My comments about labiaplasty were featured in a recent article for Newsweek. Not only is labiaplasty amongst the fastest growing aspects of my plastic surgery practice, but it has also given me an opportunity to speak to a large number of women of all ages, backgrounds, sexual orientations, and life circumstances who have concerns about this topic.
In light of this popular aspect of my plastic surgical work, I am convinced that labiaplasty is a personal decision. Nearly all women are doing it for themselves, for their own reasons-- discomfort, self-consciousness, or difficulty engaging in some normal aspect of their regular lives. Despite the Newsweek article below, I have never had a patient mention pornography, another woman's appearance, or pressure from a sexual partner during a discussion about labiaplasty.
Read below to hear more about the changing landscape of sexuality amongst American teens, including an increase in labiaplasty prevalence, below.
PORN AS SEX ED: ONLINE SMUT WARPING TEENS' VIEWS ON SEXUALITY
BY SUSAN SCUTTI ON 5/14/16 AT 9:00 AM
On the “Sexual Health—Teens” message board at HealthBoards.com, questions are asked anonymously, and most fall into a void, unanswered by others clamoring to be heard. Many focus on genitals. “Help, my testicle feels weird.” “I find just about every part of a woman's body attractive but the vagina.… Is this normal among males?” “My girlfriend and I are teens, and we are planning to have sex, so I was wondering…. What is a good size?”
Teens span “a huge spectrum” when it comes to feelings about their genitals, says Virginia Braun, a psychologist at the University of Auckland. “Some are perfectly satisfied or happy; others are deeply distressed.” But perhaps more and more are leaning toward the latter. Recently, The New York Times reported an 80 percent increase in labiaplasties—cosmetic surgery that trims and shapes the female genitalia—performed on teen girls. Overall, the numbers of teens getting the surgery done in the U.S. remain quite small; 400 teen girls had a labiaplasty in 2014, up from 222 in 2013. But the rate of increase is significant enough to be concerning and appears to be a sign of a growing trend.
“Over the last decade plus, we’ve heard increasing accounts of young women being concerned that their vulva is not normal,” says Braun. “But we are also seeing a newish concern that the vulva is unappealing or unattractive and that it can [or] should therefore be changed. This is the difference from 20 years ago, when girls may have worried that it didn’t look ‘that nice,’ but that was just how things were.”
Labiaplasty isn’t a new thing; various versions of these procedures have been performed in the U.S. for decades on women following childbirth. “Injuries need to be repaired,” says Lara Devgan, a cosmetic surgeon based in New York. Every week, she gets five to 10 labiaplasty inquiries from women and ends up operating on about half of them. Though she performs most of these procedures on adults, about 20 to 25 percent of her labiaplasty patients are younger than 25 and include teens bothered by “discomfort, chafing and skin irritation.” Some patients describe feeling self-conscious, but Devgan doesn’t see it as a “politicized” issue.
Others see the procedure very differently. Labiaplasty is one extreme in an overall response to increasingly invasive expectations of what bodies are supposed to look like, says Laura Lindberg, principal research scientist at Guttmacher Institute.
“Our society values how people look,” Lindberg says. “Why should we be surprised that teenagers buy into it when the adult population buys into it?”
“Body image is a big issue for teens—they have a lot of misperceptions about what’s normal for bodies, for their bodies,” says Al Vernacchio, a sexuality educator at Friends’ Central School in Wynnewood, Pennsylvania. He has worked as a high school teacher for 21 years and understands the ways in which today’s teens are similar to and different from past generations. “They really do get sucked into body shame and negative body image—and body perfectionism is really rampant.”
From her research on teen sex behaviors, Lindberg says what is really different these days is “teenage girls now have a normative expectation around what their pubic area is supposed to look like.” Assumptions about what is or is not attractive extend to intimate areas of the body—genital hair and the size of labia. She believes the root of these concerns is early exposure to pornography.
Easy access to pornography
According to Pew Research, 92 percent of teens report going online daily, and for most that means access on their personal phones—which also means no one is looking over their shoulder. Anna, 17, attends a Cleveland high school and believes “most people my age watch porn, absolutely.” The first time she watched was in school with a group of fifth-grade kids gathered around an iPod. “I think the first time I saw porn was probably when I was 10,” Justin, 16, says, adding that the same is probably true for most of his friends. A suburban New Jersey high schooler, Justin says most of the boys he knows watch porn online regularly.
Easy access to sexually explicit and pornographic material is “a game changer,” Vernacchio says. “Kids are seeing sexually explicit material far earlier and in far greater numbers than their parents’ generation.” A 2010 Dutch study, for instance, found that the more a teen is exposed to pornography, the more realistic they think it is and the more it influences expectations for their own sexual behavior. Meanwhile, a 2016 Italian survey found 10 percent of teens who watch porn reported a reduced sexual interest toward potential real-life partners, while 19 percent said they had an abnormal sexual response—but those numbers rose to 19 and 25 percent among frequent viewers.
“Many, many young people today are using porn as sex ed,” says Vernacchio. “They think what they’re watching is real sex instead of a staged performance of sex where there’s lights and camera angles and cuts in the action and repositioning.” In addition, porn often contains unusually proportioned and surgically enhanced bodies—Houston, a porn actress, reportedly auctioned off snipped pieces of her labia encased in a Lucite cube, as did Sydney Leathers, Anthony Weiner’s sexting partner and a former porn actress—and this may contribute to girls’ anxieties about their own developing physiques.
Today’s porn looks nothing like it did 10 or 15 years ago, says Gail Dines, a professor of sociology and women’s studies at Wheelock College. The titillating pictures and photos of naked women from past centuries have given way to close-up videos of sexual degradation. Teens who log on expecting to see a little tawdry if amiable sex may be challenged by what they find. As Dines describes it, much of mainstream porn is “brutal and cruel.” And it can impact their behavior: In 2013, Michelle Ybarra, president at the Center for Innovative Public Health Research, and her colleagues found that 14- to 21-year-old perpetrators of sexual violence were more likely to have watched violent X-rated content.
As Ybarra notes, though, “not all pornography is the same.” While the Internet may open the door on sexually violent porn for some teens, for others it offers a place to safely explore sexuality. The web has “done wonders” to help isolated kids identifying as gay, lesbian, trans or gender nonconforming find community, says Vernacchio. This is particularly important given that, taken as a whole, teens in sexual minority groups report significantly more sexual activity and more risk-taking than heterosexuals. “The experience of growing up LGBT is different than growing up heterosexual,” says Ybarra. Online community can ease a teen’s loneliness and possibly lead to less risky choices.
But as they explore their attractions—both online and off—teens’ questions and anxieties about their changing bodies clearly impact their experiences and ultimately their behavior. A 2010 study of undergraduate women in the U.S., some in their late teens, found that those who reported greater dissatisfaction with their genital appearance also were more self-conscious during intimacy and experienced lower sexual satisfaction. That, in turn, made them more likely to engage in riskier sex, like not using a condom.
Meanwhile, the bandwidth of acceptable sexual behavior has widened over time. One example is oral sex, which is more prevalent among today’s teens than past generations. Vernacchio believes this is due in part to the HIV/AIDS epidemic. A lot of the early AIDS education pointed to oral sex as a less risky form of sex, he says, and that seems to have influenced the entire culture. Today’s teen sees oral sex as far less intimate than their parents’ generation did, Vernacchio says—to them, it’s “not real sex.” Recent researchsupports the belief that oral sex is “an established component of youths’ sexual repertoires” and also suggests this form of sex slows teens’ transition to vaginal intercourse. Strange as it might sound, numbers from the Centers for Disease Control and Prevention suggest that teens overall are having typical sex less often than their predecessors: In a 2015 survey of high schoolers, 41 percent reported having had sexual intercourse, while 12 percent said they’d had four or more partners—significantly fewer students than the 54 and 19 percent who reported the same in 1991.
“It is definitely a more complex sexual landscape to navigate for youth today,” says Braun.