As more Indian women line up to get 'designer vaginas', some doctors ring ethical alarm bells

“You desire to look beautiful from the outside,” Dr Sejal Desai’s website tells potential clients. “Now you can choose to look beautiful from the inside too.”

The photographs of vaginas that cover one wall of Desai’s consulting room in Sarla Hospital, in the Mumbai suburb of Santacruz, illustrate exactly what she means. Each picture bears a tag: “before” or “after”.

Potential clients “look at the photos and start opening up”, said Desai.

What they open up about is their desire to have “designer vaginas” of the sort Desai has depicted on the wall and on her website.

To help clients get from “before” to “after”, Desai – who claims to be India’s first “aesthetic vaginal surgeon” – offers a range of procedures.

She performs complicated surgeries to unhood the clitoris and remove or trim the vaginal labia. She surgically reshapes the labia majora – the externally visible portions of the vulva – to create a single-creased vagina free of wrinkles. She tightens vaginas “for enhanced sexual arousal and pleasure or to correct age-related sagging and wrinkles which need to be lifted and filled”.

Some vaginal surgeries allow women to achieve what Desai calls the “Barbie look”. She explained: “Barbie look is like having the vagina of a newborn.”

Demand and supply

A decade ago, female genital cosmetic surgery in India was restricted to hymenoplasty or hymen reconstruction. The membrane has been long associated with virginity, and hymenoplasty was mainly performed on young women with ruptured hymens, especially if they were about to be married.

But over the last few years, there has been a growing tribe of doctors in India practicing gynaecology, plastic surgery and uro-gynaecology offering women the option of “improving their genitals aesthetically”.

The rising popularity of genital cosmetic surgery is evident from a simple internet search. There has been a sudden mushrooming of aesthetic genital surgery clinics around the country. Some doctors have even uploaded rate cards for package deals of procedures that fall under the umbrella of “vaginal rejuvenation”.

This has raised several questions. Though these surgeries are routinely performed in developed countries, several doctors’ bodies have said that there is a need for better medical evidence before they are offered to clients. In addition, critics contends that it is wrong for doctors to assign beauty standards to parts of the body.

Mumbai’s Sejal Desai sensed a rising demand for such procedures five years ago, when patients began to ask her if she would perform labiaplasties. In 2012, she signed up for surgical training in Los Angeles. She now performs two or three procedures a month.

The most routinely requested surgeries are vaginoplasty and labiaplasty. In vaginoplasty, doctors tighten the vagina which they claim helps the woman and her partner to have “better sexual intercourse”. Labiaplasty is performed to improve the “look of the area” by trimming the labia minora and majora.

Though several international medical bodies have pointed out that there is no scientific data to show that such surgeries can improve sexual functions, this has not dissuaded some women from opting to go under the scalpel. They include a 26-year-old jewellery designer from Mumbai who has had two vaginal cosmetic surgeries in the last three years. First, she tightened her vagina along with undergoing a labiaplasty. “My vagina looked strange after childbirth,” she said, requesting that her name be withheld. “My friend told me about these surgeries and I decided to get one.”

Last year, the woman, who has a five-year-old child, underwent a hymen reconstruction. The procure is promoted as “revirginisation”, with even older women opting for it. Sometimes, they are given the procedure as an anniversary gift for their partner. “My husband and I wanted to feel the way we felt at our wedding night,” said the jewellery designer. She has since convinced some of her friends to get the surgery.

To please a partner

While this kind of word of mouth is the best publicity for such procedures, doctors say, interest in such surgeries is often triggered by exposure to pornography and images on the internet.

Plastic surgeon Dr Varun Dixit said that a woman’s desire to undergo a surgery is largely influenced by her partner. Though he performs both female and male genital cosmetic surgeries, there is signicantly lower demand for procedures on men, which involve increasing the length and girth of the penis.

Dixit recalled a case of a woman who had been married for five years and wanted a surgery to “fix the problems in her marriage”. The plastic surgeon said that he turns down 20% to 25% of the requests he gets where the expectation from the surgery is unrealistic.

Another impetus for the growing popularty of vaginal rejuvenation, especially among young women, is advertising. “Teenagers are sometimes insecure and they get influenced easily,” said sociologist Nandini Sardesai who feels that doctors are ethically compromised if they offer surgeries that are not required medically. “Women should not get conned. It is absurd to me.”

The demand for “designer vaginas” is not restricted to big cities. Dr Saptarshi Bhattacharya, a plastic surgeon from Kolkata, claims to have performed labiaplasties on women from Bihar, Jharkhand and the North Eastern states. “I have operated on everyone, from students to housewives and working women,” he said.

The cost of vaginal cosmetic surgeries could be between Rs 30,000 and Rs 1.5 lakh depending on the hospital, doctor and other factors.

Making normal ugly

The rising popularity of such procedures isn’t without controversy. When a doctor performs a surgery, the procedure is aimed at alleviating a disease or threatening condition. But cosmetic surgeries, in most cases, are not “medically indicated”, meaning the surgery will not necessarily help improve the functioning of the body part being operated on. “Reshaping of the nose has no medical indication,” said Dr Parul Kotdwala, senior gynaecologist from Gujarat. “Doctors use to frown against those practicing such surgeries but now it is so common.”

Internationally, the Royal College of Obstetricians and Gynaecologists, its Canadian and American counterparts have emphasized that these procedures are not medically indicated.

Questions have also been raised about the efficacy of such procedures. The Royal College of Obstetricians and Gynaecologists in its ethical opinion paper has warned that “clinicians offering female genital cosmetic surgery must be aware that they are operating without a clear evidence base”.

Said the Society of Obstetricians and Gynaecologists of Canada in a policy statement, “There is little evidence to support any of the female genital cosmetic surgeries in terms of improvement to sexual satisfaction or self-image.” It also asked doctors to avoid advertising female genital cosmetic surgery.

The British body in its opinion paper pointed out to the complications that could arise from such surgeries. “Labia minora contain erectile tissue at their base, become engorged and have a role during sexual arousal,” it said. “Long-term damage to sensitivity and sexual function may occur after labiaplasty, as surgery will disrupt nerve supply with consequences for sensitivity.”

The American Congress of Obstetricians and Gynaecologists warned against “potential their complications, including infection, altered sensation, dyspareunia, adhesions, and scarring.” Similar views are expressed by bodies in Australia and New Zealand.

Another concern raised by several doctors is the absence of data on the immediate and long-term effects of such surgeries.

Ethical concerns

Others have pointed to the ethical dilemmas of such procedures. Just like skin lightening creams, vaginal surgeries sell a restrictive idea of beauty, critics say . “We don’t have any conversation about vaginas but yet we now have a myth of what is beautiful,” said Chayanika Shah, a member of a group called Lesbians and Bisexuals in Action.

Medicine, she said, “is not the FMCG [fast moving consumer goods] industry”, alluding to the heavy marketing of beauty products.

Some doctors are also concerned with aesthetic values being associated with genitals. “When we use words like ‘aesthetic’, there is the genuine worry of attaching labels to the look of our private body parts and therefore contributing to body shaming and actually uglification of normal,” said Dr Aparna Hegde, a uro-gynaecologist in Delhi. “Surgeries should be offered if they are medically indicated but not for ‘aesthetics’.”

Also concerned about the growing popularity of such surgeries is the non-profit organisation Sahiyo, which is working to end ritual female genital cutting in India’s Bohra Muslim community.

According to the World Health Organisation, female genital mutilation includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. Some people contend that genital cosmetic surgery is comparable, since it is also performed for non-medical reasons. There is another similarity: female genital mutilation is more likely to be carried in regions where it is believed that it increases marriageability, the WHO says.

“The two are very different issues but if you normalise genital cosmetic surgery, the other [female genital mutilation] also gets normalised by extension,” said Shaheeda Kirtane, co-founder of Sahiyo.

Clitoral hood reduction is considered the medical equivalent of the traditional Bohra practice of khatna by many, Kirtane pointed out. “And it will become another reason to justify the medicalisation of khatna,” she said.

However, doctors performing genital cosmetic surgeries for women say that the procedures should not be confused with female genital mutilation or cutting. “Here, the intent of performing the surgery is to improve sexual gratification,” said Desai.

Growing popularity

Unlike their western counterparts, Indian medical bodies have been encouraging cosmetic vaginal surgery. In October, India is expected to host the first world congress on reconstructive and cosmetic genital cosmetic surgery in Gurgaon.

Before that, in January, the All India Congress of Obstetrics and Gynaecology, the country’s largest gathering of gynaecologists, will host a workshop on Vaginal Rejuvenation and Reconstruction at which foreign and Indian doctors will give demonstrations of labiaplasties, clitoral hood reductions and other female genital cosmetic procedures. The organisers said that rationale for the workshop was to “update and expose” doctors about advances in the field.

Gynaecologist Dr Navneet Magon, who works at the Base Hospital and Army College of Medical Sciences in Delhi and has been instrumental in organising the Gurgaon conference, asserted that it is difficult to say these surgeries are purely cosmetic. “There is a huge degree of overlap,” he said.

While emphasising the need to keep the practice ethical and legal, Mangaon declared, “Women must be offered what they want. By refusing a surgery, I am giving her [the patient] stress.”

But Aparna Hegde, the Delhi uro-gynaecologist, believes that the doctors offering designer vaginas have failed to acknowledge the complex reality of the country in which they operate. In a deeply patriarchal society like India and in the absence of dialogue about sexuality, she noted, women often do not have the option of making choices.

Besides, she contended that promoting of a certain vaginal aesthetic could cause immense damage to women, since there is no ideal shape, size or look of the genital area. Said Hedge: “We are all gloriously different down there and all the different looks fall within the ambit of normal.”