Throughout the Western world, for much of human history, women’s vaginas have been uber-reliable life partners: timeless companions that, as with all things in nature, wrinkled and drooped with age, but otherwise remained largely unchanged. While cosmetic solutions – from facelifts to liposuction – were used to tauten and tighten various other body parts, vaginas faithfullyhung in there, often bravely weathering pubescence, childbirth and menopause. Labiaplasty, the surgery that cuts off “excess” parts of the labia minora, or inner vaginal lips, appeared in medical literature as early as 1971, but solely as a corrective measure for congential abnormalities. Otherwise, vaginas came in all shapes, colors and sizes, and there was no singular mainstream vulvar ideal. If you were into vagina, you were just happy when someone invited you to be near theirs. And if you possessed one, you simply played with the vagina you were dealt.
That began to change in 1984, when the first description of a purely aesthetic form of labiaplasty appeared in a scientific journal. The surgery didn’t immediately become an overnight sensation, but the cultural shifts that likely contributed to its ascent were beginning to fall into place. By the mid-1990s, the Internet had helped take pornography – and its generous close-ups of (overwhelmingly female) genitalia – from shrink-wrapped dirty secret to free and discreet ubiquity. Porn stars of both sexes were increasingly removing their pubic hair, providing fully unobstructed views of the goods, and celebrities like Victoria Beckham, Eva Longoria, and Sex and the City’s fictional Carrie Bradshaw championed the Brazilian wax. Laser hair removal got both better and cheaper. Women’s streetwear expanded to include clothes formerly reserved for the gym, including snug, crotch-contouring items like leggings and yoga pants. Photoshop became an often used, and often overused, tool, literally erasing the line between real and fake “beauty.” Our cultural obsession with youth prompted unprecedented spending on every newly developed, youth-preserving cosmetic surgery. As Dr. Norman Rowe, a Manhattan board certified plastic surgeon told me when I spoke with him, “People have gotten to the point where they’re not just happy with their face being lifted...They want their eyes done, brows done, face done. They want their breasts lifted. They want their arms rejuvenated. They want their labia lifted. They want everything lifted. Everything.”
In 2013, the most recent year for which statistics are available, more than 5,000 labiaplasties were performed in the United States. That may not seem like a huge number, but it’s an astounding 44% increase over just one year prior, making labiaplasty the second fastest growing plastic surgery that year. (The top gainer, by the way, was butt augmentation.) In the United Kingdom in 2014, the National Health Service reported a fivefold increase in the number of labiaplasties performed over the decade prior – which doesn’t include private practice surgeries, the most common kind. Australia’s national health care system noted in 2012 that claims for labiaplasty in the country had doubled since 2002. Sharon Osbourne discussed her “excruciating” labiaplasty on a talk show, and porn star Houston auctioned off the bits from her labiaplasty for $50,000. (Sydney Leathers, Anthony Weiner’s sexting partner, attempted the same but had trouble attracting buyers.) When I asked Dr. Rowe if he thought the surgery would continue to skyrocket, he suggested it had more recently become “the fastest growing procedure out there.” He added: “I don’t see any stopping it.” Vaginal rejuvenation – which can also include vaginal tightening, perineoplasty (focused on the skin between the vagina and the anus), reduction of the clitoral hood, laser vaginal bleaching, and injections to increase the size and sensitivity of the g-spot – is, officially, a booming business.
And an incredibly profitable one, too. While many medical procedures require tremendous amounts of time and offer diminishing returns in insurance reimbursements, doctors can consistently expect healthy profits from labia reduction and other forms of vaginal rejuvenation. An Atlanticarticlenotes that “a labiaplasty can be done in just a few hours, in-office, for a fee upwards of $5,000 and no “income socialism” to spread the proceeds among hospitals, insurers, and group-practice partners.” In other words, cosmetic labiaplasty – and the whole suite of “designer vagina” surgeries – can be performed in-office and isn’t covered by health insurance. For practitioners, time investment is minimal, anesthesia is applied locally, and profits from the surgery go straight into the pockets of the doctors who perform them. This has led the industry to attract all kinds of doctors, including those with no previous surgical expertise. A development which has, predictably, resulted in a few problems.
Labiaplasty requires no special certification requirements, a consequence of the fact that “cosmetic gynecology” remains unrecognized by the very accrediting bodies which would determine those requirements. In 2007, The American Congress of Obstetricians and Gynecologists released an opinionessentially stating its opposition to all forms of vaginal rejuvenation. “[T]he appearance of the external genitalia varies significantly from woman to woman,” the opinion offered, and the “safety and effectiveness of these procedures have not been documented” due to lack of “adequate studies.” Similarly, The American Board of Obstetrics and Gynecology has thus far refused to designate cosmetic gynecology a legitimate subspecialty. Though there are many training programs for doctors hoping to earn the skills to enter the field, with none actually legally mandated, botched surgeries are not unheard of. In fact, corrective labiaplasty surgery has virtually become a speciality area unto itself. (Do a quick Google search for “labiaplasty revision” and you’ll get thousands of hits, almost all for clinics offering reparative surgeries.) It’s no wonder that when I asked Dr. Rowe the most important concern a woman planning to have labiaplasty should consider, he suggested that she ensure that her doctor is a board certified, experienced surgeon. “Make sure you go to somebody who’s qualified. There’s a time to cut corners – this isn’t one of them. It’s very difficult to fix something that’s botched, as opposed to getting it right the first time.” He noted that botched surgeries can lend to a whole host of fairly gnarly issues, from chronic yeast infections to painful bleeding to more serious problems.
Even well-known clinicians seem to be developing versions of the surgery that are ever more invasive. In fact, one the most popular types of labiaplasty doesn’t just reduce the labia minora, it cuts them clean off. Dr. Red Alinsod, a California urogynecologist whose previous claim to fame was branding a woman’s name into her uterus after removing it, is today best known as the developer of “The Barbie.” If the surgery’s nickname conjures up the image of the completely smooth crotch of its fashion-doll namesake, you’re not too far off. With the labia minora completely removed, patients emerge with a vagina whose lips appear to be sealed, so to speak, with nothing peeking out from inside. “I kept getting patients who wanted almost all of it off,” Alinsod said in an 2013 interview with Guernicamagazine. “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.”
Make no mistake: Not every patient is going under the knife to get a miniaturized, “beautified” vagina. Long labia are a genuine physical problem for some women, and oversized inner (and more rarely, outer) lips can cause discomfort, particularly during rigorous activities such as exercise or sex. British filmmaker Ellie Land’s 2012 animated documentary, “Centrefold,” features interviews with women who’ve undergone labiaplasty. One describes her old inner labial skin as having had “mobility issues,” and says it often got in the way during penetrative vaginal sex. Another woman recounts dealing with problems such as soreness and chafing. “The labia would rub and cause me a lot of pain,” she says. “Sometimes I even had little blisters.”
But overwhelmingly, labiaplasty is a cosmetic solution. According to a 2011 study conducted by the International Society of Sexual Medicine, a stunning – though hardly surprising – 87 percent of women who opted for vaginal rejuvenation did so purely for cosmetic reasons. I spoke with Lily Harper (not her real name), whose 2006 labiaplasty was performed by Dr. Gary Alter, a titan in the industry who’s appeared TV shows like “Dr. 90210.” “My whole life, one side hung out, whereas the other side was neat, and was within the outer lip,” Harper told me. “So when I would look in the mirror, I didn’t like the way it looked. No boy ever mentioned it. It wasn’t like people said, ‘Oh that’s weird.’ Or even that I thought it was weird. It was that I didn’t like the way it looked. It was a purely cosmetic decision.” She says the surgery gave her a vagina she could be unselfconscious, and even confident, about. “Now I just feel less like, the first time a guy sees it, I don’t have that little passing feeling of, “Oh, I hope he doesn’t mind that thing.’”
Not that most guys would likely have noticed. In 2013, Dr. Lauren Streicher, Associate Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, conducted a survey in which she asked heterosexual men, “Do you wish your partner’s labia were shorter?” Ninety-eight percent of respondents answered in the negative. (She didn’t ask, but the other two percent probably live with their parents.) Yet, as Streicher points out, nearly 30 percent of women feel their labia are too long – an idea they’re clearly getting from somewhere. As Harper puts it, “When women look in pornographic magazines or watch porno movies, they see these [vaginas] that are very tiny and the lips are really small. Or everything is symmetrical and perfect.” And there are other sources sending the message that vaginas should be high and tight. A 2011 Dutch study found that “90 percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents society's ideal.” The same study also found that male doctors are “more inclined to opt for a surgical reduction procedure” for their female patients. What’s more, plastic surgeons are more likely than gynecologists and general practitioners to consider large labia “distasteful and unnatural” and, regardless of the size of a woman’s labia minora, more apt to consider labiaplasty a go-to solution.
The myriad controversial aspects of the surgery have earned it more than a few comparisons to female genital cutting, a millennia-old practice in 29 Sub-Saharan African and Middle Eastern countries, as well as parts of Latin America and South and Central Asia. While the UN has become increasinglyintolerant of FGC, it’s difficult not to recognize some kinship between labiaplasty and the practice, which the World Health Organization broadly summarizes as “procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.” The relationship between the two is strengthened by the fact that FGC has been medicalized – meaning performed in sterile environments by doctors and other healthcare practitioners – in countries such as Egypt. Obviously, the adult women undergoing labiaplasty and other forms of vaginal rejuvenation live in the world’s richest countries and not only volunteer for the surgery, but pay significant sums for it. Conversely, those subjected to FGC are overwhelmingly young women under the age of 15, almost none of whom have a choice in the matter. Still, if outdated cultural attitudes are to be blamed for the persistence of FGC – as they so often are by human rights organizations and the media – perhaps we should carefully consider the driving forces behind so many labiaplasties. At the very least, there’s a certain irony to the alarm over news that female genital mutilation cases have recently doubled in the U.S., given that they’re happening in the shadow of labiaplasty’s rapid expansion.
In recent years, there’s been a backlash against the surgery among women opposed to the beauty standards they believe stigmatize labia lengths. The “labia pride” movement dovetails with numerous other feminist efforts to oppose notions of beauty that disempower or otherwise objectify women. In late 2011, the movement led to the “Muff March,” a street protest organized by London’s UK Feminista, specifically in response to the growing popularity of surgical vagina redesigning. The Large Labia Project, a site that is very NSFW, btw, invites women to send commentary along with pictures of their labia, where site administrators assure subjects their vaginas are both normal and beautiful. And the New View Campaign, which proclaims its mission to be simply “challenging the medicalization of sex,” has organized a broad range of international conferences and political actions that pushback against the growth of cosmetic gynecology.
Is there really any surprise that labiaplasty is growing in a period when popular media and culture keep cranking up the crazy about what women should do to their vaginas? Recent suggestions have included giving your vulva a facial, feeding it breath mints, getting it high and – per Gwyneth Paltrow – steaming it clean, because obviously, that thing is just toxic. Capitalism relies on insecurity as a profit driver, and this is yet another example that proves that rule. And really, who among us has fully avoided buying into the smoke and mirrors of media manipulation and cultural notions of what is and isn’t beautiful? The reality is, for some women, labiaplasty has made all the difference between a life of chronic anxiety and doubt and one of pleasure and confidence. As Harper told me when I spoke to her, “If there’s something about the way you look there that’s making you feel not sexy, there are things you can do about it. If you’re stopping guys from going down on you because you’re scared they’re gonna be weirded out, research the surgery. Because you’re missing out on something.” In other words, do you. “You’re never gonna have a [vagina] like the girls in the dirty movies. Forget that. And mine doesn’t look like that. But to me now, it’s beautiful.”