Why is Labiaplasty being Compared to Female Genital Mutilation?

By Kat Cooke / 05 Jan 2017

With recent news reports that three cosmetic doctors could be facing prosecution under female genital mutilation (FGM) laws for carrying out labiaplasty for cosmetic reasons, Aesthetics asks, ‘Is labiaplasty comparable to FGM?’

On November 22, the Telegraph reported that the British courts were currently deciding whether to employ FGM laws in three cases where practitioners had carried out cosmetic genital surgery on women.1 But with the first FGM prosecution to reach the courts resulting in an acquittal last year,2 there hasn’t yet been a single conviction for carrying out the illegal practice in the UK. Could it be possible that the cosmetic doctors in question may be the first to be indicted?

The three cases currently going through the British courts – one in Cheshire and two in London – stem from private practices. According to news reports, the doctors carried out ‘illegal cosmetic surgery’ for patients wanting a ‘designer vagina’ procedure but the full details are yet to be disclosed. It is reported that the adult women paid for the surgery ‘in the belief that it would make them more attractive.’3

What is FGM?

According to the World Health Organisation (WHO), FGM ‘comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’.4 WHO estimates that 200 million girls and women alive today have been subject to the practice in 30 countries in Africa, the Middle East and Asia, where FGM is pervasive.5 WHO states it is a violation of the human rights of girls and women, has no health benefits and can cause harm in a number of ways.3

The practice of FGM4

There are many reasons why FGM happens, but, most commonly, the following apply:

To ensure premarital virginity and marital fidelity as it is believed in some communities that a woman’s libido should be reduced. When a vaginal opening is covered or narrowed during the procedure, the fear of the pain of opening it, and the fear that this will be found out, is expected to discourage extramarital sexual intercourse among women.

FGM is associated with cultural ideas of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male. It is often considered a cultural tradition, which is sometimes used as an argument for its continuation.

It is considered a necessary part of raising a girl and preparing her for adulthood and marriage.

Why do patients seek labiaplasty?

Mr Navid Jallali, consultant cosmetic and reconstructive surgeon, who performs labiaplaty procedures, says that although we don’t know the full details of the case, he believes the majority of patients in the UK are having the procedure due to severe functional issues, “A lot of my patients say the labia gives-way during intercourse, they can’t exercise because the labia is so large, they can’t wear tight clothing, and some don’t have intimate relationships because they are embarrassed of the appearance. I wouldn’t operate purely for cosmetic reasons, there has to be a functional component.”

Consultant plastic surgeon Mr Christopher Inglefield, who has carried out many labiaplasty procedures, agrees, “Very few of our patients have surgery for cosmetic reasons. The majority, over 95%, have surgery for physical symptoms or because of psychosexual symptoms.” He adds, “It is very insulting for these patients to be compared to victims of FGM who are taken at a young age to an often unknown individual and have their genitalia completely mutilated. I see many of these victims for reconstructive surgery and to even compare those to an individual who has consented to have a procedure is just degrading.”

Are they comparable?

Despite FGM being illegal in the UK for the past 31 years,6 a study in 2014 by City University London and Equality Now – an international human rights organisation dedicated to action for the civil, political, economic and social rights of girls and women – estimates that 137,000 women in the UK are affected by FGM and a further 20,000 are thought to be at risk each year.

The Home Office made a statement two years ago that labiaplasty operations may be illegal unless there was a medical or psychological reason for them,1 and now a home affairs select committee wants to outlaw female genital cosmetic surgery because they believe it is similar to FGM. “We cannot tell communities in Sierra Leone and Somalia to stop a practise that is freely permitted on Harley Street,” said the chairman of the select committee, MP Keith Vaz, in a report published in 2015.8 The committee is calling for the FGM law to be changed so that it specifically outlaws the surgery as ‘a criminal offence’.8

“Where do you draw line?” says Mr Inglefield. “Should we outlaw rhinoplasty because patients should accept their noses? Should we outlaw circumcision because it is an assault on male genitalia? I think the issue is ignorant; people are trying to impose their opinion on individuals who have free will,” he adds. Mr Inglefield explains how the process of a patient coming in for a labiaplasty is so significantly different to FGM, “A woman comes in to have a conversation because she has concerns about her labia. This happens in front of a nurse who acts as the patient’s chaperone; the patient is never seen on her own. On average, these patients have been thinking about having the procedure from anywhere between two to six years – I even had one case where a woman had been thinking about surgery for about twenty years.” 

He describes the treatment as incomparable to victims of FGM, “I saw a patient two weeks ago, who, at the age of seven, was taken by her grandmother in Sierra Leone to an individual in the village and she was severally assaulted, with most of her genital tissue removed; no anaesthetic and no sterile tools were used. You can’t compare the two.” Mr Jallali believes there is a big misunderstanding about what FGM is and what a labiaplasty is. “I think most of the general public think that the procedure for labiaplasty is done on a ‘whim’ and that patients are unsatisfied, but actually we’re finding the exact opposite; patients have very few complications, it often enhances their function, including their sexual activity with their partner, and is a positive, life-changing procedure.”

Summary

Whilst it is still unknown whether the cosmetic doctors in question will be prosecuted, going forward, Mr Inglefield says there needs to be better education for the general public and better training for surgeons, “I see women who’ve had bad labia surgery, so bad that it almost could be classed as borderline FGM – but that is a minority. You don’t pass a law to stop the minority.” He explains, “Surgical training in this country is a real challenge. Some surgeons believe they can do what they like without accountability but hopefully this will change.” At the time of publishing, prosecutors are still assessing whether or not bringing charges to the practice of labiaplasty is within the public interest. 

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