In any patriarchal society, representations of women and men dictate how each individual expresses themselves, dresses, and behaves. These social norms can also extend to the anatomy of external genital organs, as is the case in communities where female genital mutilation (and also male circumcision) is practiced.

Moreover, in certain countries, notably in Belgium, women and girls voluntarily undergo cosmetic surgeries of the vulva so that their anatomy conforms to prevailing beauty standards.

What are genital cosmetic surgeries?

Genital cosmetic surgery includes, among other procedures, labiaplasty (reductions or restructuring of the labia majora or minora) as well as modifications of the clitoris, including reshaping of the clitoral glans and reduction or removal of the clitoral hood. Additionally, hymenoplasty (the “reconstruction” of the hymen) and vaginal tightening operations are also included.

In the case of reduction of the labia minora, it is referred to as labiaplasty or nymphoplasty. One procedure, called the “Barbie” procedure, named after the famous doll, involves the surgery of the labia minora (sometimes total removal or suturing) to create a vulva completely “smooth” without visible labia minora.

The request for such surgeries can be purely aesthetic, stemming from discomfort (shame, negative comments from partners, etc.), discomfort when wearing tight clothing or engaging in certain activities (sexual, cycling, etc.), or aiming for an increase in sexual pleasure for the woman herself and/or for a partner.

Access to pornography on the internet, consumed by both men and women from a young age, is cited as one of the reasons for the increase in requests for aesthetic surgeries in Western countries. Adolescent girls and adult women come to clinics with images of “ideal vulvas” that are often retouched images from pornographic magazines or the internet, not reflecting real anatomy. Furthermore, the trend of complete genital hair removal makes the anatomy of the vulva more visible, whereas in other periods it was more concealed by hair.

There is still insufficient data on the long-term consequences of genital cosmetic surgeries on health, sexuality, and childbirth. Some research shows relatively low rates of complications, although every surgery carries risks. The identified negative consequences would relate to sexual pleasure, infections, and scarring.

What similarities are there with FGM?

Genital plastic surgeries can be compared to FGM at various levels due to the similarity of certain practices and the fact that they are performed for non-medical reasons.

Both practices are prevalent in different parts of the world: FGM is more common in countries in Africa and Asia (and among diaspora populations), while genital cosmetic surgeries are more frequently practiced in Europe, North America, and Australia. Regarding the age of interventions, FGM is primarily performed on children (sometimes infants or adolescents), whereas genital cosmetic surgeries are more often performed on adults and increasingly on teenagers. Intersex genital surgeries, which are also performed on infants and children, should be noted in this context as well. FGM is carried out by traditional excisors as well as healthcare professionals (midwives, nurses, doctors, etc.), whereas cosmetic surgeries are performed by surgeons and also by professionals in piercing/tattooing.

The demand for cosmetic surgery typically originates from women (and girls) themselves. However, it is fueled by the social norm propagated by the dissemination of the image of the “ideal vulva” or by the pre-marital virginity requirement imposed on women. Both aesthetic reasons and societal pressure can therefore play a role in the practice of cosmetic surgery, much like female genital mutilation.


  • In practice, it is common to distinguish them into two main categories: excision and infibulation (the distinction between types 1 and 2 is not always easy for a clinician who is not familiar with female genital mutilation). It also happens that the labia minora fuse spontaneously without there having been a suture with thread or acacia thorns.

  • The clitoris is a large organ (8 to 10 cm) with the majority of it being internal. Excision involves the removal of the visible or external part (the glans of the clitoris) but not the entire clitoris. The World Health Organization (WHO) adapted the description of the different types of FGM in 2022 by replacing “total removal of the clitoris” with “total removal of the clitoral glans”.

Other practices related to FGM

What do the WHO and Belgian law say about this?

The World Health Organization (WHO) defines FGM as any procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (WHO, 2008). A cosmetic procedure could therefore fall within this definition. However, while the strategy of medicalizing “traditional forms of FGM” faces strong resistance, surgical interventions on the vulva for purely aesthetic reasons are legal and becoming more common in Europe.

Belgian law also allows cosmetic surgery on minors due to discomfort felt by the individual, with parental consent. 

We may wonder why the WHO remains so silent about the increase in labiaplasties while strongly opposing female genital mutilation (FGM). Why would such practices be acceptable for a Western woman but considered mutilation for women from other continents? Why can some women consent to a reduction (or removal) of the labia while others cannot?

Similarly, Belgian law criminalizes all forms of FGM, including on consenting individuals (including adult women), while genital cosmetic surgeries are legal, including on minor adolescents. This shows a double standard.

Practically speaking, several questions arise: Can a woman living in Belgium, originating from countries where FGM is practiced, request cosmetic surgery on her external genitalia? Could the surgeon who performed such surgery risk punishment based on the origin of the patient?

“In Belgium, there is hypocrisy surrounding FGM in the sense that certain forms are tolerated and not punished by law. We think, for example, of piercings, genital cosmetic surgery, etc. Yet, according to the WHO definition, these practices could be considered forms of genital mutilation. By tolerating these practices, the protection of women and girls is put in danger because a girl could undergo a type of mutilation in a hospital or at a piercing studio, for instance. The law should protect against all types of FGM and apply to all women, regardless of their origins…”

  A peer educator from GAMS Belgium, Flanders branch.



  • Nymphoplasty / Labiaplasty – a plastic surgery procedure on the labia majora and/or labia minora of the vulva. It may involve reduction, reshaping, or enlargement of the labia. It can also be used to repair labia damaged by disease or injury.

  • Hymenoplasty – An intimate surgery procedure for women, with aesthetic purposes, aimed at “repairing” the woman’s hymen to give her a “second virginity,” meaning to cause bleeding during penetrative sexual intercourse.


Text adapted from the chapter “Genital cosmetic surgery has nothing to do with genital mutilation” from the guide “Sexual Mutilations: Deconstructing Preconceived Ideas”, published by SC-MGF and GAMS in 2016.

Bibliographies et sources
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  • Coordination des ONG pour les droits des enfants, CODE. (2014). Les mineurs ont-ils le droit de disposer de leur corps ? Analyse mars 2014.
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  • Earp, B. D., & Steinfeld, R. (2017) Gender and genital cutting: A new paradigm. In Teresa Giménez Barbat (Ed.), Gifted Women, Fragile Men. Euromind Monographs 2, Brussels: ALDE Group-EU Parliament. Disponible en ligne : (1/8/2018)
  • Shahvisi, A., & Earp, B. D. (in press 2019). The law and ethics of female genital cutting. In S. Creighton & L.-M. Liao (Eds.) Female Genital Cosmetic Surgery: Solution to What Problem? Cambridge: Cambridge University Press. Disponible en ligne :