Today’s dose of righteous anger comes, via Ophelia Benson and Marie Myung-Ok Lee writing in The Atlantic, from the fifth annual Congress on Aesthetic Vaginal Surgery, held just outside Tuscon at the end of last year.

The affable organizer of the Tucson event, Dr. Red Alinsod, was an early entrant into cosmetic-gyn, and is recognized for inventing the procedure in which the labia minora are completely amputated to create a “smooth” genital look known in the field as “the Barbie.” Though he began his career by winning a prestigious fellowship in gynecology-oncology at Yale in 1990, Alinsod now spends his days making genitalia “look pretty” for the wealthy patients who flock to his Southern California practice from all over the world. He is also an evangelist for the field, spreading its lucrative gospel to fellow doctors tired of toiling in the time-intensive and high-liability fields of traditional obstetrics and gynecology.

Cosmetic gynaecology, it appears, has been pretty much rejected by mainstream medicine – which means that it’s all-but-unregulated.  It’s a deeply weird business, though.  Actually: scrub that.  It’s really rather sinister.

I’m on record (here, for example; or here) as taking a line that, in respect of just about any surgical procedure, it’s perfectly fine for people to have done what they want: if they can find a surgeon who’ll do it, and they meet all the regular competence and consent criteria, then it’s their business.  But this case seems to be, at least potentially, rather different.

If the report is accurate, one of the disturbing things about it is the evangelism of the proponents of the surgery.  Sometimes it involves evangelising to patients (clients?):

[S]essions [at the conference] covered everything from search engine optimization for doctors’ Web sites to “The Blue Plate Special,” a urogynecologist’s advice on how to persuade a patient to add cosmetic-gyn to an incontinence surgery. The Web site of one ahead-of-the-curve doctor featured not only a $500 coupon but also “Patriot Program” discounts for federal employees and military personnel. One conference presenter summed up the new dynamic: “Retail plus medicine equals ‘retailicine.’” [emphasis mine]

Let me run that by you again: advice was being given on how surgeons could persuade people already undergoing a medical procedure to undergo a further, medically unnecessary medical procedure that it may not otherwise have occurred to them to have.

What?  Really: what?

If you want medically unnecessary surgery, then that’s fine; the onus is on you to persuade the surgeon.  But this reverses the situation: it’s the surgeon – and since this is the States, a surgeon with a financial interest (to which I’ll return) trying to persuade a patient.  This is nuts.  Brutally nuts.  It’d be dodgy enough in respect of therapeutic treatment, but here?  Surely any reasonably switched-on medic with a shred of respect for the profession would find that just a bit… well… repugn-

[O]ne conference presenter left his computer’s wallpaper—rotating images of him with his red Porsche 911—up in the background during his PowerPoint lecture. The message was tough to miss: practice cosmetic-gyn, and you too can live the life of a plastic surgeon.

Oh.  I had no idea that a sense of professional integrity had roughly the same value as a tacky car.  Ho hum.

One thing is striking about the article: the absence of the feminine personal pronoun.  The speakers and delegates at the conference are all – it would appear – men.  (If anyone reading this can attest to the accuracy or otherwise of that impression, then do say.)  The word “her” appears four times – but only in the comments.  And even then, the context frequently isn’t really an endorsement of empowered womanhood: one of the commenters – and I assume it must be both a man and a troll here – states that “If a woman wants to make herself more attractive through this surgery, that’s a personal choice” and talks about the surgery in the context of a woman choosing it freely to please her husband.  (No, really.  It’s all about marriage for him.  He’s also worried about ingrate flag-burners.)

So it might therefore be tempting to see this as yet another example of women being forced to make ridiculous sacrifices by male hegemony.  I suppose that that’s possible – but I don’t think that that’s necessarily the only possible interpretation.  For one thing, to take that line seems to indicate a very odd view of women as being utterly in thrall to their male partners and completely unable to tell those men to stick their cosmetic surgery up where Ra’s chariot does not journey.  Some women probably are that pathetic – women are people, some people are pathetic, so one might reasonably expect some of those pathetic people to be women – and maybe there’s an element of self-selection inasmuch as that it’s only the pathetic ones who accept this kind of surgery.  But that would be an empirical matter with a limited context, and it wouldn’t justify the claim about male/ female relations more generally.  And if someone is really in a situation whereby her partner may leave her because of the cosmetic details of her genitalia… well, she could well be better off without him.

For another, I’m not sure that many men (the weirdo in the comments aside, that is) are all that bothered – or, rather: if they are, then they are because of some pretty strange sexual acculturation.  (Anyone else reminded of that story of John Ruskin’s wedding night?)  Hence the complaint might well be not so much one about women’s role in relation to men, as the manner in which (a) sexuality can be influenced by culture and (b) medical incentives to create and perpetuate anxieties about the body.  Put these two together, and the result may well be toxic.  In this case, it happens to be women who bear the physical burden, but it need not be: I see no reason why men could not fall prey to similar anxieties about their genitalia, or any other part of the body.  Either way, there’d be a case to be made about some kind of “false consciousness” on the part of the person about to go under the knife.

Which is not to try to lessen the outright toxicity of women being persuaded into unnecessary surgery for the sake of a slightly perverse ideal of what  their body should look like.  Not all attempts to explain are attempts to explain away.  But with that in mind, I suppose it doesn’t really matter what the cultural explanation is.  Analyse it any way you like: it’s at best a weird, weird, weird procedure.