Clinical, Ethical, and Legal Considerations Raised by Self-Reported Genital Mutilation Following Voluntary Cosmetic Labiaplasty

Abstract

An increasing number of women are undergoing female genital cosmetic surgery (FGCS). Labiaplasty, the most commonly performed FGCS, consists of a surgical procedure to decrease the inner labia size so that no or less tissue protrudes beyond the outer labia. Anatomically, it is similar to female genital mutilation/cutting (FGM/C) Type 2a. Thus, what are the differences and similarities between FGCS and FGM/C? Even though FGCS is not recommended by most scientific societies, it is considered legal, contrary to FGM/C. Most women seeking FGCS have physiologic (neither diseased nor anatomically atypical) genitalia and are reassured by counseling. We recommend counseling, history taking, screening for relevant conditions, and, if surgery is pursued, medical care by a specialist. We present the cases of three patients who reported feeling genitally mutilated after having willingly undergone FGCS. This feeling led these women to seek care at an outpatient clinic that receives migrants, refugees, second-generation, or naturalized patients originating mainly from African countries having experienced FGM/C. We discuss clinical implications, health insurance coverage, legal, ethical, and social implications. Multiple unresolved issues must be carefully addressed by scientific societies, legislators, and anti-FGM/C advocates to ensure equal treatment of all individuals in relation to genital cutting or surgery. Genital modifications experienced as harmful, or that are performed without informed consent, should be studied in relationship to one another and evaluated with consistent principles, regardless of the skin color of the individuals concerned, their cultural, ethnic, or religious background, or the name given to the genital modification they underwent.