“I Don’t See That as a Medical Problem”: Clinicians’ Attitudes and Responses to Requests for Cosmetic Genital Surgery by Adolescents

Abstract

Background: Labioplasty is a form of genital surgery to reduce large or protruding labia minora. Internationally, the rates of this surgery among women and girls is increasing and is viewed as a worrying trend. Currently, the main clinical strategy is to reassure adolescents that they are normal by talking about the variation of labia size and appearance and showing pictures demonstrating the wide range of normal female genital appearance. For the most part, policy documents recommend against labipolasty in adolescents, claiming that it is medically non-essential surgery. In this paper, we contrast findings from our interviews with clinicians with the existing literature and policy documents and we point out areas needing more thought. Methods: This is qualitative research using semi-structured interviews. We set out to find out on what basis clinicians decide how to treat or manage adolescent patients seeking labioplasty. We interviewed clinicians who are likely to be approached by under 18s requesting labioplasty. We use interpretive content analysis and thematic analysis to analyse the data. Results: Our findings support the emphasis on education and reassurance as the first step for all patients, but other issues that have not figured previously in the literature, that would alter clinical strategies for managing patients come out as well.

What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy

“…41 A variety of classification schemes for labial protrusion have been proposed to guide different treatment paradigms but, again, with no consensus regarding definition or use. 42 The implication here is that abnormal is the key ethical criterion for labiaplasty 43 and that a cut-off or threshold exists for normal beyond which surgery is indicated. Only one study has proposed an evidence-based cut-off point for normal labia minora.…”

“…This could be conducted by presenting the normative data'. 24 The focus on normative datasets and normal has been labelled a preoccupation of the literature 43 and a distraction 45 because it implies that women who seek surgery to alter the appearance of their vulvae have 'an underlying desire for normalcy'. 43 In a recent qualitative study, the authors interviewed 11 clinicians who had received requests for labiaplasty from adolescent girls and concluded that education and reassurance do not always work.…”

“…In doing so the authors identified a clear gap in the recommendations of professional position statements, with their emphasis on education and reassurance, because they do not address how to deal with persistors. 43 Normative datasets are useful when planning reconstructive or transgender surgery but their role in patient education has This review is the first analysis of normative datasets from an anatomical viewpoint. There was no combination of search terms and databases that located all of these papers in one search.…”

To the Barricades or the Blackboard: Bioethical Activism and the “Stance of Neutrality”

“…In a further exploration of normativity surrounding sex and embodiment, two articles address requests for female genital surgery and the ways in which clinicians respond to the moral dilemmas such requests entail. Spriggs and Gillam (2018) in their qualitative study of clinician's responses to requests for labiaplasty from under-eighteens, problematize commonly drawn distinctions between genitalia characterized as structurally Bproblematic^or Bdiseased^and that deemed structurally Bnormal,^as well as distinctions between Bfunctional^and Bappearance^concerns. They question the ethical relevance of such fuzzy distinctions and argue for a broader conception of health that includes relief of psychological distress and not just physical abnormality.…”