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Leap of faith
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Getting to the Promised Land with my mother-in-law
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The high priestess of free love
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Victoria Woodhull, prostitute and presidential candidate
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Fat chance
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A teen-book author talks about obese girls, binge-and-barf clubs and why well-meaning mothers often make things worse
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Sound and sexuality
By Ros Davidson
Is lesbianism physiological?
(03/10/98)

Vanity, thy name is pukestain
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There's nothing like a (fleetingly) sick kid to highlight the humiliating flexibility of your maternal code
(03/09/98)

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Why it's time
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LABIA ENVY | PAGE 2 OF 2

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In my admittedly limited circles, I may have missed the outcry for cosmetic labia reduction. After all, other doctors say that the inauguration of Playboy in the '50s helped spawn the craze for breast enlargements in the '60s and '70s. More recently, the bodybuilding movement has inspired men to get calf and pectoral implants. Perhaps Alter is right about the Penthouse effect. I ask him how many of the procedures he's done, expecting big numbers. "Ah, five or six," he mumbles, shuffling papers on his desk.

"I think somebody could send a note to our ethics committee and say, 'That's fraudulent,' and that would be legitimate," says Dr. Dennis Lynch, president of the American Society of Plastic and Reconstructive Surgeons, when I told him that Alter's press release asserted that "many" patients had sought labiaplasty, then gave him the surgeon's actual, uh, head count. Lynch says the ethics committee could give him what amounts to a slap on the wrist: It could recommend that he tone down the language of his promotional material. Since cosmetic plastic surgery is, by design, innovative -- it's been pushing the boundaries of medicine and, in turn, culture for decades now -- it seems a bit hypocritical for the surgeons who made "boob job" a household term to be schoolmarmishly complaining about the next generation's marketing strategies, much less their latest operation. But Lynch and other doctors say they're legitimately concerned about fringe plastic surgeries pushing into the mainstream. They charge that some doctors get so caught up in expanding their repertoire of lucrative elective procedures, they forget their do-no-harm Hippocratic oath. (Patients pay out of pocket, in full, for most cosmetic surgery, while insurers are forever tightening reimbursement for nonelective treatments.) So while Alter sees penis enlargements as a victory for men demoralized by small-penis jokes, other doctors say they won't perform the operation because it can cause infection and loss of sensitivity.

Alter insists labiaplasty hasn't changed his patients' sexual sensation; his technique is relatively safe, he adds, since he avoids cutting near the clitoris. But Dr. Norman Schulman, chief of plastic and reconstructive surgery at Lenox Hill Hospital in New York, says that's impossible because the female anatomy is too unpredictable: "There are women whose nerve centers are collected at the clitoris, women whose nerve centers are collected at the labia, women whose nerve centers aren't even in the genitalia." The change in appearance is slight, he says, "and yet the consequences -- whew."

Schulman says he is already aware of lawsuits against surgeons by women who claim labiaplasty impaired their sexual responses. It's impossible to predict, but such cases could become the quintessential "he said/she said" litigation of the medical-malpractice world. If a woman says that labiaplasty took away her ability to have an orgasm, who could prove her wrong?

Every time a new procedure is invented for an as-yet-untouched region of the body, the essential conundrum of plastic surgery is pointed up: While doctors may sometimes push surgery on patients, it's also true that patients clamor for certain operations because they make them feel better about themselves. "We've accepted that having body parts that are way off the charts is painful for a person," says Dr. Nada Stotland, president of the Association of Women Psychiatrists. "Yet the question is, then, where do you draw the line? I think most of our energy should be used to help people feel proud of their bodies. But at the same time, you can't entirely denigrate the idea that a body feature could cause a person enough psychic pain to warrant surgery."

When I call one of Alter's patients (who asked not to be named), she says the surgery has made "a world of difference" to her sex life. "If you see something affecting your relationship, then, yeah, save yourself the head trauma and get it done," she says. "I'm a lot happier." She also seems aware that the procedure may not have changed her anatomy as much as her attitude toward it: "Once you get a hang-up, it just grows and grows. It's all mental, and women tend to do that in our society." Alter's patient sounds pretty well-adjusted, and the doctor, for his part, says he avoids plastic-surgery junkies who undergo serial operations desperately trying to achieve perfection. "You decide whether or not you think a patient is crazy," he says.

When it comes to cosmetic labiaplasty, however, Dr. Katharine Phillips, a psychiatrist who is the director of the body dysmorphic disorder (BDD) program at Butler Hospital in Providence, R.I., says no doctor should make a quick assessment. Although, so far, she's only treated men who are so anxious about their "deformed" genitals that they stop socializing and spend hours in front of the mirror, she says any woman who did the same would be a candidate for a BDD diagnosis. "We know that people with BDD tend not to do well with surgery and are often very unhappy with the procedure," she says. Phillips says she has also seen cases of plastic surgery-induced BDD. "We don't know how many people we're talking about, but there is some risk that this will trigger a very tormenting, very painful obsession."

If breast implants and nose jobs are acceptable, if only because we've grown accustomed to them, it's hard to argue that injecting bacteria toxins (Botox) into the forehead or implanting butt fat between the breasts is categorically wrong or too extreme. Still, the idea that women should pretty up such highly personal territory as the labia seems like a low blow. "Barbie may be plastic, pink and totally smooth down there," Stotland says, "but the fact is, people's bodies are not like that; they're not uniform, and they're not supposed to be." Even Alter seems to realize that labia reduction might not be his profession's nicest invention. "It's another pain in the ass," he says, with a whatta-ya-gonna-do shrug. "It's another insecurity to throw out there," he concludes, as if he weren't one of the guys doing the throwing. So maybe, knowing that the doctor himself admits to helping manufacture the problem he seeks to treat, women shouldn't catch the pitch.
SALON | March 16, 1998

Louisa Kamps is a writer in New York.