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Female genital cosmetic surgery: a labial obsession

On last night’s Q&A, feminist campaigner Germaine Greer suggested a comparison between practices of female genital mutilation (FGM) in Africa and female genital cosmetic surgery (FGCS) in Western nations…

Germaine Greer is right: female genital mutilation and female genital cosmetic surgery are both “cultural” issues. bombhead

On last night’s Q&A, feminist campaigner Germaine Greer suggested a comparison between practices of female genital mutilation (FGM) in Africa and female genital cosmetic surgery (FGCS) in Western nations.

To make her point, Greer cited labiaplasty (where the labia minora are surgically reduced) and clitoral reduction of newborn girls in the medical management of “ambiguous genitalia”.

Greer is right: one central reason in the West for surgical intervention in babies’ genitals is to ensure gender conformity of intersexed genitalia.

Greer tackled the difficult issue of female genital mutilation in a very un-Greer-like fashion — with tact and sensitivity, rather than her traditional style of outrageous polemical provocation.

The audience seemed perplexed. Was Australia’s mother of second wave feminism advocating cultural relativism? Was she somehow condoning female genital mutilation by suggesting such a comparison?

Yet Greer was voicing what feminist academics had already been saying in the (admittedly tiny) body of literature on Western practices of cosmetic labiaplasty.

Of course there are differences between female genital mutilation and female genital cosmetic surgery, the most striking of which is the conditions under which they are performed. Common to FGM is the use of non-sterile instruments in unhygienic conditions, whereas FGCS is typically “medicalised”, carried out in professional surgical environments like plastic/cosmetic surgeons’ clinics.

Yet FGM and FGCS may not be as dissimilar as we might imagine.

People in the West who have never been exposed to genital mutilation in their own cultures tend to think of genital cosmetic surgery as a singular thing – that is, as clitoral excision and the sewing together of the lips of the vulva to leave a small hole for menstruation and urinary flow, which is then painfully reopened for childbirth and stitched back together afterwards.

In fact, FGM, as it is defined by the World Health Organization, covers a range of interventions, from infibulation (the sewing up of the lips), removal of the clitoris and labia minora and/or majora, removal of the labia minora only, and removal of the clitoral hood to piercing, pricking, scraping, incising and cauterisation.

Just like FGM, FGCS is also a variety of procedures, from vaginal tightening and plumping up or syphoning fat from the outer labial lips, to cutting off the inner lips.

In Britain, the United States and Australia, FGM is outlawed but FGCS is not.

As far as I know, infibulation is not performed by Western cosmetic or plastic surgeons, however, they do perform clitoral hood reduction and labial excision.

I even read one case study in the literature where a clitoridectomy was performed on 33-year-old heterosexual woman in the United Kingdom (who, the surgeons said, was not from a culture that conducted FGM) at the woman’s behest.

Q&A: Greer echoed what feminist academics have been saying about Western practices of cosmetic labiaplasty. AAP

You might think consent is important in distinguishing between FGM and FGCS, as indeed one audience member of Q&A put to Germaine Greer. The questioner suggested that girls upon whom FGM is performed are forced to undergo the procedure against their will. But in Australian FGM legislation, as feminist academic Nikki Sullivan points out, consent is immaterial.

It does not distinguish between the genital modification of children and consenting adults, stating that “consent to FGM is not a defence to a charge under the relevant sections of the Acts”.

Why then, even if women are consenting to it, is FGCS legally defensible?

Health practitioners say it may be therapeutic. If a patient can demonstrate that she’s suffering from her condition (for example, if the size of her labia are causing her acute embarrassment or physical discomfort), then surgical removal is a therapeutic option.

There seems to be a sly double standard at work here.

It seems easy and natural for us to assume that FGM is a grave cultural wrong and should be stopped, but we have a harder time thinking of FGCS as a “cultural” issue, preferring instead to label it a medical one.

If, as the literature tells us, the majority of women seeking labiaplasty are mainly worried about the appearance of their genitals, we might conclude that cultural standards of appropriate femininity are increasing pressure on women to conform, especially now that the public gaze appears to have reached the genital area – it’s not just confined to small breasts, flabby stomachs and ageing faces anymore.

But when it comes to what we understand as “culture”, the ethics get muddy.

Is “culture” only culture when it applies to other people? This is at the heart of feminist thinking around the comparisons between FGM and FGCS.

A look back at our colonial history muddies the ethical waters of FGM/FGCS even more.

When 19th century white colonists encountered the Khoi women of the Cape of Good Hope, they were horrified and titillated by the size of their genitals.

Anthropological writers such as Captain Cook, Ten Rhyne, Blumenbach and Cuvier publicised their observations of these women’s labia minora and came up with the moniker of the “Hottentot Apron” to describe the condition of “labial hypertrophy” that they believed the women’s bodies displayed.

One particular Khoi woman by the name of Saartjie Baartman – labelled by Europeans as the “Hottentot Venus” – came to be widely known in Europe as the definitive model of black female sexuality. She was literally put on display (in the tradition of human zoos) for the European public, but also for men of science who were given the opportunity to “examine” her, especially her intimate parts, until her death in 1815.

This encounter with European anatomists would produce Baartman’s body as one of the most visible and enduring images of black femininity in the history of white, colonial ethnography.

The point is that ideas about genital abnormality always exist in a social context. What we might understand today to be a white, Western practice – the surgical removal of the labia for cosmetic reasons – is historically embedded in 19th century race science.

In other words, the diagnosis of labial hypertrophy is a slippery term that was once used primarily to promote the idea of a fundamental difference between blacks and whites in the service of racist notions of white superiority (all white women were deemed to have small labia minora, which we know now to be factually incorrect).

In the discussion around the differences and similarities between FGM and FGCS, we would do well to remember Saartjie Baartman, and to give pause to the way in which our own cultural assumptions may be influencing how we value different forms of body modification.

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28 Comments sorted by

  1. John Coochey

    Mr

    I think the long and the short of it was Germaine was trying to cover her tracks on previous outrageous statements designed once again to give her center stage. She tried to evade the non consensual mutilation of children and by passed the issue of male circumcision.

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  2. Daryl Adair

    Associate Professor of Sport Management at University of Technology, Sydney

    It would be helpful if you had explored the question of why, as you have put it "consent is immaterial". I am not a lawyer, but mutilation seems to infer lack of consent (or at least, because FGM is often practised on young girls) a lack of power to invoke consent. FGCS, as I understand it, is not something imposed on women, but a choice they make as adults (whether the procedure is necessary or even desirable is another matter). Indeed, you only mention the word "children" once in this article, and only in respect of legislation around consent. Why do the rights of children not feature in your discussion? Or have you addressed this in another article?

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    1. nikki sullivan

      Associate Professor, Critical and Cultural Studies, Department of Media, Music, Communication, and Cultural Studies, Macquarie University

      In reply to Daryl Adair

      The claim I make, and that Camille cites in her article, is that Australian anti-FGM legislation, unlike its Canadian counterpart, does not distinguish between the genital modification of children and ‘consenting adults,’ stating that “consent to FGM is not a defence to a charge under the relevant sections of the Acts”. By contrast, Canadian legislation does not criminalise procedures where “the person is at least eighteen years old and where there is no resulting harm”

      At the same time, so-called…

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  3. Sue Ieraci

    Public hospital clinician

    There are two other issues that have not been addressed in this discussion.

    Firstly, the intent of the procedure: FGM is intended to reduce female sexual sensation. FGCS is intended to modify external appearance.

    Secondly, there is relative harm. While acknowledging the author's point that there is a wide range of procedures in both categories, the tiny hole left after the most extreme FGM causes severe disability in its own right - while uncomplicated FGCS is unlikely to cause disability (uncomplicated in the sense of no infection or wound breakdown).

    I don't favour a culture where external genitalia need to be surgically modified to fit some concept of norm, but I don't see voluntary adult FGCS as anywhere in the same spectrum as forced childhood FGM.

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    1. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to Sue Ieraci

      Sue

      "FGM is intended to reduce female sexual sensation. FGCS is intended to modify external appearance."

      Female sexuality is still feared in all cultures. In our warm and cosy western culture women have FGCS to appear more acceptable; according to the near impossible feminine ideal displayed in media intended for men and women.

      FGM - which is without doubt the dark side to the fear of female sexuality is part of the same theme that females must look and behave certain way to be acceptable…

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  4. Philip Dowling

    IT teacher

    It is comforting to know that Australia is wealthy enough to fund research into genital cosmetic surgery of the middle and upper classes but not wealthy enough to take effective research into genital mutilation of young girls born in Australia.
    The "Butcher of Bega" would have still have been free if his barbaric operations had been performed on a different demographic.

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    1. Camille Nurka

      logged in via Facebook

      In reply to Philip Dowling

      Dear Philip, if you are referring to my project, 'Vulvatalk', I should point out that this research is unfunded. Moreover, we are not only recruiting wealthy white Australians. In addition, it would be premature to assume that the majority of women who experience genital dissatisfaction are white. It would be salient to point out that the construction of the 'white rich girl' served as the dominant image in discussions of anorexia until women of colour questioned that assumption by pointing to evidence to the contrary. This is why I'm conducting this research - to hear from women themselves about how they think about their genitals. Given that we have already received a fantastic response, I think it's research worth doing, because I believe, as a feminist, that women's opinions are important.

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    2. Ana Eugenia Castro

      logged in via Facebook

      In reply to Camille Nurka

      I am looking forward to read the result research from the Vulva talk. The finding may have some applications in the following:
      Self-Esteem
      Identity
      Maturity
      and others.
      I have being following the research for a while. I am looking forward to read the result and think about application.
      I think a face to face forum would be great to discuss application in the different areas of human study.

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    3. Agoodopinion

      logged in via Twitter

      In reply to Ana Eugenia Castro

      Unfortunately research and discussions are usually kept in educated elite close circles.
      Is important to do research but essential to bring the results and discussion to the rest of us specially to young women.
      Is there none or not enough involvement or discussion sought or provoked in schools or universities?Apparently young adults unless they choose to take gender studies rarely discuss this kind of issues.
      Asking questions, promoting discussion and involving many on issues that matter is in my opinion the only way to fix them.

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    4. Camille Nurka

      logged in via Facebook

      In reply to Agoodopinion

      This is what I'm trying to do right here! But also, we've been recruiting people to our survey through Facebook, not through the university institution precisely so that we would get a range of participants, because the broader your sample population is the less skewed your data is going to be. When we've analysed the data and got the results, we will definitely be sharing it with the public via media sources and published papers.

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    5. Agoodopinion

      logged in via Twitter

      In reply to Camille Nurka

      Thanks for sharing information about your project and looking forward to read about your results.
      Wish you well in your research.

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    6. nikki sullivan

      Associate Professor, Critical and Cultural Studies, Department of Media, Music, Communication, and Cultural Studies, Macquarie University

      In reply to Camille Nurka

      I'm really glad to see that this research is being carried out. good on you Camille. I look forward to hearing about the responses you get from participants.

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  5. Agoodopinion

    logged in via Twitter

    Sad women in society feel pressure to do cosmetic surgery of any kind (like breast augmentation, nose or FGCS)some are not informed others suffer peer/society pressure but if they are consenting adults it is not anyone's business.
    We can pressure government and media to put in place laws and programs to inform and educated but as long as you are an adult it is a matter of individual choice.
    To allow the "torture" of children it is another matter, and in my opinion criminal. As much as I respect…

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    1. Agoodopinion

      logged in via Twitter

      In reply to Daryl Adair

      Not being an eminent professor my impression was that anyone reading what I wrote would quickly understood which should be or was the intended word but if your clarification was/is a genuine one I thank you for alerting me to my mistake (a genuine thank you ) not easy to write in a non native language.
      The word I wanted to use was "mos moris" excuse me the foreign language not mine an old one.Latin
      I leave you with a few good quotes
      "Ad minora me demittere no recusabo" - I will not refuse to descent to the most minute details (Quintilian)
      I enjoy "direct to the point" but not particularly the hidden sarcasm...maybe I am wrong.
      "Ab alio spectes alteri quod feceris"

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    2. Daryl Adair

      Associate Professor of Sport Management at University of Technology, Sydney

      In reply to Agoodopinion

      Hi there, absolutely no sarcasm intended. I'm very much inexpert in the debate above and wondered whether I had misconstrued something in that costume was central to the custom. Then I thought, maybe the author means custom? So that's why I asked. I think your points were very interesting and I very much appreciated them. Also, I am someone who is rather limited - I only know English! So to converse with anyone who writes in more than one language is always something I appreciate. All the very best to you.

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    3. Agoodopinion

      logged in via Twitter

      In reply to Daryl Adair

      Hi, as I previously said a genuine thank you to you it is unfortunate I cannot correct my mistake.
      Sometimes events trigger memories and not all are pleasant ...
      It may sound to you, that I am upset to the question or critique( I never take those personally even when people call me names in twitter, sometimes I even laugh took me a long time but I am free... just want to make the point on behalf of others, those that can stop contributing to society because of bad experiences ...)
      Many times in…

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    4. Daryl Adair

      Associate Professor of Sport Management at University of Technology, Sydney

      In reply to Agoodopinion

      As it happens I am writing a book with a Brazilian friend of mine who has only been in Australia for three years. His English has improved markedly, but my Portuguese is terrible! We laugh a lot at these moments.

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    5. Agoodopinion

      logged in via Twitter

      In reply to Daryl Adair

      I think you are too kind to your friend probably the progress is similar taking into account he/she is everyday receiving English lessons (media, friends , etc)a big help.
      I can imagine the laughs ...some Portuguese words can be challenging apparently the fist thing they are told is do not use knife in their language sounds rude in English.lol
      Good luck with your book, all the best to you both

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  6. emily vicendese

    undergrad

    I would very much like to hear the author's response to Darryl and Sue's comments, both of which I think convey important points which the author cannot overlook in her analysis.

    I would also like to add that there is a difference between an ethical wrong and a legal one, and I think the author conflated them in order to avoid the crucial issue of consent.

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    1. Camille Nurka

      logged in via Facebook

      In reply to emily vicendese

      Hi Emily (and Daryl and Sue),
      Yes, I agree with you that forced childhood FGM is not the same as participation in FGCS by consenting adults. I was not trying to suggest that FGM and FGCS are essentially the same thing (clearly, they are not), but I was attempting to complexify the distinctions we easily slip into between 'cultural' FGM and 'medical' FGCS. If that point got a bit lost in the discussion, then I'm sorry I wasn't able to make it clearer (the original draft was much longer!). In terms…

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Camille Nurka

      Thanks, Camille - I think I understand your point better, but I;m not sure that the procedures are as similar as you suggest.

      In FGM, as I understand it, where the labia are excised, the intent is to close the introitus.

      If there is surgery on the labia in FGCS, the intent is not to remove the labia and close the hole, but to make the labia "neater". This is not always cosmetic in the sense of appearance - it can relate to comfort (labia come in a huge range of shapes and sizes).

      So although, at first, it seems like the procedures are similar, I don't see them as being "some of hte same procedures". Does that make sense?

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    3. Camille Nurka

      logged in via Facebook

      In reply to Sue Ieraci

      Hi Sue,
      I see what you're saying, but in relation to your suggestion that "In FGM, the intent is to close the introitus", please refer back to what I said about the WHO definition of FGM. You will find that under this definition, FGM covers a range of practices, not all of which include infibulation. Some practices excise the labia only. Have a look at the WHO's definition of the procedures here: http://www.who.int/mediacentre/factsheets/fs241/en/

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  7. juliet rogers

    Lecturer, Criminology University of Melbourne

    This is an excellent conversation and I am delighted to see the debate in the air again. I would like to point out a few articles which may help those who assume some things about female circumcision - importantly he communities in melbourne uses the term circumcision and not female genital mutilation. as Rick Shweder (Chicago Univ) writing on this says:
    “Female genital mutilation” is an invidious and essentially debate-subverting label. The preemptive use of that expression is just as invidious…

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  8. brigitte jones

    Social Worker

    I'll agree with Greer that the two kinds of surgery do overlap in most cases as physically unnecessary and both do pose degrees of risk and interference with the fullest capacity of genital originated sensations.
    The FGM is a result of cultural pressure to essentially access future economic security and social security through the increased options of marriage FGM will bring. FGM could be claimed to be a by product of practical chauvanism and marriages arranged by practical concerns to assist keeping…

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    1. brigitte jones

      Social Worker

      In reply to brigitte jones

      I don't believe there is much point in worrying about the females who are shallow enough to succumb to FGCS or really even cosmetic breast surgery.
      Common sense indicates that what rates is a woman looking fit , healthy and not being overweight as the most marketable basis where clothes and hair styles cap things off.
      Far more information needs to be provided about these surgical irreversible procedures and how little they can ever improve life or only for how long before more problems come up.That's…

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    2. brigitte jones

      Social Worker

      In reply to brigitte jones

      FGCS is a choice made through a mental illness that's untreated.This is less of an informed choice than when modified FGM is performed in proper clinics to sustain a the successful continuity of belonging in a childs culture. Most Islamic migrants are happy to get modified FGM procedures done in a safe medical clinic and do so when they can access such. Even the criticism of more disabling FGM operations done in awful circumstances probably aren't that much ahead of all the problems that come up with cosmetic surgery of breasts and genitals. Our cosmetic surgery is of breasts and genitals is exploitation of the vulnerable to distorted self views and expectations, not cultutal pressure of any substantial sort.

      (The highly sensitive send on this resulted in my continuing via self replies.)

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