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‘enhancement’ or ‘mutilation’?
Dr Michelle M Fynes
MD MB BCh (Hons) BAO (Hons) MRCOG DU(RANZCOG) DipUS
Subspecialty Accredited Urogynaecologist with RCOG RANZCOG
Specialist Complex Peri-partum Childbirth Injury
Adolescent and Paediatric Gynaecology Specialist
Hans Baldung
Born: c.1484 Schwäbisch Gmünd Germany
Died: 1545 Strasbourg France
What has gone wrong?
Normal Sexual Development
Tanner stages 1-5
Size Zero
Stage I (Preadolescent) - Only papilla elevated above level of the chest wall.
Stage II - (Breast Budding) - Elevate breasts/ papillae (small mounds), wider areola
Stage III – breasts/areolae continue enlarging no separation of contour.
Stage IV – areola/papilla elevated, secondary mounds, increase overall breast tissue.
Stage V – Mature breasts, papillae extend above breast contour, areolar recession.
Stage I - Vellos hair over pubes, no more than on abdominal wall. No sexual hair.
Stage II - Sparse, long, pigmented, downy, straight/slightly curled, hair along labia.
Stage III - Darker, coarse, curlier hair now spread sparse over junction of the pubes.
Stage IV – Adult hair distribution , reduced total quantity, no hair on medial thighs.
Stage V - Hair adult quantity/type, appears as inverse triangle (feminine type).
Size?
Coca: a size 6 former Vogue cover girl
claims she's been rejected for being Model stands waiting for the Rosa Cha show
'too fat‘ 18 February 2010 during a fashion week in NY
Rapid increase in
Body Dysmorphic Disorders (BDD)
2. 1-2% world population meet criteria for BDD (risk male=female). Causes include a
combination of biological, psychological, environmental factors.
6. BDD symptoms include depression, social phobia, and OCD. Affected individual may
become hostile towards family members for no reason.
7. Diminished QoL, can be co-morbid with major depressive disorder; social phobia
(chronic social anxiety); suicidal ideation 80%, extreme cases linked to dissociation.
Do your Bits Look Good?
What’s normal?
What does the science say?
Observer Newspaper 2010/11: figures from Harley Medical Group (leading UK cosmetic surgery provider)
• > 5 000 inquiries for cosmetic gynaecology in 2010.
• 65% of which were for labial reduction, the rest for tightening and reshaping
“We haven’t completed the research, but there is suspicion that it is related to much greater access to porn,
so it is easier for women to compare themselves with actresses who may have had it done. This
phenomenon has to do with the increasing sexualisation of society. It’s the last part of the body to be
changed.”
King’s College London researcher Dr David Veale (Consultant Psychiatrist)
Visual depictions of female genitalia differ depending on source
Helena Howarth, Volker Sommer, Fiona M Jordan
Background:
• Very little research describes normal human variation in female genitalia
• No studies compare visual images women might use in constructing their ideas of average and
acceptable genitalia
Aim:
Do visual depictions of the vulva differed according to their source capture normal variation and
influence perceptions of ‘normality’ ?
Findings:
1. Post hoc tests showed that labial protuberance was significantly less (p<0.001, equivalent to
approximately 7 mm) in images from online pornography compared to feminist publications.
2. All 5 measures of vulval features were significantly correlated (p<0.001) in the online pornography
sample, indicating a less varied range of differences in organ proportions than the other sources
where not all measures were correlated.
3. Women and health professionals should be aware that sources of imagery may depict different
types of genital morphology and may not accurately reflect true variation in the population
4. Consultations for genital surgeries should include discussion about actual and perceived range of
variation in female genital morphology.
A new complaint
1. Our own opinions, and how we see ourselves our self ‘body’ image is based on what we
experience and ‘see’ in the world around us.
2. This ‘truth’ is how we gauge confidence, self-esteem, in how we ‘look’.
3. How do we measure up to our girlfriends, peers or icons
4. Programming starts in childhood and is modified by family, school and education
5. What do our children and adolescents see?
What are the drivers?
Consumer
• Aesthetic: desire achieve certain look
• Physical symptoms: real or Imagined
• Psychosexual issues Provider
• Disposable income • Size of the market and projected
• Designer influence expansion
• Profit
• Risk: litigation
• Market control: GMC, Government (CQC),
advertising standards
Multimedia influences?
Consumerism versus Science
> 45, 000 Google references versus <100 Medline references for scientific publications
Female Genital Cosmetic Surgery (FGCS)
Common Procedures
Labiaplasty FORGET facial fillers to reduce lines and wrinkles, a cosmetic treatment that
promises to plump up a woman’s most intimate area is coming to the UK
British women hanker for designer vaginas: labiaplasty sees 109 early next year.
per cent rise to become third most sought-after surgery. The Labial Puff, a groundbreaking vagina rejuvenation jab that works in a
Procedure costs from £1,300 to £3,700 similar way to lip and facial fillers, promises to boost volume, reduce wrinkles
and add elasticity "down there" in just 15 minutes.
Growth driven by increased consumer awareness
Published: Wed, October 23, 2013
PUBLISHED:16:51, 16 August 2013
Adolescents and the Designer Vagina
In the last few years, the popularity of cosmetic surgery has greatly increased.
Many people opt for procedures, when performed safely, give them excellent results.
But regulation of the cosmetic surgery industry in the UK is in a worrying state.
No accurate statistics relating to how many cosmetic surgeries are carried out in the UK.
British Association Aesthetic Plastic Surgeons: 43,039 cosmetic procedures carried out by members in 2011.
Total number cosmetic surgeries carried out UK is likely to be 130,000.
Around 5% of these procedures end with botched results.
NHS medical director, Sir Bruce Keogh, conducting major review UK cosmetic surgery
Royal College of Surgeons (RCS) published preliminary guidance
The Professional Standards for Cosmetic Practice report.
Female Genital Cosmetic Surgery (FGCS)
‘enhancement’ or ‘mutilation’?