June/July 2009

The Vagina Dialogues


This past November, two women wearing giant plush vulva costumes were shouting on a street corner in New York City. But they weren't trying to reel in tourists; these vulvas had a purpose. They were standing in front of the Manhattan Center for Vaginal Surgery, performing a short play entitled "Dr. Interest-Free Financing and the Two Vulvas," part of a creative, eye-catching protest against vaginal cosmetic surgery. There was even a brief cameo from a giant pair of scissors.

Fifteen years ago, "The Designer Vagina" would simply have been a good name for a band. Now, vaginal cosmetic surgery is the fastest-growing cosmetic procedure in the U.K. While there are still only about a thousand surgeries done each year in the U.S., there was a 30 percent increase in 2005 alone. The numbers could actually be even higher, but data is still scarce. More and more women are opting to have their labia snipped off and "sculpted" through labiaplasty, or their vaginas stitched smaller and tighter with vaginal rejuvenation. These women are of all ages, many in their early 20s. Even scarier, some surgeons have conducted consultations with patients as young as 15.
What the hell is going on here? Who are these women, and what is pushing them to the extreme of slicing up their lady flower? As with anything involving our sexuality, the answer is complex, and a number of factors are at play. But the most common reason women give for wanting labiaplasty is, of course, cosmetic. Simply put, they want a "prettier" vagina. (And yes, I know the vagina is actually only the interior tract, but I'm using the word in the colloquial sense.) We live in the age of the Britney vadge flash, thongs, Brazilian waxes, and "sexting." With that much crotch on display, it's not surprising that the concept of an "ideal vagina" has emerged. But what exactly is it? When asked to describe such a thing, many of us would probably be at a loss. One that shoots out gold coins? Or can whistle Prince on cue?
Some women are quite clear on what makes for a perfect vagina-they believe it can be found in porn and bring centerfolds to their surgeons for reference. As the Web site for the Laser Vaginal Rejuvenation Institute of Manhattan proclaims: "Many people have asked us for an example of an aesthetically pleasing vulva. We went to our patients for the answer, and they said the playmates of Playboy." Other docs concur that porn is the gold standard. Gary Alter is a Beverly Hills-based surgeon who has perfected his own "Alter Labia Minora Contouring Technique." He says, "The widespread viewing of pornographic photos and videos has lead to a marked rise in female genital cosmetic surgery. Women are more aware of differences in genital appearance, so they wish to achieve their perceived aesthetic ideal."



Viewing vaginas in porn as "the ideal," however, poses a number of problems. For starters, the majority of mainstream porn magazines and videos show only one very specific type of crotch-the perfect pink clam. Women with large or asymmetrical inner labia don't get a lot of page room or airtime. (Interestingly enough, this doesn't always have to do with aesthetics. Sometimes it's a question of censorship laws-inner labia are deemed more "provocative," and by not showing them, a mag can get a "softer" rating. Playboy is known for tucking in or airbrushing away labia.) So actually, Dr. Alter, women are not so aware of differences in genital appearance. While lesbians are probably a bit more informed, many women aren't familiar with the look of regular, everyday vaginas, which come in an endless range of shapes and sizes. If you're straight, it's very likely your vadge knowledge is limited to a squat with a hand mirror, or Jenna Jameson. Maybe you also had a diagramed health-book drawing to stare at or a gym teacher who drew a crooked vulva on the blackboard. But Coach Sartini certainly never barked at me, "And by the way, Gohmann, there are all kind of labes out there! Long ones, hidden ones, asymmetrical ones, all kinds! Got that?"

The vagina has long been shrouded in mystery and shame for many women. Thankfully, Eve Ensler's The Vagina Monologues did a lot to break our culture's vadge code of silence. As she so eloquently remarks in the play's opening: "There's so much darkness and secrecy surrounding them-like the Bermuda Triangle. Nobody ever reports back from there." Sadly, it appears we're still doing a pretty crappy job of reporting back if some women are using Barely Legal as a gauge for what is "ideal." But if some women believe that's what men find attractive, they're willing to do whatever it takes to be "hot."

However, through the course of my research, I encountered, time and again, men who say they really "do not care" what a woman's vadge looks like. The general sentiment seemed to be that any vagina is a good vagina. Obviously, some men must care, or there would be more diversity in porn. But has their preference been programmed by porn, or vice versa? Personally, I think any man who calls a vagina "ugly" needs to be handed a photo of his testicles and sent packing, but unfortunately, not everyone feels this way.

Yet not all women are getting labiaplasty for men. Or at least, so they claim. I spoke with Melissa, a bright and bubbly 24-year-old from California, who carefully researched her labiaplasty and breast implants, which she had done on the same day. Melissa was not only adamant that she wasn't doing it "for a man," but she also seemed rather insulted by the idea: "I don't care if men like my nail polish color, and I certainly don't care if men like my vision of an ideal vagina." Melissa insists her desire for surgery mainly had to do with physical discomfort. Though she's completely healthy with perfectly normal anatomy, Melissa's labia were causing her pain-another major reason women list for getting labiaplasty. Some women with bigger labia say they become sore from too much time on the exercise bike, they feel tender after sex, or that certain underwear "doesn't fit right." While these problems are pretty universal for women, long labes or not, some feel it's worthy of surgical intervention. In Melissa's case, her labia were interfering with her passion for horseback riding. But she also admits to being a "perfectionist," and after she made up her mind to get the surgery, she wanted to "look stellar down there." She scanned porn sites to find the right "look," then trolled before-and-after albums at cosmetic-surgery sites like MakeMeHeal.com. She found only a few "after" shots that suited her, and expressed surprise that "most people wanted their doctor to leave more labia than I even had to begin with!" Melissa ultimately ended up getting what is known as "The Barbie Doll look," or "the youth/preteen look": she had all of her inner labia removed.

Plastic surgeon John Di Saia asserts that these surgeries are helpful to women and believes the practice has merely been sensationalized in the media. He used to do about three labiaplasties a month, but in the current economy, he performs less than a dozen a year. (Wow. This really is like the Great Depression. Who will pen our Labes of Wrath?) In an email interview, I asked him about the validity of labia interfering with women's exercise, and he responded, "Some patients cannot wear tight clothing because of the discomfort. That is not normal." But he then went on to say, "In borderline cases, you may have a point, as each patient justifies her decision differently. Some women just plain don't like the way their Labiae [sic] look. They want them looking 'tighter,' smaller, and frequently more oval-shaped."

It would seem that when "physical problems" are cited as reasoning for surgery, they are often closely intertwined with the cosmetic. And when those problems have to do with sexual dysfunction, the line between the physical and the cosmetic becomes even more blurred. In 2004, Dr. Laura Berman, director of the Berman Center (a treatment clinic for female sexual dysfunction) completed a study on the relationship between women's genital self-image and their sexual function. She surveyed 2,206 women and, not surprisingly, found that the way you feel about your vadge plays a huge part in how much you enjoy sex. But rather than helping women deal with dysfunction by teaching them about their bodies and working toward overcoming esteem issues, our cultural response is to offer surgery as the solution. Doctors will simply trim away your "ugly" bits.

"It's promoted with claims of increased sexual pleasure, increased self-confidence, and a 'better' aesthetic appearance. These are seductive and sound good-who wouldn't want better self-esteem or a better sex life?" says  Virginia Braun, a psychologist and senior lecturer in psychology at The University of Auckland, New Zealand. She has been studying female genital cosmetic surgery since 2002. She points out that the claims these surgeons make "are not evidence-based, although they are presented as if they were facts-what will happen to you if you have the surgery." So despite there being no real evidence (a formal medical study has never been done), many surgeons are loudly proclaiming the surgeries as a cure for your bedroom woes. The tricky thing is that in some cases, it's true. But this is where the snake starts to swallow its tail. Dr. Di Saia himself probably explains it best: "Sexual response is frequently increased, but I think this has to do with comfort. Women tend to have a much more cerebral experience with sex than men do.



Self-consciousness or worry of pain can stop things in their tracks, and nobody wants that." I think we can all agree that women have a more cerebral response to sex. But that seems to be the crux of the problem. Women are slicing off parts of their sex organs in the hopes of having better sex. Before we raise the scalpels, it seems going to the source-the cerebrum-would be a much better option.

Unfortunately, that's not nearly as easy as a one-hour outpatient procedure performed under local anesthesia. A root canal takes longer! A simple Google search offers a slew of Web sites promising the "solution" to your vagina problems, whether your sex life sucks, you're training for the Tour de France, or you're convinced your vagina is straight out of Cloverfield. Many of the sites look like they're advertising a relaxing spa treatment, not a procedure that ends in dissolvable stitches. They call the surgery "empowering!" And something you can "do for yourself!" LabiaplastySurgeon.com explains that the surgery is a good choice for "women who are either experiencing sexual dysfunction, embarrassment, or pain because their labia minora are oversized or asymmetrical." It states surgery is also for "women who dislike their large labia or shape of their labia, which may cause inelegance or awkwardness with a sexual partner." That's right, ladies! Dr. Bernard Stern wants to save you and your big, floppy labia from an inelegant moment in the bedroom. Extra helpful are the site's many before and after photos. On the left is a perfectly normal vulva; on the right is the same vulva, now trimmed of all that inelegant, nerve-filled tissue that can greatly contribute to a woman's sexual pleasure. If you still aren't sold, check out the loads of online "success" stories from past patients who make the surgery sound as easy as a belly piercing. And almost every doctor offers a "free consultation!"

I tracked down a local clinic that offered labiaplasty and met with Michelle, a lovely registered nurse in her mid-20s. I gave her my made-up spiel about why I wanted labiaplasty, emphasizing that I had no physical problems whatsoever but just didn't like the way I looked. "Many women have it strictly for cosmetic reasons," she assured me. "It's about making you feel better about yourself!" She then gave me a sunny presentation about how simple it was, how attentive they would be, and how I needn't feel embarrassed. I listened to her very convincing pitch, after which I asked about possible side effects, like nerve damage or loss of sensitivity. "Oh," she said, looking sincerely befuddled. "I've never heard of anything like that happening here. Really, it's such a simple procedure. But you could ask the doctor at your next appointment." With that cleared up, she slipped into hard-sell mode and pulled up her online calendar to book my follow-up. By the time I left the office, I almost felt excited for my pretend surgery. It's all so easy! Like getting my teeth whitened. Sure, it was going to cost me ($5,934), but really, I should have done it years ago! I could only imagine what it must be like for women who truly are ashamed of their vagina and who encounter the bright-eyed, Noxzema-clean Michelle, who promises such a quick and simple solution to their woes.

While it's not hard to find a doctor happy to perform labiaplasty, it's a bit tougher to find info on how safe the surgery is-as exemplified by my free consultation. And this is because no one really knows. Again, no long-term studies have ever been done. Web sites and doctors downplay possible side effects and instead list "mild discomfort and swelling" as the main things to worry about. In 2007, The American College of Obstetricians and Gynecologists issued a statement that the surgery is "not medically indicated," and that it is "deceptive to give the impression that vaginal rejuvenation, designer vaginoplasty, revirginization, G-spot amplification, or any other such procedures are accepted and routine surgical practices." They offer a frightening list of potential complications, including "infection, altered sensitivity, dyspareuinia, adhesions, and scarring." The surgeries were also blacklisted by The Royal Australian and New Zealand College of Obstetricians and Gynecologists after doctors saw an increase in women needing reconstructive surgery due to badly botched jobs. They issued a statement saying the procedures are "not very anatomically based and have the potential to cause serious harm."

So despite the lack of a formal study, there is little doubt that these surgeries can be incredibly risky and can come with grave complications. But it's tough to find anyone who will open up about a procedure gone wrong-no one wants to be the cover girl for bungled vagina surgery. Even our reigning queen of vaginas, Jenna Jameson, was close-mouthed about her experience; when the famed porn star reportedly underwent a vaginoplasty in 2007, she was supposedly so upset with the results that she went into hiding. And when a woman with an "ideal" vagina is getting vaginoplasty, we've got a problem.

There are a handful of organizations and individuals who are trying to tip the information scale in the other direction, letting women know there are roads to empowerment that don't involve incisions. Most notable is The New View Campaign (www.fsd-alert.org), a group dedicated to "challenging the medicalization of sex" and the organizers of the aforementioned vulva play. Its Web site provides an extensive overview of vaginoplasty, as well as links to books and videos on women's sexual health and dysfunction. The group has a long list of endorsements from various doctors and social scientists; it even gets the thumbs up from former prostitute turned sex guru and performance artist Annie Sprinkle. Its latest efforts include The International Vulva Knitting Circle, a playful way to bring women together to talk about their bodies and knit vulvas. So far there are circles in Brooklyn, Melbourne, Toronto, and Auckland, with hopes to exhibit a global collection of the handiwork in New York next year.

Offering a male perspective on the subject is British artist Jamie McCartney, who's educating people on vadge variety with a piece called "Design a Vagina." He is making 200 casts of volunteers' lady parts and will be hanging them together in large panels. I had the opportunity to participate as a volunteer and see McCartney's work-let's just say it made a lasting impression. McCartney hopes his sculpture will eventually find a home in a public space, saying, "for many women, their vagina is a source of shame rather than pride, and this piece seeks to redress the balance, showing that everyone is different, and everyone is normal."

For the younger ladies, there is Scarleteen.com, a fabulous site that offers "sex ed for the real world." In its "Give 'Em Some Lip: Labia That Clearly Ain't Minor" section, the site answers young women's questions about what a "normal" vagina looks like and provides helpful pictures and diagrams, including a link to the eye-opening drawings of Betty Dodson, a regular contributor to BUST.

So there are a few voices yelling into the void, people working to follow Ensler's edict to "spread the word." And while some women might cringe at the idea of vagina sculptures and labia costumes and vulva cozies, they would no doubt prefer them to the proliferation of perfectly healthy women putting their most intimate body part under the knife for a potentially dangerous, unnecessary procedure. As it stands now, any means to bridge the gap between the mass of swirling misinformation and the truth should be welcomed, since what we have are the conditions for a perfect storm. With a lack of education and information, a built-in cultural shame surrounding vaginas, a preponderance of false images in the media, and a line of medical professionals taking our signed checks and nodding reassuringly, in five years time, will getting a streamlined vagina be as common as a tummy tuck?

As The New View Campaign points out: just as the fight to rid Africa of female genital mutilation is gaining real momentum, the West appears to be picking up the very knives they are putting down. And yes, there are numerous differences between FGM and labiaplasty. But there is also the eerie similarity that both are born of cultural standards imposed upon the women of a society. While our surgeries may be done entirely by choice, one wonders at what point the disconnect occurs between denouncing the use of a scalpel by others and then picking it up ourselves. B


1. Have you ever examined your vagina with a mirror?
Yes: 95%
No: 5%

2. What did you experience when you first looked at yourself?
A little wonder, a little disgust: 44%
Indifference-no big deal: 24%
Wonder-the body is amazing: 23%
I never looked: 5%
Disgust-it's like an alien: 4%

"Oooh, it's so pretty! Nobody told me there would be purple."
"I found out my lips are as uneven as my boobs."
"It looked like the inside of my mouth, minus the teeth."
"I thought I was looking at a picture of Mick Jagger."
"I discovered I have a freckle down there!"

3. Do you know your vagina well enough that you could pick it out of a lineup?
Yep: 53%
Probably Not: 47%

"Ain't no labia like my monster left labia!"
"Only if I can use my hands."
"I could definitely win a game of 'spot my twat.'"
"Not only a lineup but a scratch 'n' sniff as well."
"Oh, God, what the hell did it do this time? I told it I wasn't
bailing it out of jail again!"

4. Would you consider your vadge an innie or an outie?
Outie-like a butterfly: 46%
Innie-like a walnut:    34%
I don't really know: 19 %

"Mine looks more like a sea anemone that someone poked."
"In between. Like a butterfly emerging from its cocoon."
"My girlfriend says it looks like it's sticking its tongue out!"

5. Are your labia symmetrical or asymmetrical?

Symmetrical:    41%
Asymmetrical:  40%
I don't really know: 19%

6. Are you comfortable saying the word vagina?
Yes! Vagina, vagina, vagina!: 90%
Mmmm...no: 10%

"I prefer cunt or pussy. Vagina is for biology class."
"Vagina means 'sheath for a sword.' Not female-friendly!"

7. Can you identify the different parts of your vagina? (Do you know where your clitoris is, your labia, etc.)

Of course: 88%
Not exactly: 12%

8. Have you ever watched porn?
Yes: 94%
No: 6%

9. How do you generally feel seeing vaginas in that context?
Turned on-porn is hot: 41%
Amused-porn is ridiculous: 29%
Indifferent-porn is boring: 16%
Disgusted-porn is degrading: 9%
Grossed out-porn vadge is bad: 5%

10. Have you ever felt your vagina was unattractive or "gross"?
Nope, it's part of the body: 40%
On occasion: 39%
Yes, but for health reasons: 17%
Yes, all the time: 4%

"It's kinda gross, but so are toes."
"It's just like a bad hair day-sometimes you have bad vagina days."
"Yes, once a month!"

11. What does a "normal" vagina look like?
No two are exactly alike: 74%
I have no idea: 20%
Symmetrical: 3%
Small labia and a tiny clitoris: 2%
There is an ideal, but not here: 1%

12. If you could safely and inexpensively have cosmetic surgery on your vagina, would you?
No way! Are you crazy?: 88%
I'd consider it: 9%
Sure! I'd love to: 3%

13. How would you feel about someone else undergoing vaginal cosmetic surgery?

Neutral: 41%
Somewhat opposed: 26%
Adamantly opposed: 25%
Somewhat supportive: 5%
Adamantly supportive: 3%

Ilustrated by Damien Correll