The girl lies in a half-conscious state, her legs wedged wide apart, her exposed genitals splayed. By her shoulders, a man and woman are stationed to prevent her from stirring. Standing over her naked body, the man in charge brandishes the metal instrument in his hand. The metal glints, he clamps the red lip of her most intimate parts into the jaws of his scissors, and he cuts. There is no other sound in the world like that of flesh severed by a blade and that’s the sound made as he snips, slices and chops away bloody chunks from the healthy tissue of the young woman’s vulva.

This is not snuff porn. These are not the superstitious rituals of ancient traditions in faraway lands. This is not a horror movie. This is labiaplasty, the cosmetic reduction and reshaping of the female labia minora; one of surgeries gaining such rapid popularity in Australia that its official numbers have tripled in little more than a decade. There were 1565 women who claimed the surgery on Medicare in 2011 alone. The scene described above I saw in a documentary.

The growing trend of female genital surgery is back in the news since this month’s introduction by the Royal Australian College of General Practitioners of new guidelines on how to handle queries from female patients presenting to GPs seeking the procedure.

With surgery reported on girls as young as 15, the increase in Medicare claimants is disturbing for several reasons. The first is that this number of patients is far fewer than those estimated to be paying up to $9,000 to get the procedure in the unmonitored private system. The second is that the majority of these surgeries are talking place on healthy tissue; peer-reviewed studies have established that most women who undergo labiaplasty have entirely normal anatomy.

Since the prevalence of labiaplasty and vulvoplasty began to spike a few years ago, medical researchers have been hesitant to conclude a reason for the popularity of the “tucked-in look” beyond that “implicit in a woman’s desire to alter genital appearance may be the belief that her genitals are not normal”.

But given that the “normal” range of labia size falls between a length of 2cm to 10cm and width of 0.7cm to 5cm, cultural commentators are more insistent that a confluence of contemporary pressures on gender are fomenting this genital self-scrutiny.

Because it wasn’t always thus, nor is it thus everywhere. The 18th century Scottish poet Robbie Burns celebrated the “untucked” labia among his bawdy “Merry Muses of Caledonia”. The early British stage actress Elizabeth Barry was feted for her large labia and in present day Zambia, girls report pressure from elders and counsellors to actually stretch their labia minora “if they wish to marry”.

In the west, the motivation for the reverse trend is not expressed so blatantly, although cultural messaging remains arguably the same. The popularity of porn has spread a new genital ideal that has more to do with cinematic direction than anything else: the removal of pubic hair was a means by which pornographers could show greater sexual explicitness without hair obscuring the view.

Now hair removal in the non-porn population is so common, medical writers suggest the detail of women’s genitals are now not only exposed to more visual scrutiny – but irritation. Friction applied to exposed genitals can inflame the vulva, and the labia can engorge and thicken in response.

Women electing to have unnecessary surgery on intimate tissue risks a permanent impairment or loss of erotic sensation.

Porn also standardises bodies and acts for those who have not been directly exposed to so many of them; as many as 30% of women seeking the procedure report that their partners have criticised their genital appearance, yet few themselves have seen much if any female genitalia outside of porn with which to establish their own sense of normalcy.

Online projects like the labialibrary.org.au may offer a comparative guide for the curious. Offline, a curious quirk in Australian censorship laws for years demanded that to show a photograph of a naked woman, any visible bits of labia had to be photoshopped away in order to retain a “soft core” classification. And these atypical, edited, imaginary women appeared in media with far more traction than feminist self-help sites.

As a cosmetic procedure that doesn’t need to be performed by a qualified surgeon, only someone with a medical degree, the opportunity for a commercial exploitation of women with imaginary abnormalities is vast, and Medicare has pursued a recent crack down on labiaplasty claims.

But what remains are young women volunteering for surgery that may be sold as a “low-risk procedure” but which is delicate and irreversible, and of which the long-term effects are not known. Yes, the patients elect themselves to have these surgeries. Yes, many do report satisfaction with the result.

So what? Women electing to have unnecessary surgery on intimate tissue risks a permanent impairment or loss of erotic sensation. Taking that risk in order to meet culturally-constructed ideals of “desirability” is an issue of great concern. That she and/or her partner may be happy with it afterwards isn’t something to be celebrated as much as mourned.

Complications of the surgery are actually common; in America, there are doctors now specialising in the repair of botched operations. And yet the number of labiaplasties continue to grow.

In 2013, the United Nations General Assembly approved a ban on female genital mutilation, which the World Health Organisation defines as any procedure to “intentionally alter or cause injury to the female genital organs for non-medical reasons.”



At the time, associate professor Sonia Grover, director of the Department of Gynaecology at the Royal Children’s Hospital in Melbourne, echoed a growing concern when she remarked that “there’s an extension to ask whether or not ... that’s now being done in western women.”

The argument has always been that western women are embracing their own surgery as a personal “choice” – but if the messages from our culture are strong enough to convince women they’re abnormal when they’re not, it’s not hard to draw comparisons with the folk mythologies that inform the “choice” of genital mutilation elsewhere.

Whenever and wherever someone stands over a young woman, tearing apart their genital flesh for no other reason than for her to meet the pressure of an ideal, it’s a victory for cultural coercion, not for anyone’s freedom.

Monash University is currently undertaking a study on female genital modification in Australia. You can participate here.