Female genital cosmetic surgery

How female genital mutilation/cutting legislation applies to FGCS

Female genital cosmetic surgery
Download PDF
  3. Search

The World Health Organization (WHO) defines FGM/C as ‘all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons’. It is generally performed on children or adolescents who are not able to provide informed consent. There are no known health benefits and it is known to be harmful to girls and women in many ways.47

All Australian states and territories have enacted legislation banning FGM/C and a variety of health and educational activities are in place to promote health and support cultural change required to eliminate its practice. Some people from countries that have traditionally practised FGM/C regard the selective application of the legislation to FGM/C but not FGCS, both of which could be considered to be culturally determined, to be discriminatory and unfair.48

There is some debate about whether FGCS is covered by legal definitions of FGM/C and, therefore, illegal under existing regulations. The adequacy of outcome data considered is central to informed consent for FGCS, as for all medical procedures.49

According to medical defence organisation, Avant:

‘purely cosmetic procedures may not trigger the exceptions under each Act, particularly in NSW and VIC where the procedure must be necessary for the health of the person. However Acts do not define the words ‘necessary’ and ‘health’. Legal concern is heightened given the fact that the patient’s consent is not a defence.’49,50

The Australian Government’s Review of Australia’s Female Genital Mutilation legal framework – Final report is a valuable source of further information.

  1. Royal College of Obstetricians and Gynaecologists and British Society for Peadiatric and Adolescent Gynaecology. Joint RCOG/BritSPAG release: Issues surrounding women and girls undergoing female genital cosmetic surgery explored jointrcogbritspag-release-issues-surrounding-women-and-girls-undergoing-female-genital-cosmetic-surgery-explored [Accessed March 2014].
  2. Bramwell R, Morland C, Garden A. Expectations and experience of labial reduction: a qualitative study. Br J Obstet Gynaecol 2007;114(12):1493–9.
  3. Australian Government Department of Human Services. Medicare Item Reports statistics/mbs_item.jsp [Accessed 20 January 2015].
  4. Australian Government Department of Health. MBS Reviews: Vulvoplasty Report, 2014 [Accessed January 2015].
  5. Liao LM, Creighton SM. Female genital cosmetic surgery: a new dilemma for GPs. Br J Gen Pract 2011;61(582):7–8.
  6. Iglesia CB, Yurteri-Kaplan L, Alinsod R. Female genital cosmetic surgery: a review of techniques and outcomes. Int Urogynacol J 2013;24(12):1997–2009.
  7. Lloyd J, Crouch N, Minto C, Liao LM, Creighton S. Female genital appearance: “normality” unfolds. BJOG 2004;112(5):643–6.
  8. Basaran M, Kosif R, Bayar U, Civelek B. Characteristics of external genitalia in pre- and postmenopausal women. Climacteric 2008;11(5):416–21.
  9. Davison SP, Baker C, West J. Labiaplasty and labia minora reduction. Medscape 2014 article/1372175-overview [Accessed May 2015].
  10. Andrikopoulou M, Michala L, Creighton SM, Liao LM. The normal vulva in medical textbooks. J Obst Gynaecol 2013;33(7):648–50.
  11. McDougall LJ. Towards a clean slit: how medicine and notions of normality are shaping female genital aesthetics. Cult Health Sex 2013;15(7):774–87.
  12. Alter GJ. Labia minora reconstruction using clitoral hood flaps, wedge excisions, and YV advancement flaps. Plast Reconstr Surg 2011;127(6):2356–63.
  13. Pardo J, Sola V, Ricci P, Guilloff E. Laser labioplasty of labia minora. Int J Gynaecol Obstet 2006;93(1):38–43.
  14. Rouzier R, Louis-Sylvestre C, Paniel BJ, Haddad B. Hypertrophy of labia minora: experience with 163 reductions. Am J Obstet Gynaecol 2000;182:35–40.
  15. Liao LM, Taghinejadi N, Creighton SM. An analysis of the content and clinical implications of online advertisements for female genital cosmetic surgery. BMJ Open 2012;2(6):DOI:10.1136/ bmjopen-2012-001908.
  16. Choi HY, Kim KT. A new method for aesthetic reduction of labia minora (the deepithelialized reduction of labioplasty). Plast Reconstr Surg 2000;105(1):419–22.
  17. Balmforth J, Cardozo L. Designer vaginas. Journal of the Association of Chartered Physiotherapists in Women’s Health 2006;99:72–7.
  18. O’Connor M. Reconstructing the hymen: mutilation or restoration? J Law Med 2008;16(1):161–75.
  19. O’Connell HE, Eizenberg N, Rahman M, Cleeve J. The anatomy of the distal vagina: towards unity. J Sex Med 2008;5(8):1883–91.
  20. Tiefer L. Female genital cosmetic surgery: freakish or inevitable? Analysis from medical marketing, bioethics, and feminist theory. Fem Psychol 2008;18:466–72.
  21. Chase C. Re: measurement of pudendal evoked potentials during feminizing genitoplasty: technique and applications. J Urol 1996;156(3):1139–40.
  22. Diamond M, Sigmundson HK. Sex reassignment at birth: long-term review and clinical implications. Arch Pediatr Adolesc Med 1997;150:298–304.
  23. Schober JM, Meyer-Bahlburg HF, Ransley PG. Self-assessment of genital anatomy, sexual sensitivity and function in women: implications for genitoplasty. BJU Int 2004; 94(4):589–94.
  24. Schober JM, Alguacil NM, Cooper RS, Pfaff DW, Meyer-Bahlburg FL. Self-assessment of anatomy, sexual sensitivity, and function of the labia and vagina. Clin Anat 2015;28:355–62.
  25. Ostrzenski A. Cosmetic gynecology in the view of evidence-based medicine and ACOG recommendations: a review. Arch Gynecol Obstet 2011;284(3):617–30.
  26. Goodman MP. Female cosmetic genital surgery. Obstet Gynecol 2009;113(1):154–9.
  27. Sharp G, Tiggemann M, Mattiske J. Predictors of consideration of labiaplasty: an extension of the tripartite influence model of beauty ideals. Psychology of Women Quarterly 2014;DOI: 10.1177/0361684314549949.
  28. Fatah, F. Should all advertising of cosmetic surgery be banned? Yes. BMJ 2012;345:DOI: 10.1136/bmj.e7489.
  29. Keil A, Greenhalgh, S. Genital anxiety and the quest for the perfect vulva: A feminist analysis of female genital cosmetic surgery. Women and the Body 2010 [Accessed March 2014].
  30. Howarth H, Sommer V, Jordan FM. Visual depictions of female genitalia differ depending on source. Med Humanit 2010;36(2):75–9.
  31. Howarth C, Temple-Smith M, Simonis M, Hayes J. What are young women’s views on ‘normal’ and ‘desirable’ vulval anatomy? Melbourne: General Practice and Primary Health Care Academic Centre, University of Melbourne; 2013/2014 (research pending publication).
  32. Barlow J. Cleo Magazine: Stop digitally altering images to change appearances #RealGirlsCleo magazine-stop-digitally-altering-images-to-change-appearances-realgirlscleo [Accessed March 2013].
  33. Women’s Health Victoria. Women and genital cosmetic surgery genital-cosmetic-surgery-issues-paper.pdf [Accessed March 2013].
  34. Cain JM, Iglesia CB, Dickens B, Montgomery O. Body enhancement through female genital cosmetic surgery creates ethical and rights dilemmas. Int J Gynaecol Obstet 2013;122(2):169–72.
  35. Australian Attorney-General’s Department. Office of Legislative Drafting and Publishing. Guidelines for the classification of publications 2005 [Accessed October 2014].
  36. Hungry Beast – Labiaplasty 2010, television program, Australian Broadcasting Corporation, Sydney.
  37. Michala L, Liao LM, Creighton SM. Female genital cosmetic surgery: how can clinicians act in women’s best interests? The Obstetrician and Gynaecologist 2012;14(3):203–6.
  38. Reitsma W, Mourits MJ, Koning M, Pascal, van der Lei B. No (wo)man is an island – the influence of physician’s personal predisposition to labia minora appearance on their clinical decision making: a cross-sectional study. J Sex Med 2011;8(8):2377–85.
  39. Simonis M. Addressing young women’s desire for genital beauty. Australasian Sexual Health Conference, 2013.
  40. Paarlberg KM, Weijenborg PT. Request for operative reduction of the labia minora; a proposal for a practical guideline for gynecologists. J Psychosom Obstet Gynaecol 2008;29(4):230–4.
  41. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Guidelines for Gynaecological Examinations and Procedures C-Gyn 30 [Accessed October 2014].
  42. Women’s Health Victoria. Labia Library
  43. Werner P. 101 vagina: One hundred and one women, one hundred and one stories. Melbourne; Philip Werner; 2013.
  44. Blank J. Femalia. San Francisco: Last Gasp paperback; 2011.
  45. Liao LM, Michala L, Creighton SM. Labial surgery for well women: a review of the literature. BJOG 2010;117(1):20–5.
  46. British Society of Paediatric and Adolescent Gynaecology. Position statement: Labial reduction surgery (labiaplasty) on adolescents [Accessed March 2014].
  47. World Health Organization. Eliminating female genital mutilation: An interagency statement [Accessed October 2014].
  48. Vaughan C, White N, Keogh L, et al. Listening to North Yarra Communities about female genital cutting. Melbourne: The University of Melbourne; 2014.
  49. Australian Government Attorney General’s Department. Review of Australia’s female genital mutilation legal framework: Final report female%20genital%20mutilation%20legal%20framework.pdf [Accessed October 2014].
  50. Avant. How FGM legislation applies to cosmetic procedures cosmetic-procedures [Accessed October 2014].
  51. Department for Victorian Communities. Voluntary Media Code of Conduct on Body Image. Melbourne: Department for Victorian Communities; 2008
  52. Shaw D, Lefebvre G, Bouchard C, et al. Female genital cosmetic surgery. J Obstet Gynaecol Can 2013;35(12):1108–14.
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log

Advertising