Read My Lips (20 page)

In the same way that genital concerns may deter women from seeking out sexual behavior that they may want, it may also prevent women from getting the healthcare that they need. Gynecologist Dr. Elizabeth Stewart, in her excellent book
The V Book
,
¹⁵
wrote about how women would often delay scheduling GYN exams so that they could have time to get their genitals ready (she urges women not to worry about how their genitals look or smell when it comes to healthcare). In another study, Debby found that women who felt more positively about their genitals were more likely to have had a recent gynecological exam. And in her dissertation work, Vanessa found that young women who are uncomfortable about the appearance of their genitals were more likely to be concerned that the exam would be embarrassing, making them feel anxious about the exam and eventually putting off a GYN exam entirely. This may have been because some of these women were anticipating their first OB/GYN exam, so they had yet to receive any reassurance about their genitals (which they would
hopefully
get at the GYN). In a series of interviews with women after their exams, Drs. Oscarsson and Benzein
¹⁶
found that the only details that young women remembered after their first Pap smear was reassurance that their genitals were normal. Try to think back to your first exam. What can you remember?

GETTING READY FOR THE GYN

One urban myth that we have heard refers to a woman who was rushing one day for her annual OB/GYN exam. She was in a hurry but wanted to make sure that she “washed up” before she saw the doctor. So, she grabbed one of her children’s washcloths, wiped her vulva quickly, and took off to make her appointment on time. While at the doctor’s office, everything went well; she didn’t have to wait long and got a clean bill of health. However, she was puzzled by something the doctor had said during her examination. When she first got into the stirrups, the doctor mumbled, “fancy.” She was a little disturbed by the comment but let it go in the hope that she had misheard. When she got home and went to the bathroom, she realized that she had not misheard at all. She had used her child’s arts-and-crafts washcloth covered in glitter to wipe her genitals! She had presented the doctor with a special little surprise that day.

Take home point from the story: no matter how embarrassed you feel while visiting the gynecologist, just be thankful you are not covered in glitter (accidentally—more power to our sisters who intentionally go disco ball at the gynecologist!).

THE CONTROVERSY OVER ELECTIVE GENITAL SURGERIES

In the UK, there is a popular show called
Embarrassing Bodies
.
¹⁷
The premise is an interesting one: men and women visit doctors to get a medical consult, treatment, and follow-up for a physical concern that may be considered, well, embarrassing. Many clips begin with patients talking about how their conditions have impacted their lives and how they have been too embarrassed to seek help in the past. (For some unknown reason, the patients find discussing and showing their “medical conditions” on camera to millions of viewers less distressing than bringing up the conversation in the privacy of their clinicians’ offices, but we digress.)

The show is meant to normalize and de-stigmatize medical conditions. The TV show’s web site (
www.channel4embarrassingillnesses.com
) features videos and information about what “normal vulvas” look like, how to perform a vulva self-exam, and other positive genital messages, which we applaud. Given that the TV show focuses on medical conditions that are supposed to be “embarrassing,” it’s perhaps not surprising that a number of women’s complaints related to their genitals, a common site of taboo (even if we wish it weren’t so). At least one video titled “Enlarged Labia” shows a woman’s journey to the doctor’s office to ask about her inner labia. After a quick consultation is done and shown on film (kudos to them for not hiding the genitals), the doctor delivers the good and bad news. She says, “Don’t think that you are abnormal or a freak. What you have got is a normal variant. . . . I think that we could be able to help you with this. . . . I am not thinking gynecologist here, I am thinking more cosmetic surgeon.”

We are not questioning the doctor’s advice. The patient came in to see her with a concern, and the doctor told her that there was no reason to be concerned but if she was concerned, then there was a way to “fix” the problem. Is it possible that flipping through
Petals
,
Femalia
, or watching one of Betty Dodson’s empowering films could have appeased the woman’s concerns? Perhaps so, perhaps not. Regardless, we are not telling this story to question the doctor’s approach to her patient. We are much more interested in how this consultation affected the viewers.

If you are a woman who has ever worried or wondered about the size of your labia, you likely would have watched closely as a woman receives a consult from a medical professional on this very topic. Sure, the doctor suggests that the appearance of the woman’s labia is not abnormal, but she also suggests surgery in order to resolve the “problem.” Meanwhile, the viewer is undoubtedly comparing her labia size with that of the woman onscreen to decipher whether she has a similar problem that would likely have a similar solution.

Embarrassing Bodies
is far from the only show that has helped to popularize elective genital surgeries in the past decade. An increase in the number of television shows, newspaper articles, and web sites about elective genital surgeries has brought this subject to the public’s attention. Try searching “large labia” (or even just “labia”) on the Internet, and you will get a range of advertisements for labia-reduction surgery (called labiaplasty). Labiaplasty is designed to help women who suffer from labial hypertrophy. Sound scary? It isn’t. That is just a medical term for long labia. How is it defined? It isn’t; or at least it isn’t defined very well. Some doctors have used two inches as a rough approximate guideline for classification.
¹⁸
Yet, just as a six-inch penis would look massive on some men and small on others, two-inch inner labia may appear longer on some women than they would on others. As such, many doctors use the patient’s own feelings about and experiences with her labia to diagnose the patient. If a woman’s labia present problems for the patient, the doctor may recommend surgical treatment as one possibility.

Why Labiaplasty?

Women may decide to get labiaplasty for many reasons. Of course, there are the aesthetic reasons, including concerns that labia are too long, too uneven, or too dark around the edges. There are also those women whose labia cause them physical discomfort (e.g., chafing or pain) while engaging in physical activities such as walking, biking, hiking, running, dancing, or horseback riding. One gynecologist we know who routinely performs genital surgeries told us that a large percentage of the women who request labiaplasty in his practice are women in the military because of the amount of physical activity required by their job (apparently the physical nature of their job results in labia discomfort for some women). This, of course, is anecdotal. There is very little research on who gets these surgeries, why they get them, and how they feel about them. We are doing our best to remedy this with a study we currently have underway with a surgeon who specializes in these procedures. The data are still being collected, so be on the lookout for the results.

I have not seriously considered labiaplasty but I have on more than one occasion declared it the cosmetic surgery I would have if I were ever to have cosmetic surgery. I am confident and comfortable, appearance-wise with my genitals. I love the way my partner can pull and suck at my inner labia. I even like the way they look jutting out between my outer labia when closed. BUT—they can be hazardous! They get pinched in lace underwear, jeans, tight pants, hose . . . anything! This can happen in the most unfortunate instances and is excruciating until manually adjusted—not always possible in polite company. So—I get the controversy that surrounds labiaplasty and I am always sad to hear women talk about the embarrassment they feel around their large labia minora, but the very real physical discomfort and occasional pain is not often validated.

—
S
TEPHANIE,
25, Canada

Elective genital surgeries such as labiaplasty have been the subject of a great deal of controversy within the scientific and medical communities. In a discussion on this topic at an international medical conference, a gynecologist from France indicated that she sometimes performs labiaplasty for women who are sexually bothered or distressed by their labia size or appearance. Some of the American gynecologists took issue with her statement, with a couple saying that they only perform labiaplasty for patients if their labia get in the way of daily activities such as exercise and going to the gym. This interested Debby, who joined the conversation by asking why being comfortable exercising is any more important than being comfortable having sex. After all, if a woman feels that her labia get in the way of her sex life—if she’s embarrassed about them in spite of being well aware that others consider them normal or beautiful, or if her labia are uncomfortably pushed inside her vagina during intercourse, then why should she be turned down for surgery?

As sex researchers and educators, we don’t believe that one activity (sex or exercise) should be prioritized over the other. As long as a woman is fully informed about all other options (some women may just need to flip through a book of realistic vulva images) and is choosing surgery for herself (some women report being pressured by their partner), then what is offered to one woman should be offered to all. And this is coming from two women who adore vulvas and vaginas and who wish, from their hearts, that every woman could feel happy with their genitals (and their breasts, thighs, freckles, and hair) as they are, rather than feel a need for surgery.

The only time I have ever felt ashamed or really less-than-satisfied with my genitals was my mother-in-law’s fault. She’s got some weird, creepy competition thing going on with me, and since I first got pregnant has made it a point to tell me, my friends, random waiters, that HER vagina is as tight as it ever was because SHE had a C-section. Then, in the delivery room immediately after I’d given vaginal birth to my first daughter and was having the episiotomy stitched up, she told my midwife to “put in an extra stitch for my son— or maybe two; that looks like he’ll be throwing a hot dog down a hallway.” There’s nothing like having your husband’s mother standing there looking at your stretched and bruised and bleeding genitals and cheerily declaring them to be no longer fit for her son to fuck to really make you wish you’d gone with the Fentanyl instead of the epidural. I just keep reminding myself that she was taught anatomy by nuns, it’s not all her fault she’s completely retarded about how lady parts work.

—
G
LORIA,
32, Kansas

Being offered the surgery and going through with the surgery are two different things. Insurance companies tend not to cover such surgeries,
¹⁹
meaning that these procedures often cost several thousand dollars. In addition to money, they require a small amount of time for the surgery and a larger amount of time to recover from the surgery (often several weeks to a couple months). There is not a great deal of good research on how painful these procedures are but like any major surgery, we imagine, and have heard from some patients, that there is likely a fair amount of potential for pain or discomfort.
²⁰

The controversy about elective genital surgeries is not only about who should be allowed to get elective cosmetic surgery; some genital advocates are critical about the way that these surgeries are marketed to women. In addition to labiaplasty, other elective genital surgeries include those intended to resize and reshape the clitoral hood, tighten the vaginal canal (vaginal “rejuvenation”), and surgery to reduce the size of the mons pubis. There are also procedures designed to create a fake hymen to partially cover a woman’s vaginal entrance. Most of these surgeries have not been well researched (we’re trying to change this in conjunction with an OB/GYN we know who performs such surgeries).

Some feminist scholars, among others, are well-known critics of labiaplasty, suggesting that it pathologizes the diversity of women’s genitals.
^20–23
This means that the existence and marketing of the surgery creates the perception that there is only one “normal” vulva appearance and that any other appearance outside of this single appearance norm is viewed as abnormal and in need of fixing. This idea is further perpetuated by web sites that show “before” and “after” pictures, which can be used to define and differentiate between appropriate and abnormal vulva appearances. It is a complicated issue without a simple solution. What do you think? Should all women have access to these surgeries? And how should they be presented to women so that they can best make such an important decision?