital mutilation, a socially dictated solution to the problem of women's (sexual) freedom. This implies that the increase in demand for this surgery may be less about individual choice and more about a political system attempting to retain control over women and their sexuality.

On the one hand, female genital cosmetic surgery is not a special case, in that it can be seen as connected to a wide set of ideals applied to women and their bodies. On the other hand, female genital cosmetic surgery goes further than other types of cosmetic surgery in its impact on the “femaleness” of the woman in question, in that it pretends to determine a woman's sexual attractiveness based on her external genitalia.

Acknowledgements

Many thanks to my supervisor Dr Mick Finlay, University of Surrey, who oversaw the master's dissertation on which this review is based.