Invisible Labour? Tensions and Ambiguities of Modifying the 'Private' Body: The Case of Female Genital Cosmetic Surgery
Amy Shields Dobson, Karalyn McDonald, Maggie Kirkman, Kay Souter, and Jane Fisher
The ‘designer vagina’ is a relatively new phenomenon, becoming part of public discourse only in the late 1990s. Although female genital surgery has a history longer than 150 years, modification has not usually
A.S. Dobson (*)
Institute for Advanced Studies in the Humanities, University of Queensland, Brisbane, QLD, Australia
K. McDonald • M. Kirkman • J. Fisher
The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Faculty of Law and Business Australian Catholic University,
Melbourn, VIC, Australia © The Author(s) 2017
A.S. Elias et al. (eds.), Aesthetic Labour,
been for aesthetic reasons (Green 2005). Nowadays, cosmetic surgeons promising ‘designer vaginas’ offer to modify all parts of women’s genitals, often to render them more attractive: the labia minora are minimised and made symmetrical (labiaplasty), the clitoral hood is made less prominent (clitoral hood reduction), the labia majora are plumped to make them look more ‘youthful’, and liposuction is available for a ‘fat’ mons pubis (Michala et al. 2012). Normal genital variation among women has been pathologised by describing visible labia minora as ‘hypertrophic’ (Miklos and Moore 2008). Simone Weil Davis (2002) quotes a cosmetic surgeon as telling her that ‘the ideal look for labia minora was not only minimal and not extended but also symmetrical, “homogeneously pink,” and “not wavy .
This genital pathology discourse blurs the distinction between aesthetics and function, where ‘vaginal rejuvenation’ to improve sexual pleasure may be sought in conjunction with procedures to alter appearance. Whose sexual pleasure is being improved? It can be argued that it is not the woman’s, because genital surgery may entail nerve damage and reduced sensation. Nevertheless, Virginia Braun’s (2005) analysis of magazine articles and interviews with surgeons found that female genital cosmetic surgery (FGCS) was framed as enhancing female sexual pleasure, specifically orgasm. Further reasons given for female genital cosmetic surgery include ‘discomfort’, where larger labia are claimed to be problematic in tight clothing, when cycling, or during sexual activity (Miklos and Moore 2008), and cleanliness, with the unsupported assertion that larger labia limit good hygiene (Bramwell et al. 2007).
Australia has a taxpayer-funded universal health care system known as Medicare. It is not straightforward to interpret the threefold increase in Medicare claims for labiaplasty between 2001 and 2011 (Medicare Benefits Schedule 2012) because of the exclusion of all cosmetic procedures except those that have been presented as having clinical indications. The most prominent category of women claiming for labiaplasty in Australia from January-April 2012 were those aged 15 to 24. There is no national register of the vast majority of cosmetic procedures that are privately funded. The as-yet-unanswered question is why girls and women in Australia and elsewhere appear to be seeking cosmetic surgery on their genitals.
The modification and disciplining of women’s bodies through cosmetic surgery has long been critiqued by feminist scholars (Blum 2003; Davis 1995). They have reflected on the ways in which cosmetic surgery is normalised, for example, through reality television shows (Markey and Markey 2010; Sperry et al. 2009) as well the neoliberal rhetoric of choice and agency (Banet-Weiser and Portwood Stacer 2006; Fraser 2003). Shame about their inadequate bodies appears to underpin the decision made by some women to have cosmetic surgery (Northrop 2012). In accepting the need to attempt to perfect their bodies, women have been positioned as victims of a patriarchal construction of femininity and beauty (Taylor 2012).
The instance of FGCS is, like cosmetic surgery in general, positioned as both a surgical and a cultural practice (Fraser 2003). Lih-Mei Liao et al. (2010) reviewed the literature on labial surgery for ‘well women’ and concluded that medically unjustified surgery to the labia minora was being promoted as beneficial to women (claiming high levels of patient satisfaction based on methodologically unsound data) in the absence of any data on clinical effectiveness. In online advertising by surgical providers, FGCS was found to be presented as an effective treatment for concerns about genital appearance, with little reference to genital diversity, clinical outcomes, risks, or other potential ways of managing concerns about appearance (Liao et al. 2012). Braun (2010, this volume) has identified the limited scholarship on FGCS and called for the deficiency to be remedied. Building on what is already known, this chapter arises from a project that seeks to map the gendered cultural and psychosocial factors leading women to seek FGCS, and to explore broader public discourses about ‘normal’ female genital appearance among women and men in Australia, health care professionals, beauty therapists, and in social media communications. At the outset of this project, we first see a need to try to ascertain where and how FGCS currently fits within neoliberal and postfeminist discursive frameworks of ‘body work’ and ‘self’ transformation and reinvention. Our views are shaped by our interviews with women about genital modification.
The purpose of this chapter is to consider how labour on the private body should be understood differently from labour on the publicly visible body. Thinking through the ways in which genital cosmetic surgery fits within ‘inner’ and ‘outer’ body work projects is vital for understanding contemporary attitudes in Australia and the Anglophone West towards FGCS, as well as women’s own complex positionings and experiences of genital modification. We explore some possible differences between cosmetic surgery on women’s genitals and other, more publicly visible, parts of the female body that are commonly modified through surgery. The excerpts are taken from our interviews with women who have undergone or thought about FGCS or modified their genitals in others ways. They distinctively offer examples of women’s reflections and comments that have prompted us to think through tensions and contradictions arising around projects of modifying the private body in a postfeminist and neoliberal social, cultural, and economic context.  FGCS, we contend, confuses and begs questions about neat divides between the labour of aesthetics and the labour of intimacy and relationality. More specifically, tensions arise in relation to three concepts that are theorised as central to understanding cosmetic surgery practices more broadly. These are: (1) tensions between ‘body’ and ‘self’ work; (2) cosmetic surgery as driven by neoliberal, individualist competitive culture; and (3) autonomous versus relational understandings of the self in society. We suggest that a more open analytical framework than is currently available is needed in order to start a public conversation about FGCS that can move beyond simple logics of choice and agency versus cultural determination, as well as beyond the logic of neoliberal, postfeminist individualism as an allpervasive internalised ideology that has ‘colonised’ across divides of class, gender, sexuality, and race in the West (Skeggs 2014). Relationality and intimacy are areas that are sometimes overlooked in analyses of discourses about cosmetic surgery and FGCS in the postfeminist neoliberal context. We argue these aspects of discourse should be further considered as potential sites of rupture or contradiction of neoliberal individualism in relation to cosmetic surgery practices; but also so as not to miss the ways in which power may operate via deeply intimate encounters and relations as well as via more ‘public’ cultural discourses of individualised aesthetic competition and the body beautiful.
-  These interviews are part of a research project, Elucidating the Increasing Demand for GenitalCosmetic Surgery among Girls and Women in Australia (2014—2017), funded by the Australian
-  Research Council and partners Jean Hailes for Women’s Health, Monash Health, Women’s HealthVictoria, Family Planning Victoria, and the Australian Federation of Medical Women. The fourcomponents are in-depth interviews with women; semi-structured interviews with medical practitioners and beauty therapists; a national online survey; and analysis of social media.
-  We do not have space to map this context here and point the reader to the work of Gill and Scharff2011; Scharff 2012; Evans and Riley 2015; and Dobson 2015 for fuller discussions of postfeminism and neoliberalism in feminist cultural studies.