Extreme Makover: Vagina Edition (part 2)

wood grain

Can women be trusted to make decisions about their own bodies?

In a previous post, I discussed the rising popularity of genital cosmetic surgery (Extreme Makeover: Vagina Edition). While the concept has been warmly embraced by women, it has elicited reactions ranging from distaste to outrage by others.

Everyone agrees that vaginal and vulvar cosmetic surgery has no medical benefit. Everyone agrees that views of genital attractiveness are strongly influenced by the prevailing culture. The point on which people disagree is whether women can be trusted to make decisions about their own bodies. Reactions range from paternalism and maternalism to acknowledging the possibility of autonomous decision making.

Paternalism is best exemplified by Daniel Sokol, writing in the British Medical Journal. According to Sokol:

The 16th century French author and physician Rabelais was obsessed with vaginas. In one of his stories an old lady drives the devil away by showing him her vagina. Today the devil might recommend she go to the nearest aesthetic surgeon for vaginal rejuvenation. A touch off the labia (labioplasty), a bit of tightening here (vaginoplasty), and voilà: a designer vagina…

Here is my paternalistic view: medical professionals, whether working in the private or public sector, should not succumb to these requests. Although it would be hard to argue that anyone seeking aesthetic genital surgery is unable to make an informed decision, it is plausible to argue that patients’ autonomy is often diminished by strong social or peer pressures.

Sokol at least is honest about his paternalism. Feminists who oppose genital cosmetic surgery seem to be entirely unaware of their maternalism. Their alarm shades into, dare I say it, hysteria. Bonnie Zylbergold asks whether genital “beautification” is plastic surgery or mutilation.

… Dr. [Lenore] Tiefer maintains that … all [genital cosmetic surgery] really produces is a generic model of women’s genitalia… So enraged is Dr. Tiefer, that in 2000 she founded The New View Campaign, an organization devoted to stopping all form of FGCS. The group compares FGCS to Female Genital Mutilation (FGM).

… [P]oints out Dr. [Virginia] Braun, “In both cases, what’s being done is that women’s genitalia are being altered to conform to a certain set of notions and expectations about what genitalia should look like, what they need to look like if they are to be appropriately feminine and appropriately desirable.”

Genital modification may be unnecessary, potential harmful, and the result of peer and marketing pressure, but it is not mutilation. And the claim that female genital mutilation represents a notion of genitalia “beauty” completely misrepresents the procedure. Genital mutilation is performed specifically to deprive women of sexual pleasure in an effort to ensure chastity. In other words, FGM is meant to prevent women from engaging in sexual intercourse, while vaginal cosmetic surgery is meant to enhance a woman’s opportunities for sexual intercourse.

The paternalists and maternalists agree on one fundamental point: women cannot be trusted to make decisions about their own bodies. Individual physicians must refuse to honor their wishes; regulatory agencies must make it impermissible for women to choose genital cosmetic surgery.

It is interesting to note that no one seems to think that men are incapable of making decisions about genital modification. Procedures to lengthen genitalia, prolong erection and otherwise enhance sexual “attractiveness” are equally if not more common among men, yet neither the paternalists nor the maternalists suggest that men must be restrained by their physicians or governmental regulations from making independent choices.

As distasteful as female genital cosmetic surgery may be to its critics, they are wrong to assume that women (and only women) should not be allowed to make these decisions. Rather, the principles that apply to all medical decisions should be invoked. Dr. Michael Goodman, writing in the journal Obstetrics and Gynecology explains:

Patients must be adequately screened, taking note of the ethical principles of autonomy, nonmaleficence, beneficence, justice, and veracity. Patients should be adequately protected and guided to develop reasonable expectations and understand that their genitalia are not abnormal. Surgeons should be adequately trained and experienced and should use universally accepted, accurate, and descriptive terminology. The procedures should be adequately described to patients, and risks and expected outcomes should be fully explained.

Genital cosmetic surgery, like all cosmetic surgery, has no medical benefits, substantial risk of harm and is often undertaken in response to cultural pressure. Nonetheless, informed consenting adults have a right to choose genital cosmetic surgery, just as they have the right to choose any cosmetic surgery.