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Female genital mutilation and cosmetic genital surgery: Do they have anything in common?

FRIDAY FILE: At first glance, female genital mutilation and genital surgery carried out for cosmetic purposes might seem intrinsically different. On closer examination, however, they may be more similar than they initially appear.

By Kathambi Kinoti

Female Genital Mutilation (FGM) is the centuries-old practice of removing part or all of the external genitalia of women. It is predominantly carried out in parts of Africa and the Middle East as a tool to control women’s sexuality. Genital cosmetic surgery is a modern practice that is undertaken, mainly by women, in order to improve the appearance of their genitalia. Although they are practices that have developed from very different premises, they share some commonalities.

Female Genital Mutilation

The World Health Organization (WHO) classifies the different forms of FGM as follows:

  1. “Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

  2. Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina).

  3. Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.

  4. Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. “

The harmful effects of FGM are numerous: shock, haemorrhage and sepsis are some of the immediate effects. Some girls and women bleed to death after undergoing the practices. In the long term, women can face infertility, obstructed labour during childbirth, obstetric fistula and other conditions.

FGM is recognized in international law as well as in the laws of several countries as a human rights violation, but it remains deeply entrenched in the cultures in which it is practised.

Labioplasty and other modern cosmetic procedures

In recent years there has been a dramatic increase in the number of women electing to undergo cosmetic surgery on their genitals in order to appear younger or more beautiful in modern youth- and beauty-obsessed cultures. Between 2004 and 2007 the number of labiaplasties in private hospitals the United Kingdom tripled, while there was an increase of almost 70 percent in public hospitals in the country between 2006 and 2008.[i]

Procedures include “reduction of the inner labia (labia minora), vaginal tightening, hymen ‘reconstruction,’ clitoral ‘lifts’ and liposuction of the mons veneris (fatty tissue over the pubic bone, these are performed in order to create a sense of proportion when the inner labia have been shortened) clitoral hood reductions and clitoral repositioning.” [ii]

Viv Groskop[iii] wrote of the rise in the numbers of women seeking cosmetic genital surgery: “In the vast majority of cases, labiaplasty is simply a response to the physical appearance of the labia, a desire for more ‘attractive’ genitalia.” Tracey Plowman, a social psychologist who reviewed the ‘The Perfect Vagina,’ a documentary filmed in the United Kingdom, says: “It is common for youth and beauty to be conflated in the world of cosmetic surgery… [and] female genital cosmetic surgery is no different.][iv]

Different but some commonalities

At a basic level, FGM and cosmetic female genital surgery are similar because they both involve modification to female genitalia and neither of them are performed for medically justifiable reasons (although in rare cases there are medical reasons for genital modification such as when girls are born with labia that have not developed properly). Both are performed based on cultural norms and expectations.

Any surgery or excision to the body comes with risks. These risks are on the whole much higher with FGM, since girls or women undergoing cosmetic genital surgery generally have access to top-notch medical facilities. In some contexts, FGM is now carried out by qualified medical doctors in hospitals, but the ‘medicalisation[v]’ of FGM has been strongly advocated against by international entities such as the World Health Organization and United Nations.

The primary difference between the procedures is consent. While cosmetic genital surgery is carried out on women who agree to the procedure, FGM is largely carried out on young girls who do not have the capacity to consent. There are, however, some women who elect to undergo FGM. But for women who consent to either procedure, their decision may not always be from a position of knowledge or power. What constitutes informed consent? Questions about how the practice of cosmetic surgery is regulated have been raised. Are the risks and possible complications of the surgery explained? Is it the knowledge that the procedure is unnecessary, or that they risk losing their lives from excessive bleeding? Or is it about understanding that human vulvas come in a variety of forms, and there is not an “ideal-looking” form?

The power of social pressure

FGM is a measure to curb women’s sexual desire, even though it is acknowledged that it does not always eliminate this desire. FGM is also a community affair. In many cultures there is a regular circumcision season during which girls who have attained a certain age collectively undergo rituals that “transform them into women.” These rituals involve the physical removal of parts of the genitalia, as well as the impartation of social and cultural mores that prepare them for womanhood in that community. Some societies that practice FGM do not require girls and women to undergo any particular ritual, but their state of being circumcised or uncircumcised is still considered the business of their communities. Not having undergone the cut isolates them and precludes them from marriage. FGM confers social status on many parties: parents, extended families, husbands, circumcisers and of course, women and girls themselves.

On the other hand cosmetic genital surgery is a measure that is regarded as improving women’s desirability. Although the choice to undergo the surgery may be an individual one, the suggestion that it is necessary originates in evolving societal values that define what desirable genitalia look like. The beauty industry, mainstream media and profit-making health care sector all collaborate to exert immense pressure on women to be youthful and beautiful according to rigid standards. Groskop quotes a gynaecologist, Dr Sarah Creighton who says that “women are aiming for a certain genital appearance that used to be an obligation only for some glamour models.” While it can be argued that women have the right to make decisions about their own bodies, the combination of actors influencing any woman’s decision to undergo this surgery makes it difficult to ascertain to what extent her choice is completely informed.

Sara Johnsdotter and Brigitta Essén [vi] argue that “procedures involving genital modifications are intertwined with political considerations; they are never purely about anatomy and physiology but are intrinsically entangled with cultural norms and ideology.” In the context of women’s bodies, these cultural norms and ideology give rise to notions about how women are expected to look. So a woman who elects to undergo cosmetic genital surgery may be unduly influenced to think that she needs to modify her body. In the case of FGM these cultural norms and ideology restrict women’s sexuality.

The harmfulness and pervasiveness of FGM should never be downplayed. Indeed, there is extensive work being done to eliminate FGM, and there has been some success even though the practice persists. It is also important to challenge modern ideologies that influence women to seek to modify their genitalia. Although the two practices may stem from different beliefs and have different effects, they both have roots in societal impositions on women’s bodies.

[i] “A cut too far: the rise in cosmetic surgery on female genitalia.” The Guardian, November 20, 2009. Site accessed on February 7, 2011.

[ii] Johnsdotter, S and Essén, B. 2010: “Genitals and ethnicity: the politics of genital modifications.”Reproductive Health Matters 2010; 18 (35) 29-37.

[iii] See note ii.

[iv] Plowman, T. “The Perfect Vagina.”Reproductive Health Matters 2010; 18(35) 111-114.

[v] FGM provided by medical practitioners in order to make it safe – advocates cite the performance of this needless procedure on children as a violation of medical ethics. (Broken bodies broken dreams, 2005:52)

[vi] See note ii