On the youth sex-education website Scarleteen.com, dozens of teenage girls can be found commiserating about their labia. "i REALLY h8 mine! They hang really REALLY low and r SO long!" reads one comment. Meanwhile, on MakeMeHeal.com, a consumer site that sells special bras and other gear for women recovering from plastic surgery, women of all ages submit photos of their nether regions and ask for feedback on whether they should get nipped and tucked down there. Welcome to the strange new world of female genital cosmetic surgery, where body insecurity issues are fueling a small but growing Western market for such procedures as labiaplasty, clitoral un-hooding, G-spot augmentation and hymen reconstruction, a.k.a. "revirginization."
Appalled at the popularity of so-called designer vaginas, a grass-roots organization called the New View Campaign staged its first-ever protest on Monday outside New York City's Manhattan Center for Vaginal Surgery. Two dozen women ranging in age from teenagers to, ahem, sexagenarians handed out index cards and held up orange poster boards with the message "No Two Alike," while two members of the group donned giant cloth vulva costumes. New View, which was created in 2000 in response to the introduction of Viagra, is trying to fight what it calls "the medicalization of sex," the idea that there is a physical right and wrong when it comes to all things sexual. Says the group's leader Leonore Tiefer, a sexologist and psychologist at New York University: "Promoting a very narrow definition of what women's genitals ought to look like even for those women who don't want surgery, it harms them." (See the Top 10 Medical Missteps.)
The number of women getting genital cosmetic surgery is still relatively small, with as few as 1,000 women in the U.S. going under the knife each year and 800 in the U.K. But the pace is accelerating: in the U.S., the number of women getting these procedures, which often cost upwards of $5,000 at clinics from Texas to Kansas to California, increased 20% from 2005 to 2006. In the U.K., the number of surgeries more than doubled between 2002 and 2007. And for the first time, a U.S. medical textbook on women's reproductive health to be published in 2009 will include a chapter devoted entirely to female genital plastic surgery. The media have been doing their part to get the word out too. Post-op patients regularly extol their newly improved sex lives in women's magazines. Dr. Robert Rey, star of E!'s Dr. 90210, is big on vaginoplasty, and this fall NBC's Lipstick Jungle featured an episode about G-spot enhancement (via collagen injection).
Dr. Susan Kolb, a plastic surgeon in Atlanta who has noticed a 20% increase in demand for female genital plastic surgery every year since 2004, says for many of her patients, most of whom are professionals in their 20s and 30s, the surgery is about gaining control over their sexuality. "In my experience, it is a healing procedure," she says. Because long labia can cause pain during sex or exercise, labiaplasty is sometimes covered by insurance. Data on these procedures is scarce, but Dr. Michael Goodman, a gynecologist who has a private practice in Davis, Calif., is preparing to submit to peer-reviewed medical journals a study on female genital cosmetic surgery. He says the study the first to include more than one surgical center, with more than 250 patients in seven states and Canada will show that in follow-ups ranging from six months to 3 1/2 years after surgery, women are overwhelmingly happy with the results. "Virtually always, it has improved their sexual relationship," he says. (See the best inventions of 2008.)
But critics say the surgeries are more dangerous than the glossy advertising and glowing testimonials suggest. The American College of Obstetricians and Gynecologists issued a committee opinion last year warning that women may experience scarring, chronic pain, obstetric risks or reduced sexual pleasure; a similar statement was issued in July by the Royal Australian and New Zealand College of Obstetricians and Gynecologists. Which is why the New View Campaign with the endorsement of dozens of sex educators, doctors and psychologists from around the world is demanding new regulations that would require the Federal Trade Commission's consumer protection division to monitor the ads. At the Manhattan protest, New View members chanted "More research, less marketing." The group is also calling for a moratorium on the procedures until monitoring and guidelines are in place. (See TIME's A-Z Health Guide.)
In addition to the physical risks, critics cite the more insidious psychological ramifications, whether women get the surgery or not. "Before" and "after" photos that juxtapose normal, healthy bodies alongside surgically streamlined ones readily available online promote the impression that so-called aberrations are abnormal, when in reality genitals are as diverse as faces or fingerprints. The focus on a quick fix, which is epitomized by the search for a female Viagra, is an oversimplification that puts even more pressure on women's sex lives, says New View's Tiefer.
And if research on another type of female plastic surgery is any indication, that post-op happiness may be short-lived. A 2007 study published in the Annals of Plastic Surgery found that 10 years after women get cosmetic breast implants, a disturbing trend emerges: they are nearly three times as likely to commit suicide as other women. With the even more intimate genital surgery, says Tiefer, the potential long-term consequences are troubling. "[Women] are projecting their anxiety about sexuality onto this one thing: 'If only I could get this fixed, then I would feel confident to be sexual,' " she says. "This is a complicated issue."
The growing popularity of female genital cosmetic surgery could have troubling ramifications beyond the effects for individual patients. Broadly speaking, these surgeries may meet the World Health Organization's criteria for female genital mutilation as "procedures that intentionally alter or injure female genital organs for non-medical reasons." This kind of cosmetic surgery can interfere with advocates' ability to fight forced ritual mutilation in places like Africa, where the practice is still common, says Taina Bien-Aimé, executive director of international women's rights watchdog Equality Now. Designer vaginas "are considered reasons for not throwing stones, so to speak, at other cultures," she says.
Even in the U.S., by promoting a narrow definition of what is normal, the surgeries may discourage women from grappling with a morass of cultural and personal forces shaping their body image and sexual identity. After all, one of the most common reasons women cite in seeking the surgery, some doctors say, is a negative comment from a disgruntled sexual partner. By contrast, women in steady relationships, according to a study published in the December 2008 issue of Current Sexual Health Reports, are far more likely than their single peers to feel comfortable with their natural appearance below the belt and that comfort translates into higher scores on six separate measures of satisfaction between the sheets. In other words, says the study's co-author, social worker Laura Berman, of Chicago's Northwestern Memorial Hospital, who has a PhD in sex education, the best way to start enjoying your body could be far simpler than surgery: "You may need a new boyfriend."