There are few things left in society that are considered taboo. Soap operas serve to benchmark society and when East Enders portrays homosexuality, abortion, bipolar disorder and HIV, it is a sign that we are no longer uptight about any of these issues.
However, there is one area that remains a mystery, both for patients and professionals alike.
As a female GP, I see a surprising number of females who believe they are abnormal or deformed because of the size or shape of their labia. The disturbing feature about these consultations is that many are teenage girls who are accompanied by their mothers, who share their perception of abnormality. These are women of all ages and races who have been exposed to a mainly uncensored media, and yet have no idea about the wide ranging appearances of the female form.
In addition to this group, when I also see large numbers of women seeking a reversal of the female genital mutilation that occurred in their childhood, I wonder why there is such a fear surrounding female genitalia. These procedures often dissect away the labia minora; those flappy little fleshes of skin that are the visible statement of being a woman.
The RCOG recently produced an ethical opinion paper on the subject of female genital cosmetic surgery (FGCS), following a fivefold increase in NHS surgery in 2010. It concluded that there was little evidence for an outright ban but proposed it should be restricted to adults over the age of 18 who have been psychologically assessed and have been educated about normal anatomical variation.
And here lies the problem…..where is this educational resource for patients and clinicians? Where can we find images of female genitals that have not been digitally enhanced or infantilized in pornographic material? A recent study actually confirmed statistically significant differences between images of labia portrayed in pornography and those portrayed in medical textbooks. The RCOG recognises this dearth of images portraying the normal female form and intends to tackle this.
In the meantime, I will continue to direct my patients to Great Wall of Vagina, where art is succeeding when medicine and the media cannot.
(1) Ethical Opinion Paper: Ethical considerations in relation to female genital cosmetic surgery
RCOG Ethics Committee, October 2013
(2) Visual depictions of female genitalia differ depending on source
Howarth et al, Medical Humanities 2010, 36: 75 – 79
Dr Shaba Nabi is a GP trainer in Bristol