Re-thinking the Zero Tolerance Approach to FGM/C: the Debate Around Female Genital Cosmetic Surgery

Abstract

Purpose of Review To examine the ‘zero tolerance’ policy for female genital cutting (FGM/C) in the international health community in light of the growing popularity of FGCS (female genital cosmetic surgery) worldwide. Recent Findings ‘Traditional’ FGM/C performed in Egypt and Sudan and cosmetic labiaplasty performed in Europe, the Americas, and Antipodes by medically trained gynaecologists and plastic surgeons are based on similar aesthetic logics: labia minora that protrude beyond the labia majora are deemed ugly, masculine, and ‘abnormal’. Drawing on the burgeoning medical, social science, and humanities literature surrounding labiaplasty, the paper documents the narrowing of aesthetic standards governing ‘normal’ genital appearance and finds that, in addition to adult women, thousands of (mainly Caucasian) adolescents have undergone these operations whose long-term health consequences are unknown. Summary Western heteronormativity, gender binarism, ageism, and the colonial association of protruding labia minora with animality contribute to body image insecurities and fuel the labiaplasty phenomenon, despite the ethical challenge that the procedures are clearly defined by the WHO as type II (a–c) female genital mutilations.

Genital Cutting as Gender Oppression: Time to Revisit the WHO Paradigm

“…The WHO conceptualizes "female genital mutilation" (FGM) as all non-therapeutic cutting, however slight, of the external genitalia of (non-intersex) 4 females-irrespective of the individual's consent-and categorically condemns such cutting as a violation of the human right to bodily integrity. However, the WHO has exclusively sought to eliminate medically unnecessary female genital cutting (FGC) practices that are customary in parts of the Global South, while ignoring comparable practices that are common in the Global North, such as elective labiaplasty (see Table 1) which is increasingly performed on adolescent girls (Liao et al, 2012;Runacres and Wood, 2016;Boddy, 2020).…”

“…Numerous scholars have argued that this selective focus reflects moral double standards rooted in racism and cultural imperialism (Gunning, 1991;Obiora, 1996;Tangwa, 1999;Ahmadu, 2000Ahmadu, , 2007Ahmadu, , 2016bMason, 2001;Shweder, 2002Shweder, , 2013Njambi, 2004;Ehrenreich and Barr, 2005;Oba, 2008;Dustin, 2010;Smith, 2011;Kelly and Foster, 2012;Boddy, 2016Boddy, , 2020Onsongo, 2017;Shahvisi, 2017Shahvisi, , 2021Shahvisi and Earp, 2019). Some have therefore called on the WHO to revise its policy: either by including Western-associated 5 so-called "cosmetic" female genital surgeries in the campaign against "FGM" (Esho, 2022), or by establishing an age limit or consent criterion for FGC to be applied without discrimination or favor (Dustin,3 For the purposes of this paper, an intervention to alter a bodily state is medically necessary "when (1) the bodily state poses a serious, time-sensitive threat to the person's well-being, typically due to a functional impairment in an associated somatic process, and (2) the intervention, as performed without delay, is the least harmful feasible means of changing the bodily state to one that alleviates the threat" (BCBI, 2019) (p. 18).…”

An Algorithm for Labia Minora Reduction Based on a Review of Anatomical, Configurational, and Individual Considerations

“…economically flourishing societies. (3) The number of registered labiaplasties in the U.S.A., for example, has increased seven-fold over the last decade, from 2142 in 2011 to 14,386 in 2020. (4) Parallel to the increase, a variety of labiaplasty techniques have been developed, presented, and reflected on.…”

Attitudes and Sexual Behaviours Associated With Adolescent Online Pornography Consumption: A Critical Commentary During COVID-19

“…al., 2019;Rodenhizer & Edwards, 2019;Shor, 2019;Waterman et al, 2022). For example, girls may experience body-image difficulties impacting their self-esteem due to perceived decreased desirability (Boddy, 2020;Dogan & Yassa, 2019;Paslakis et al, 2022;Rasmussen et al, 2015). Dogan and Yassa (2019) examined the motivating factors of 71 women who sought vulvar cosmetic surgery to improve their genital appearance.…”

“…Girls have been found to be negatively compared with female pornography performers by their boyfriends. It is concerning that labiaplasty is undertaken on girls as young as 13 years as a result of adolescent genital dissatisfaction, which is a growing trend worldwide (Boddy, 2020). Vandenbosch et al (2018) in a longitudinal study in the Netherlands with 1,022 adolescents with a mean age of 15.13 years (53.8% were boys and 46.2% were girls), investigated attitudes and sexual behaviours related to pornography use.…”