Female genital cosmetic surgery in Indonesia: a qualitative analysis of medical advertising on Instagram

Research on female genital cosmetic surgery usually comes from Anglophone countries. We investigated female genital cosmetic surgery in the predominantly Muslim South-East Asian country of Indonesia, aiming to identify the procedures offered by medical clinics on Instagram, how they are justified, and what they claim to achieve; and to understand what this means for women and their bodies. The 184 eligible posts from 19 clinics between 1 January to 31 March 2021 offered vaginoplasty, labiaplasty, hymenoplasty, and other procedures. Reflexive thematic analysis yielded three themes: Why you should have female genital cosmetic surgery, Indications for female genital cosmetic surgery, and What you will gain from female genital cosmetic surgery. Posts were similar to those identified in other countries, revealing implicit vulvar aesthetics, expectations that women choose to 'improve' their genitals, the need to please men, and that female genital cosmetic surgery is straightforward. Two differences from Anglophone advertising were the use of euphemisms to describe the vulva and an emphasis on physical 'virginity'. Across countries, female genital cosmetic surgery advertising appears to arise from patriarchal constructs of women's bodies and determination to control them. We contend that Indonesia shares with other countries the need for education-of medical practitioners and the general public-about sexuality and the vulva, and that the advertising of female genital cosmetic surgery should be regulated and rigorously monitored.

The strength of correlation between female genital self-image and sexual function: a systematic review and meta-analysis

BACKGROUND

Mounting evidence indicates that female genital aesthetic complaints impact sexual relationships.

AIM

The study sought to determine the strength of the correlation between genital self-image and sexual function.

METHODS

Electronic databases were comprehensively searched including PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library from January 2000 to December 2022. After duplicate removal, 146 articles were retrieved by searching keywords in titles and abstracts.

OUTCOMES

A positive correlation is noted between genital self-image and sexual function; the strength of this correlation was 0.375.

RESULTS

By omitting irrelevant articles according to the eligibility criteria, 16 articles remained for a total of 13 505 participants. All but 1 of them indicated a statistically significant positive correlation between genital self-image and sexual function. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity.

CLINICAL IMPLICATIONS

The results of this study may be used in counseling women with sexual dysfunction who are dissatisfied with their genital appearance.

STRENGTHS AND LIMITATIONS

This study is the first systematic review to reveal the strength of the correlation between genital self-image and sexual function. The most important limitation of this study is the heterogeneity of the studies reported.

CONCLUSION

This systematic review indicates a positive correlation between genital self-image and sexual function. The results are restricted by inconsistency of the articles considered. Using different tools in different cultural contexts without considering confounding factors leads to a wide range of correlation sizes and significant heterogeneity is evident.

Conceptualising the continuum of female genital fashioning practices

Genital fashioning practices, such as Brazilian waxing and female genital cosmetic surgery, have become increasingly prevalent within contemporary western societies. This paper explores the role of genital fashioning in the construction of contemporary femininity. It uses in-depth interviews and focus groups with Australian women aged 18-30 to investigate female genitalia as a site of alteration. Drawing on broader understandings of the body as socially mediated, this paper contends that multiple modification practices are employed to produce genital appearance. It departs from previous investigations which consider genital fashioning practices in isolation. In identifying the scope of genital fashioning, this research reveals a continuum of genital fashioning practices, both physically and discursively mobilised by women to negotiate their identity, sexuality, and femininity.

Pathologising diversity: medical websites offering female genital cosmetic surgery in Australia

Female genital cosmetic surgery (FGCS) is increasingly popular. Medical organisations report concern about adverse outcomes and inadequate clinical indications. Given the Internet's role in health decisions, we aimed to discover what was being communicated about FGCS on Australian provider websites. Thematic analysis of 31 prominent websites identified six themes: seeking aesthetic perfection; resisting natural diversity; gaining from FGCS; indications for surgery; a simple procedure; and ethical practice. Desirable vulvas were represented as 'neat' and 'youthful'. Sites promoted a discourse in which to be 'feminine' means having no visible sex organs, consistent with the historical repression of women's sexuality. FGCS was constructed as a simple and empowering solution, improving women's comfort, hygiene, self-esteem and sexual relationships. The apparent primary concern was commercial. Attention was rarely paid to ethics. Sites reinforced women's responsibility to strive for aesthetic perfection, implied that vulvar diversity is pathological, made unfounded claims for the benefits of FGCS and downplayed adverse consequences. Findings have implications for public health and medical authorities in countries where FGCS is practised and advertised. Enforcing the first do no harm principle would reduce websites' capacity to promote discourses and practices that damage women's bodies and wellbeing.

'Botched labiaplasty': a content analysis of online advertising for revision labiaplasty

A new development in female genital cosmetic surgery (FGCS) is the promotion of revision surgery for 'botched labiaplasty'. This content analysis study reviews the quality of information offered on websites specifically advertising revision labiaplasty. Twelve websites were identified through online searches and were examined for the quality of their clinical information. All sites defined botched labiaplasty as unsatisfactory appearance after labiaplasty. Four gave no further details and five listed asymmetry, irregular labial edges or removal of too much or too little tissue. Four websites described primary botched labiaplasty as 'mutilation'. Inadequacy of the primary surgeon was cited as the cause of botched labiaplasty in 11/12. Only two websites mentioned risks of surgery. Good outcomes were not defined and no website provided outcome data although guaranteed satisfaction was implied in two websites. This study highlights the existence and promotion of services for botched labiaplasty using non-specific and emotive descriptions. These findings suggest that unsatisfactory results from consumers' perspectives are far from uncommon. The same women whose expectations have not been met by primary surgery are now being targeted for repeat surgery with online advertising capitalising on their unchanged motivations.Impact StatementWhat is already known on this subject? Female genital cosmetic surgery (FGCS) is mainly advertised online with labiaplasty as the most commonly performed procedure. A market for labiaplasty revision to correct 'botched' primary procedures is developing. Academic literature and advertising materials are inconsistent when defining indications and determinants of success for labiaplasty or revision.What the results of this study add? A content analysis of websites specifically advertising revision labiaplasty describes the emotive and nonspecific terms used online to promote revision labiaplasty.What the implications are of these findings for clinical practice and/or further research? The existence of services for botched labiaplasty suggests dissatisfaction is common. Women whose expectations have not been met by primary surgery are targeted for repeat surgery through online advertising capitalising on their potentially unchanged motivations. This study demonstrates the need for clearer outcome data for labiaplasty and highlights the need for better advertising standards for FGCS promotion.

Knowledge and attitude of women on genital cosmetic surgery at University College Hospital, Ibadan, Nigeria

Background

Female genital cosmetic surgery (FGCS) is performed in other to restore or enhance the female genitalia.

Materials and Methods

This is a cross-sectional study assessing the knowledge and attitude of 310 women attending gynaecology clinic towards FGCS at University College Hospital, Ibadan, Nigeria. Data were analysed using SPSS 20.

Results

Mean age of respondents was 33.28 ± 7.68 years. Majority were married (76.1%) in monogamous family (87.7%) and almost half (49.7%) were multipara. About 56.1% had vaginal delivery of which 84.5% had perineal tear or/and episiotomy. Overall, 27.7% had heard about FGCS and 84.2% had positive attitude towards the procedure. Respondents' age, marital status and occupation were associated with their knowledge and attitude to FGCS. Women with skilled occupation were more likely to have the knowledge and positive attitude to FGCS.

Conclusion

The knowledge of FGCS was low; however, majority had positive attitude towards it because of its associated sexual and psychological satisfaction.

Vaginal rejuvenation: current perspectives

Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed.

Body Dysmorphic Disorder: Contraindication or Ethical Justification for Female Genital Cosmetic Surgery in Adolescents

Is Female Genital Cosmetic Surgery for an adolescent with Body Dysmorphic Disorder ever ethically justified? Cosmetic genital surgery (specifically labioplasty) for adolescent girls is one of the most ethically controversial forms of cosmetic surgery and Body Dysmorphic Disorder is typically seen as a contraindication for cosmetic surgery. Two key ethical concerns are (1) that Body Dysmorphic Disorder undermines whatever capacity for autonomy the adolescent has; and (2) even if there is valid parental consent, the presence of Body Dysmorphic Disorder means that cosmetic surgery will fail in its aims. In this article, we challenge, in an evidence-based way, the standard view that Body Dysmorphic Disorder is a contraindication for genital cosmetic surgery in adolescents. Our argument gathers together and unifies a substantial amount of disparate research in the context of an ethical argument. We focus on empirical questions about benefit and harm, because these are ethically significant. Answers to these questions affect the answer to the ethical question. We question the claim that there would be no benefit from surgery in this situation, and we consider possible harms that might be done if treatment is refused. For an adolescent with Body Dysmorphic Disorder, the most important thing may be to avoid harm. We find ourselves arguing for the ethical justifiability of cosmetic labioplasty for an adolescent with Body Dysmorphic Disorder, even though we recognize that it is a counter intuitive position. We explain how we reached our conclusion.

The contribution of online content to the promotion and normalisation of female genital cosmetic surgery: a systematic review of the literature

BACKGROUND

Women considering female genital cosmetic surgery (FGCS) are likely to use the internet as a key source of information during the decision-making process. The aim of this systematic review was to determine what is known about the role of the internet in the promotion and normalisation of female genital cosmetic surgery and to identify areas for future research.

METHODS

Eight social science, medical, and communication databases and Google Scholar were searched for peer-reviewed papers published in English. Results from all papers were analysed to identify recurring and unique themes.

RESULTS

Five papers met inclusion criteria. Three of the papers reported investigations of website content of FGCS providers, a fourth compared motivations for labiaplasty publicised on provider websites with those disclosed by women in online communities, and the fifth analysed visual depictions of female genitalia in online pornography. Analysis yielded five significant and interrelated patterns of representation, each functioning to promote and normalise the practice of FGCS: pathologisation of genital diversity; female genital appearance as important to wellbeing; characteristics of women's genitals are important for sex life; female body as degenerative and improvable through surgery; and FGCS as safe, easy, and effective. A significant gap was identified in the literature: the ways in which user-generated content might function to perpetuate, challenge, or subvert the normative discourses prevalent in online pornography and surgical websites.

CONCLUSIONS

Further research is needed to contribute to knowledge of the role played by the internet in the promotion and normalisation of female genital cosmetic surgery.

Make her a virgin again: when medical disputes about minors are cultural clashes

Recalcitrant disputes among health care providers and patients or their families may signal deep cultural differences about what interventions are needed or about clinicians's professional duties. These issues arose in relation to a mother's request for hymenoplasty or revirgination for her minor daughter to enable an overseas, forced marriage and protect her from an honor killing. The American College of Obstetrics and Gynecology committee recommends against members performing a hymenoplasty or other female genital cosmetic surgeries due to a lack of data concerning their safety and efficacy. A key issue in such cases is how to determine what is in the minor's best interest and the scope of health care moral or professional's duties. The Best Interests Standard can serve as a powerful moral tool for resolving cross-cultural disputes and identifying needed policy.