YOUNG TEENAGE GIRLS are having genital cosmetic surgery due to the influence of pornography and advertising, UK experts have said.
According to Hospital Episode Statistics (HES), the number of labial reduction procedures has risen five-fold in the UK’s NHS over the past 10 years, with over 2000 operations performed in 2010.
Today, two new papers published by the Royal College of Obstetricians and Gynaecologists (RCOG) and the British Society for Paediatric and Adolescent Gynaecology (BritSPAG) state that little research exists about the clinical effectiveness and risks in female genital cosmetic surgery (FGCS) and that it should not normally be carried out on girls under 18 years.
The RCOG paper, produced by the College’s Ethics Committee, focuses on women of all ages undergoing FGCS.
What is FGCS?
non-medically indicated cosmetic surgical procedures which change the structure and appearance of the healthy external genitalia of women, or internally in the case of vaginal tightening.
This includes the most common procedure, labiaplasty, as well as others including hymenoplasty (vaginal reconstruction) and vaginoplasty (vaginal rejuvenation).
The RCOG’s paper explores the ethical aspects of FGCS, and looks at the reasons why women ask for these procedures.
Labiaplasty is a procedure undergone for problems relating to the size of the labia minora and concerns with, for example, hygiene, difficulties during sexual intercourse, and discomfort when wearing tight clothes.
But the main reason for requesting labiaplasty for some women can be concern about genital appearance, and in extreme cases this is an aspect of body dysmorphic disorder.
Labiaplasty, like any surgical procedure, carries short-term risks of bleeding and infection. But the experts say that there are no data on the potential physical and psychological risks in the medium and long-term.
They are calling for more data to inform women about the potential of long-term damage to sensitivity and sexual function.
Influence of mass media and pornography
Dame Suzi Leather, Chair of the RCOG’s Ethics Committee, said that they are concerned about the increase in labial reduction procedures, “fuelled in part by the mass media and inaccurate advertising”.
She said that some women’s decisions are influenced by images from popular culture and the pornography industry. “We need to inform women that everyone is unique and that variation in appearance is normal in the vast majority of cases,” she said.
Paul Wood, Consultant Obstetrician and Gynaecologist, and chair of BritSPAG said that there is “no scientific evidence” to support the practice of labiaplasty, and that for adolescents the risk of harm is even more serious.
He said that it is important that clinicians inform girls about labial anatomy, its development, and variation.
“In addition girls should be aware of distortions in popular culture, the unknown risks and efficacy of procedures and ways to manage labial discomfort,” he said.
When significant distress is detected, these girls should receive a psychological assessment.
The paper includes a number recommendations, such as:
- Women should be provided with accurate information about the normal variations in female genitalia and offered counselling and other psychological treatments for problems such as body image distress
- Women must be informed about the risks of the procedure, the lack of reliable evidence concerning its positive effects
- As full genital development is not normally achieved before 18, FGCS should not normally be carried out on girls under 18 years
The BritSPAG position statement focuses on adolescents undergoing labiaplasty, as a result of growing concerns over this type of surgery being performed on girls aged under 18.
It looks at reasons behind surgery, including “accessibility to unrealistic and narrow representations of vulval appearance in popular culture and intensive marketing of labiaplasty as an unproblematic lifestyle choice”.
The paper’s recommendations for best practice include:
- Information about normal variations should be offered
- Surgical reduction before the completion of pubertal development may lead to long term problems and this should be communicated to the girl and her guardian where appropriate
- In case of significant psychological distress, the girl and family should be offered a referral to a paediatric clinical psychologist