Making sense of female genital alteration practices

Making sense of female genital alteration practices

Virginia Braun

Department of Psychology, The University of Auckland, Private Bag 92019, Auckland, New Zealand.


Around the globe, girls and women routinely undergo a range of genital alteration procedures. Some procedures, such as some intersex surgery or labial reduction, are performed once with permanent effects; others, such as pubic hair removal or vaginal drying, need to be done repeatedly, as their effects are only temporary. Some are done without choice, or against the person's will; others are 'freely' chosen. Some practices are agonised over; others are so mundane and routine they are barely questioned. Some, such as 'traditional' genital cutting ([FGC] also known as female genital mutilation (FGM)), are illegal and legislated against in many countries; others, such as genital cosmetic surgery, are available to all who can pay up front or qualify for finance. What unites all these procedures is an understanding of the way women's genitalia should be, if girls and women are to be appropriately gendered and sexually desirable. My focus in this article is exploring understandings of women's genitalia, and how they inform and enable alteration practices, through an examination of the specific practice of female genital cosmetic surgery in the west.

In the late 1990s, western media started to cover a 'new' area of cosmetic surgery: the 'designer vagina'. Media coverage has since increased dramatically, as have the number of surgeons offering genital 'cosmetic' procedures, and, apparently, the number of women having these surgeries. Genital cosmetic surgery for women is reported to be the fastest emerging growth trend in the cosmetic surgery in the US. Almost every part of women's genitalia is subject to surgical alterationthe vagina is tightened, the labia minora are reduced, the labia majora are plumped up, the mons pubis is reduced, the clitoral hood is reduced, the hymen is reconstructed, and the much debated G-spot is pumped full of collagen to increase its size. Unlike many other cosmetic procedures, with these there is a messy line between aesthetics and function. Some (e.g., vaginal tightening) are primarily about function: claims for increased sexual pleasure abound. Others (e.g., labia reduction) are primarily about form: looking 'right' is key, although function overlaps here too. (This overlap is evidenced in some labia reductions being covered by public health services in the UK, if there is 'discomfort').

Surgeons report that they are offering a much needed service to women, that they are addressing their anxieties, providing solutions, and thus fulfilling women's needs and desires. The surgery is framed as women-driven, as women's choice. Choice appears to be the appropriate word, as women do not typically appear to be coerced into it. One important issue that is currently neglected is why western women are 'choosing' to have cosmetic surgery on their genitalia. Choice needs to be examined critically, and broadly, and 'coercion' needs to be theorised at a cultural (and interpersonal) level. Choice is at the heart of liberal individualism, our dominant western ideology, but within that framework choice exists in a socio-cultural and political vacuum. However, for many, choice becomes a thorny issue when applied to situations where the individual might be 'choosing' to act in ways that could be deemed not in her best interest. In some cases, we have legislation regarding this. For instance, many countries have extensive laws banning FGC [e.g., 2]. Here, oppressive cultural traditions are deemed too powerful, too coercive, for a woman to 'choose', and choice is curtailed through legislation. In contrast, western women's choices apparently supersede cultural influence [3], and genital cutting is just cosmetic surgerya liberated (if somewhat indulgent) choice.

However, if we theorise coercion at a more cultural level, we need to examine the context of 'choice'. In the west, the dominant meanings associated with women's genitalia have been negative [4], and, despite plays like The Vagina Monologues [5], these remain [e.g., in genital slang, see 6]. Western women's experiences of their genitalia are diverse [7, 8], but anxiety, shame and embarrassment remain key aspects for many. Alongside this, genital cosmetic procedures tend to be promoted in the media as transforming women's sex lives [9], not to mention their self-esteem, while the 'horror stories' of surgery that goes wrong remain absent, emerging only occasionally in locations like internet bulletin boards. Some surgeons engage in 'hard sell' campaigns with excessive claims of success, despite no scientific proof of surgical effectiveness. These contexts work to render women's genitals 'surgical' [10] ' that is, make them a viable site for surgery, and offer surgery as a solution to many genital concerns. Thus we can theorise choice as individual, but also as culturally coerced, or at least culturally enabled. While surgery might provide 'genital liberation' for individual women, it does nothing to change the context in which women choose these procedures, and, arguably, actually reinforces a model of women's genitalia as in need of surgery, and women's genital concerns as fixable through surgery [9]. As culture and individuals exist in a reciprocal feedback loop, these surgeries can be seen to render the situation worse for women, in terms of genital acceptance. They implicitly and explicitly promote one particular genital formation as the 'right' one.

Overall, female genital alteration procedures tend to be about reduction ' reduction of size of various parts, and removal of certain visible tissue. They are informed by the logic of gender dimorphism, where men's and women's genitalia must be visibly and discretely different, with women's small, neat, and containedwhich can be interpreted as a modern rendering of the idea that women's genitals are marked by absence, by what they are not, rather than by what they are, by presence. Too much presence (e.g., too much labia minora tissue, too much glans clitoris projection) is deemed 'wrong'. The notion that we must have discretely gendered genitals informs practices like genital cosmetic surgery (where some women interpret their pre-surgical genitalia as 'male' in appearance), FGC, and infant intersex surgery. So genital diversity and sexual diversity remain key issues to address and to educate about. There is no such thing as 'normal' where women's genitalia are concerned; diversity in appearance is the order of the day, just as it is in women's faces. A recent British Medical Journal of Obstetrics and Gynaecology article found enormous variety in vulva size and shape, far more than anticipated, in women who experienced no genital 'problems' [11], indicating that even genitalia that might currently medically be deemed hypertrophic, may well be within the range of normal variation.

The social contexts we grow up in profoundly affect our knowledge, and indeed our experiences. Despite the feminist and women's health movements in the 1970s and beyond, many western (and other) women have grown up in a cultural context in which women's genitalia remain loaded with negative cultural meanings. Women tend not to be brought up to conceptualise their genitalia as functional and active, and many women remain ignorant about the form and function of their genitalia. Coupled with broader cultural meanings, this ignorance can impact on women's sexual and reproductive health. What we have to understand is that everybody within a culture is exposed to these meanings, so it is not only women and girls who are affectedmen and boys are too, as are those we interact with professionally, such as gynaecologists and obstetricians [e.g., 12]. So it is at this level of cultural meaning that we need to intervene.

Ultimately, we want women and girls (and men and boys) to be able to make critically informed, healthy choices about their sexual and reproductive lives. While women (and men) remain ignorant of women's genital diversity and function, women's sexual and reproductive health is liable to suffer. A key solution is to provide better sexuality education which not only informs, but also challenges, common-sense cultural attitudes and ideas about women's genitalia, and women's sexuality.


Individuals with intersex conditions do not have exclusively 'male' and 'female' bodies, at the level of chromosomes, hormones, gonads and/or external genitalia. Intersex conditions have often been treated surgically, and a primary focus has been 'normal' genital appearance. This standard medical management of intersex has been challenged in recent years [e.g., 1].


1. Creighton, S.M. and C.L. Minto, Managing intersex: Most vaginal surgery in childhood should be deferred [editorial]. British Medical Journal, 2001. 323: p. 1264-1265.

2. Rahman, A. and N. Toubia, Female genital mutilation: A guide to laws and policies worldwide. 2000, London: Zed Books.

3. Essn, B. and S. Johnsdotter, Female genital mutilation in the West: traditional circumcision versus genital cosmetic surgery. Acta Obstetricia et Gynecologica Scandinavica, 2004. 83(7): p. 611-613.

4. Braun, V. and S. Wilkinson, Socio-cultural representations of the vagina. Journal of Reproductive and Infant Psychology, 2001. 19: p. 17-32.

5. Ensler, E., The vagina monologues. 1998, New York: Villard.

6. Braun, V. and C. Kitzinger, 'Snatch', 'hole', or 'honey pot'? Semantic categories and the problem of non-specificity in female genital slang. Journal of Sex Research, 2001. 38: p. 146-158.

7. Braun, V. and S. Wilkinson, Liability or asset? Women talk about the vagina. Psychology of women Section Review, 2003. 5(2): p. 28-42.

8. Braun, V. and S. Wilkinson, Vagina equals woman? On genitals and gendered identity. Women's Studies International Forum, 2005. 28(6): p. 509-522.

9. Braun, V., In search of (better) female sexual pleasure: Female genital 'cosmetic' surgery. Sexualities, 2005. 8(4): p. 407-424.

10. Blum, V.L., Flesh wounds: The culture of cosmetic surgery. 2003, Berkeley, CA: University of California Press.

11. Lloyd, J., et al., Female genital appearance: 'Normality' unfolds. British Journal of Obstetrics and Gynaecology, 2005. 112: p. 643-646.

12. Pliskin, K.L., Vagina dentata revisited: Gender and asymptomatic shedding of genital herpes. Culture, Medicine, and Psychiatry, 1995. 19: p. 479-501.

Author bio

Virginia Braun is a Senior Lecturer in Psychology at The University of Auckland, New Zealand, and on the Trust of the NGO Women's Health Action ( She has longstanding research interests in women's genitalia, women's health, and sex, and has published in these areas. Email

Individuals with intersex conditions do not have exclusively 'male' and 'female' bodies, at the level of chromosomes, hormones, gonads and/or external genitalia. Intersex conditions have often been treated surgically, and a primary focus has been 'normal' genital appearance. This standard medical management of intersex has been challenged in recent years [e.g., 1].