Marie Claire Australia September 2017

marieclaire.com.au 71

PHOTOGRAPHED BY GETTY IMAGES. *NAME HAS BEEN CHANGED.

†“FEMALE GENITAL COSMETIC SURGERY: A CROSS-

SECTIONAL SURVEY EXPLORING KNOWLEDGE, ATTITUDE AND PRACTICE OF GENERAL PRACTITIONERS”,

BMJ JOURNALS

cause injury to the female genital

organs for non-medical reasons”.

FGM is common practice in many

African countries and the Middle East,

but is illegal in Australia and the UK.

Unlike labiaplasty, FGM is frequently

performed without anaesthetic and is

forced upon girls by family members.

“We cannot tell communities in

Sierra Leone and Somalia to stop

a practice which is freely permitted in

Harley Street,” MPs on the UK Home

Affairs Select Committee wrote in a

report, referring to the London street

famous for its cosmetic surgery clinics.

“Labiaplasty is culturally driven

and one would have to ask whether it’s

also female genital [mutilation],” associ-

ate professor Sonia Grover, director of

the Department of Gynaecology at the

Royal Children’s Hospital in Melbourne,

told SBS in 2012.

In Australia, Victorian state legisla-

tion already stipulates the removal of

the labia minora from girls under the

age of 18 as FGM unless it is “necessary

for the health of the person”. (As yet no

cases of elective labiaplasty surgery on

under-18s have been prosecuted.)

While feminist writer and Guard-

ian columnist Van Badham doesn’t

believe we should enact a total ban on

labiaplasty, she is concerned that we’ve

reached a point where women are

making decisions about their anatomy

driven by cultural expectations.

“Women seem to have this skewed

perception of what’s ‘normal’ and what’s

acceptable,” says Dr Simonis.

“We’re seeing girls and young wom-

en who have very little experience in the

world, and presumably very little sexual

experience, and they’re prepared to have

this radical surgery that’s irreversible.”

Many plastic surgeons are equally

concerned with how the surgery is sold

to vulnerable women.

One Sydney clinic told marie claire

they get around 10 enquiries every week

about labiaplasty and that they turn

away at least two to three of these

women based on suspicions they

only want the surgery due to body

dysmorphia, or because they’re un-

der pressure from a partner.

The problem is that for every

responsible clinic, there’s another

willing to take someone’s money.

And the reality is many women

are now so concerned about how

they look, they’re willing to try any-

thing. Dr Simonis cites a colleague

whose patient allegedly went

to Thailand for the surgery and

woke up with a complete clitoridectomy

(removal of the clitoris).

On a Reddit forum, someone claim-

ing to be a 14-year-old girl wrote that

she hates the look of her vagina so much

she’s considering trying to cut off the

“excess” tissue herself, seeing as her par-

ents won’t let her get the surgery.

RIGHT TO CHOOSE

The increased demand and spotlight

on labiaplasty is causing some experts

and politicians to question whether the

surgery should be performed at all.

In the UK, there’s a renewed push

to ban the procedure, seeing as it tech-

nically falls under the definition of

female genital mutilation (FGM) – the

removal of some or all of the external

features of a woman’s vagina, often in-

cluding the labia and clitoris. The World

Health Organization defines it as

“procedures that intentionally alter or

“Women need to make their own

choices about their bodies and the skin

they feel confident in,” she explains.

“But I wonder how much of it

is really women’s choice when the media

and culture is feeding them a constant

diet of standardisation and telling

women that they look abnormal

when they don’t.”

Eloise finds this viewpoint frustrat-

ing. She does admit it would have been

nice to find out from a younger age that

her vagina looked normal, and adds

that education might have been

reassuring, but insists only the sur-

gery could make her feel confident.

“I think women should wait

until they’re 18 and take the time

to properly research the surgery,”

she says. “But if it will make them

more comfortable and happier, why

shouldn’t [they] have it done?”

Dr Sharp agrees that the last

thing women need is more people

telling them what they can and can’t

do with their bodies.

“We have this idea that doing

something for appearance’s sake is

not a valid reason – especially when it

comes to women’s vaginas. We’re more

accepting of boob jobs and nose jobs

than we are of labiaplasty.”

Her research also shows that, like

Eloise, most women are happy with the

results of their surgery in terms of func-

tion and appearance.

There are also positive shifts in

educating young girls: resources such as

LabiaLibrary.org.au, a website devel-

oped by Women’s Health Victoria which

provides women with free access to

unaltered images of real vaginas.

“The big distinction between our

culture and the cultures who are

performing FGM is that women in Aus-

tralia have the ability to make the choice

for themselves,” says Dr Simonis.

“We just need to make sure women

are empowered with the right informa-

tion, so they know their own bodies and

their decision is educated.”

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Stopped at the door: Labor MP Courtney Houssos and her 19-month-old daughter Anna.

Photo: Fiona Morris

Harwintorequesttherulesmovewith

thetimes,toallowyoungchildrenin

thechamberduringadivision.

MsHoussossolvedherdilemma

onWednesdaynightbycallingher

husband,whohappenedtobeinthe

building,tocomeandholdAnna.She

saystheincidentwashandledsens-

itivelybygovernmentWhipPeter

Phelps,whoinitiallyofferedhera

‘‘pair’’–whereagovernmentMP

wouldhaveabstainedfromvotingto

makeupforMsHoussos’absence.

Butshebelievesthechanging

MrMoselmanesaidhehopesthe

NSWLegislativeCouncilcanoffer

moreleniencytochildren,asit

allowsothervisitorsintothecham-

beronspecialoccasions.

MrHarwinsaidabriefingpaper

wasbeingpreparedonpractices

adoptedinotherparliaments.

committeetoconsiderwhetherany‘‘Iintendaskingtheprocedures

changesneedtobemadetocurrent

standingorders,totakeintoaccount

womenmembersandtheirparticular

needswheretheyhavechildrenolder

thanbreastfeedingage,’’hesaid.

Warning clinics ‘upselling’ genital surgeries

»AMY CORDEROYHEALTH EDITOR

Thesecretwomen’s

businessnooneis

talkingabout

Extra, Page 34

W

omenarebeing

‘‘upsold’’invasive

genitalsurgeriesby

meticclinicsthatdonotproperlyunscrupulouscos-

informthemabouttherisks,or

whetherthesurgeryisevenneces-

sary,healthexpertssay.

Whiledatashowspublichealth

authoritieshavemanagedtolower

ratesofpubliclyfundedlabiaplasty,

whichinvolvescuttingawaypartsof

thelabiaminora,theprivatesector

isstilla‘‘wildwest’’,accordingto

cliniciansworkinginthearea.

TheRoyalCollegeofGeneral

PractitionersinJulyreleasedanew

guidefordoctorsontreating

patientswhorequestgenitalsur-

gery,includingrecommendingthat

theybedirectedtoimagesoffemale

genitaliathathavenotbeendigitally

altered,suchasonlinedatabaseThe

LabiaLibrary.

Italsowarnspurelycosmetic

femalegenitalsurgerycouldactually

fitthelegalcriteriaforfemalegeni-

talmutilation,areligiousandcultur-

alpracticeamongsomegroupsthat

isbannedinAustralia.

Medicaredatashowsa28percent

declineinthenumberofsubsidised

labiaplastiesinthepastfinancial

year,afternewruleswereputinplace

toensurewomenwerenotundergo-

ingtheprocedureunnecessarily.

Womenwhoapplytohavelabia-

plastymustnowprovideanexpert

reviewpanelwithphotographsof

theirgenitaliatobeassessedfor

unusualphysicalsymptomsthat

needrepair,ortobetoldtheyfall

withintherangeofnormalvariation.

MagdalenaSimonis,whowrote

thecollegeguidelines,saidpublicly

fundedgenitalsurgerywasjust‘‘the

tipoftheiceberg’’.

‘‘Privatecosmeticsurgeonsdon’t

needtolisttheirdataandthey

don’t,’’shesaid.‘‘Therearesome

plasticsurgeonswhosaytheysee

100patientsayear,butthenthere

arebigcosmeticfranchiseswhosay

theyaredoingthousands.’’

Whileplasticsurgeonsmust

undergoyearsoftrainingtoqualify,

cosmeticproceduresarelessregu-

latedandmaybedonebypractition-

erswithvaryinglevelsoftraining

andexpertise.

DrSimonissaiditwasquestion-

ablewhetherallwomenundergoing

genitalsurgerywerebeinggiventhe

informationabouttherangeof

appearancesthatwerenormal,and

therisksofsurgery,whichthey

neededtogiveinformedconsent.

Insomecases,womenwerebeing

pressuredintomoreextensivesur-

gerytotheclitoralhoodbecause

doctorshadremovedsomuchof

theirlabiathattheyneededto‘‘bal-

ance’’outtheotherareas.

‘‘Someofthecliniciansthatare

performingthesesurgeriesarenot

actinginthebestinterestsof

patients,’’shesaid.

FrancesD’Arcy-Tehan,acoun-

sellingpsychologistandclinical

sexologistwhoiscompletingaPhD

attheUniversityofSydneyongeni-

talperceptionsandsurgeryamong

Australianwomen,saiditwas

strangethatfemalegenitalmutila-

tionwasbanned,butgenitalcutting

wasOKfor‘‘SusiefromNorth

Sydney’’.

‘‘Idon’tthinkwomenhereare

reallygettingthefullstory,’’shesaid.

‘‘This[surgery]isstillforcultural

reasons,butit’sjustforanideal

image[ratherthanreligion].’’

Shesaidmanypatientswerenot

warnedthatcuttingtheirlabiacould

reducesexualfunction.

‘‘Thelabiaminoraisahighlyero-

ticandsensitivetissueandit’s

importantforarousal.It’snormalto

haveprotrusionandwhenyouare

aroused,itactuallygetsengorged.’’

MsD’Arcy-Tehansaidtheindus-

trywasa‘‘wildwest’’andtherewere

anecdotalreportsofwomenseeking

repairsforbotchedtreatment.

Shesaidwomenmightseekthe

surgerysotheycouldfollowtransi-

entfashiontrendsfortightclothes

orsmallbikinis,becausetheyhad

removedtheirpubichairandwere

uncomfortablewiththesightoftheir

labia,orbecausetheyortheirpart-

nerhadonlyseenhighlystylised

labiadepictedinpornography.

‘‘Onestudyfoundabout30per

centofwomenwhohadlabiaplasty

wereteasedbytheirboyfriend

abouttheappearanceoftheir

labia,’’shesaid.

“We’re seeing girls who are

prepared to have this radical

surgery that’s irreversible”

• Dr Magdalena Simonis

AUSTRALIAN REPORT