Texto acadêmico: cirurgia plástica e cultura

Por Helô Righetto

Eu estou concluindo um mestrado em Gênero, Mídia e Cultura na Goldsmiths, University of London. Escrevi esse artigo para a matéria Gender, Sexuality and the Media (Gênero, Sexualidade e a Mídia), no começo de 2018. Resolvi disponibilizá-lo pois tive um ótimo feedback da professora da matéria (Dra. Margarita Aragon) e foi um texto que gostei demais de escrever. É sobre como usamos cultura como argumento tanto para emancipação quanto para opressão feminina, dependendo a qual cultura nos referimos.

Caso alguém se interesse em fazer a tradução, é só deixar um alô nos comentários ou entrar em contato comigo por emai: helo@conexaofeminista.com

‘Our own cultural practices are often so normalised that they are rarely subject to the same scrutiny as the practices of ‘others’. Turning a critical lens on what is not challenged in our own practices, but challenged in the practices on culturally different ‘others’, can offer a compelling insight into our practices, and the unquestioned presumptions which they both rely on, and reproduce’ (Braun, 2009: 234). With reference to this quotation, critically analyse how media and culture have influenced the normalisation of cosmetic surgery.

‘In trying to modify female genitals to make them conform to the cultural norm, the cultural norm continues to ignore the fact that female genitalia come in an assortment of shapes, sizes, and sensuality that are unique to each woman.’ (Green, 2005: 171)


On her article about feminist disability theories, Rosemarie Garland-Thompson argues that ‘our unmodified bodies are presented as unnatural and abnormal while the surgically altered bodies are portrayed as normal and natural’ (2002: 12). A straightforward yet striking affirmation, which summarizes how cosmetic surgery is now so embedded in the western culture that is often disassociated with the risks and disadvantages of medical procedures. Virginia Blum affirms that cosmetic surgery is usually ‘justified’ with arguments based on the patients’ mental health, as there is no other way to understand harm being done to a healthy body (2003: 13). According to Blum, Psychological damage takes over for physical impairment. Healthy bodies begin to appear “diseased”’ (Ibid). Heyes and Jones also mention ‘inferiority complex’, ‘a claim that could not be disproved’ (2009: 5) as a justification to go on with aesthetic procedures. In a contemporary world where the female body that did not undergo any type of cosmetic reconstruction is increasingly scrutinised by society – especially by the media – and perceived as disruptive, plastic surgery becomes a source of self-empowerment of the ‘civilised’ and ‘successful’ western woman. Moreover, non-invasive everyday practices such as wearing girdles and high heels are normative – some feminists might say that they are compulsory -, even though such practices, especially when repeated throughout adulthood, ‘impair women’s bodies and restrict their physical agency, imposing disability on them’ (Garland-Thompson, 2002: 17). And again, just like plastic surgery, the act of wearing high heels or any other piece of clothing or accessory that interferes with the natural structure and aesthetics of the female body is perceived as choice. Choice is immediately understood as a result of women’s liberation. Therefore, women who choose to undergo a surgical procedure or wear attire that reduces mobility and causes long-term lesions are not perpetuating oppression embedded in western culture: they are simply expressing their right to choose.

In this essay, I will argue that western society’s understanding of culture creates an environment where surgical aesthetic modifications – cosmetic surgery, with a special focus on labiaplasty – are normalised and even encouraged. Although I will use some examples to show the influence of media in our construction of beauty standards, my objective is to offer a critical reflection on how we use culture to support the pursuit of smooth and homogeneous bodily surfaces. I will start by defining culture, and reflecting on how essentialized notions of culture are hurtful for women (Merry: 2006). I will then discuss how western society accepts media influence as part of culture to justify the control over women’s bodies disguised as choice and empowerment. Moreover, I will use Jones’ arguments on skins and screens to complement the idea of women’s bodies constructed to perform within a patriarchal and heteronormative society (2017). I will finish by comparing labiaplasty and FGM within the human rights framework.

What is culture?

I want to emphasize and define culture, as it is an essential concept for this essay. I want to analyse how western perceptions of culture are not only responsible for the normalization of female bodily modifications in western society, but also for using this normalization as a tool to disguise the perpetuation of women’s oppression by ‘othering’ non-western societies. When writing about humans rights and gender violence, Sally Engle Merry (2006: 10-16) deconstruct essentialized models of culture that often become obstacles to the realisation of human rights, especially women’s rights.

The first essentialized model is culture as tradition. When we construct an indestructible link between culture and tradition we evoke an evolutionary idea that ‘all cultures are positioned on a continuum from primitive to modern’ (Ibid: 12). The culture as tradition model maintains the idea that ‘traditional societies are at an earlier evolutionary stage than modern ones, which are more evolved and civilized’ (Ibid), and is often used to describe poor countries in the global South. Dorothy Hodgson points out that ‘“cultures” are seen as fundamentally local, moored to specific places, people, and times. Culture (or at least so-called “third world” or “traditional” culture) is often attacked as the obstacle to rights, the impediment to human progress and prosperity’ (2011: 2). Therefore, peoples from ‘traditional’ societies become, in the view of the global North, victims of culture: they need to be rescued, saved and civilized to overcome oppression. Female genital mutilation is the poster child of this essentialized view of culture, and is typically described as a ‘harmful cultural practice’ (Merry, 2006: 12).

The second essentialized model is culture as national essence. This view is rooted in Germany, as a result of the claims of universal civilization from England and France in the nineteenth century. ‘German romantics asserted the importance of a distinct culture (…) which formed the spiritual essence of their society’ (Ibid: 13). Cultural as national essence emphasizes national distinctiveness such as language, law and religion. The main issue with this model is that culture is used as a shield to human rights. Those who are opposed to women’s rights use national essence as a disguise to ‘defend culture’ and keep patriarchal privileges. According to Merry, to define culture as national essence is to believe that ‘providing [women’s] rights will cause social chaos and disturb established hierarchies’ (Ibid: 14). Therefore, culture as national essence is an excellent excuse for governments when they fail to adopt, protect and provide women’s rights. The idea of ‘not intervening with culture’ is especially dangerous for women. According to Florence Butegwa, ‘why is it only when women want to bring about change for their own benefit do culture and custom become sacred and unchangeable [?]’ (2002: 123).

The two essentialized models of culture explained above imply that culture is something that exists in villages, in remote places far away from urban world capitals, but not in places where human rights and women’s rights are discussed, such as the conference halls of the United Nations in New York or Geneva. Merry presents a more organic and inclusive conception of culture, based on anthropological observations. She calls this conception ‘culture as contentious’ (2006: 14-16) and explains that the emphasis in on making and transforming culture as it consists of many more pillars than beliefs and values. Cultures ‘include institutional arrangements, political structures, and legal regulations. As institutions such as laws and policing change so do beliefs, values and practices’ (Ibid: 15). Saying that culture is contentious is accepting that it is malleable, it is shaped according to changes in institutions, it is open to hybridization. It is in constant change instead of being ‘closed’ and ‘pure’. Consequently, a contentious culture is a culture that allows barriers to be broken and includes local practices as resources for thinking and realising women’s rights. Analysing and theorizing culture as contentious rather than an immutable concept amplifies the debate and allows for a more in-depth and accurate women’s rights activism.

Culture, media and choices

When I speak to friends, family and acquaintances about the definition of feminism, even with fellow feminists activists, I come across the word ‘choice’ several times. ‘Freedom to choose’, ‘right to choose’, ‘women making choices’ are ready-made answers to the question ‘how to do you define feminism in a few words?’. Virginia Braun says that ‘Ideas of autonomy and agency, and alongside these, choice, have been at the heart of feminism since the first efforts towards women’s emancipation, and have remained an important tenet of feminist discourse since that time’ (2009: 235). Choice is cherished and used as an argument for those that believe that there are no such a thing as sexism or misogyny in western society, that these are issues encountered only outside the global North, issues rooted in cultures that do not allow women to make choices. By stigmatizing and othering non-western cultures, including practices such as FGM and customs that exclude women from the fabric of society, we are building a pretence in which all women in the global North are emancipated, free and therefore able to make unbiased choices. Including choosing to do bodily alterations such as labiaplasty.

Virginia Braun suggests that the alleged patient’s autonomy is not free from marketing and advertising influences and that free choice is ‘culturally circumscribed’ (Braun, 2010: 1400). She points out: ‘how autonomous individual choices can be when considerable societal and media pressure exist for women to alter their appearances (?)’ (Ibid). Braun presents other sociocultural factors that influence choice, such as women’s lack of awareness of the diversity of vulvas as a result of the visual attention that only certain versions of vulva get, especially in pornography: ‘The most oft-cited visual vulval reference is pornography. A result of the ‘pornographica- tion’ of mainstream culture, where pornography is chic and (use is) normalised, is that seeing women’s genitalia – particularly supposedly desirable versions – has become more common for heterosexual women. This ‘porn’ vulva is reportedly desired by women’ (Braun, 2009: 242). Green corroborates, saying that several studies suggest that women are more likely to consider labiaplasty after seeing edited images of vulvas in photographs as well as pornography (2005: 174). This is particularly evident when Braun provides examples of the aesthetically ideal vulva that patients-to-be seek through: ‘a “neat” vulva that resembles that of a prepubescent girl, a fleshy but smooth-skinned (and firm) vulva, with labia minora that do not “protrude” beyond the labia majora; a “nicely” hooded and “contained” clitoris, as well as a “tight” vagina’ (Braun, 2010: 1401). In a website dedicated to promoting cosmetic surgery practice in the United States, the following statement was found: ‘The purpose of the procedure is to provide a youthful look of the labia minora and reduce the excess prepuce the excess skin along the sides of the clitoris. Patients want to have a youthful look of the minora. Patients want the minora nice, thin and perky. Patients do not want sagging, droopy and bunched up minora. Patients want a clean look. Patients also want the excess skin of the clitoris to be sculptured down so that the prepuce hugs the clitoris like a piece of paper draped tightly over a pencil’.

Images of ‘perfect’, unattainable bodies – including flattened, symmetric, screen-like vulvas – populate social media and screens. A recent article published on Huffington Post investigated the power of influence of social media celebrities on consumer habits, especially when it comes to beauty trends and habits. The report highlights the ‘Kardashian effect’, and refers to the physically harming homemade procedure to obtain temporary plump lips showcased on social media by Kylie Kardashian back in 2015, which led millions of young women to do the same. The same report also suggests that image editing apps such as Facetune – used to smooth skin or to make eyes look bigger – or face filters from Instagram and Snapchat play an important role in homogenizing the idea of beauty. Interviewed by the Huffington Post, Professor Renee Engeln said that ‘It’s not enough [to] have to compare yourself to these perfected images of models, but now you’ve got this daily comparison of your real self to this intentional or unintentional fake self that you present on social media. It’s just one more way to feel like your falling short every day.’

In 2017 an app named Princess Plastic Surgery, aimed at young girls, encouraged users to use scalpels and fillers to save the princess from being ugly as a result from a spell cast by a wicked witch. And in 2016 a cosmetic surgery clinic ran a television ad with a popular fashion blogger that had breast augmentation, in which she talks about how her self-esteem and confidence have increased after the procedure. A similar message was at the heart of a campaign that ran on television in 2017. Using the ‘do it for you’ rhetoric, the ad targeted new mothers who have insecurities about their bodies look after childbirth. The pressure to return to their pre-pregnancy weight leave new mothers vulnerable and at risk of depression. Although the ad was later deemed irresponsible and banned, it was on air long enough, exposing women once again to images of perfect bodies under the pretence of choice. Women are taught, from a very young age, that not only their natural features are wrong and that is normal to have plastic surgery to fix their bodies but also that doing a cosmetic procedure is empowering.

On the other hand, images of childbirth and breastfeeding, which include exposed vulvas and breasts which are far from the ‘youthful look’ promised by plastic surgery, are banned from social media and censored under misogynistic ‘community guidelines’. According to a report published on the website The Pool about the hashtag #stopcensoringbirth movement, ‘What has incensed and mystified campaigners worldwide is how something as natural, everyday and universal as childbirth can be classed as obscene, when women’s bodies are routinely used on social media for arguably more offensive purposes and positively sail through clearance. And because, as users, our squeamishness is highly selective and that – dare anyone say it – suggests deep-seated misogyny over how women’s bodies are permitted to be seen and for whom and what purpose they exist’.

Therefore, women are willing to have labiaplasty not because they can choose but because they feel the need to conform, to fill expectations, to be the idealised woman created by a patriarchal society. Angela King adds that ‘surgery is also promoted as being about individual choice and self-determination, but the end results aimed for, especially by the most popular procedures, seem to be profoundly normalizing’ (2004: 36). It is only normal then women that have done the procedure feel satisfied and happy with the result. Moreover, according to Braun, these women are not perceived as ‘victims’ of culture, even though they are influenced by it and may see labiaplasty as a positive side of western culture: the possibility of ‘choosing’ to undergo surgery is the argument itself, as women have the information they need to make a decision and can choose not to do the surgery (Braun, 2009: 238). Although I agree with Jones when she affirms that ‘we need to abandon narrowly reductive politics of representation such as “the media made me do it” narratives’ (2017: 44), and with Green when she says that women are not ‘cultural dupes’ (2005: 176), especially because patients are aware of media influence, I do believe that western society fails to acknowledge that labiaplasty and cosmetic surgery in general are a tool for perpetuating oppression. Jones herself says that ‘Our surgical culture literally shaves labia down to be even, immobile and small – and there’s no doubt that this is a profound way of silencing women’ (2017: 42), which could easily be a comment on FGM practices. There is no doubt that women with perfect health are putting themselves at risk to have aesthetically pleasing vulvas as a result of ‘growing cultural ideals of female genitalia seen in popular women’s and men’s magazines, as well as in pornography’ (Green, 2005: 175).

In summary, even though cosmetic surgery might be considered an aspect of western culture, the choice of becoming a surgical subject becomes an individual act, free from social norms. The woman that seeks aesthetics modifications is taking control over her body, is doing it ‘for herself’ and using her alleged freedom of choice (Braun, 2009: 238). This view taps into Merry’s aforementioned arguments that culture has different connotations in western society: it is prejudicial and oppressive for women in the global South, and a source of self-empowerment and agency for women in the global North.

Flattened vulvas and heteronormative sexuality

On her investigation about ‘media-bodies’, Meredith Jones argues that skins and screens are merging (2017: 29-48). Jones affirms that media – and especially social media – and bodies – especially female bodies – are so entangled that screens’ flatness (representation) is affecting the way we perceive three-dimensional surfaces (real life) and vice versa (Ibid: 29). She suggests that we no longer should mourn the detriment ‘real life’ relations because of our ‘parallel’ online lives, but instead we should ‘interrogate the paradigm in which bodies and media are formed together and continually re-form each other in an ongoing and under-examined tension between two- and three-dimensional ways of being’ (Ibid: 30). Jones proposes that skins and screens are coming together, and that ‘both are interfaces, both are media’ (Ibid: 33). For this essay, I will use Jones’s arguments that focus on the relations of images on media and plastic surgery – more specifically labiaplasty – in order to construct and support my own argument that, for western society, culture is only relevant and brought to the fore to support women’s rights when it highlights women’s oppression outside the global North.

When investigating the merge of skins and screens, Jones focuses on labiaplasty not only because of the vulva’s ‘complex and fraught history (…) and its distinction as the quintessential liminal part of women’s bodies’ (Ibid: 34) but also because of its three-dimensionality (folds, curves, asymmetry) and ambiguity (skin and orifice, hidden and exposed, receiver and expeller) and most importantly because we are led to perceive vulvas as ‘messy and irregular’ rather than just normal (Ibid: 34-35). The asymmetry and complexity of vulvas, as well as its individual particularities, instead of being seen as part of a woman’s essence and a normal and healthy component of a woman’s body, has become problematic, something to be improved, corrected, flattened, in order to be adapted to heteronormative homogeneity (Braun, 2010).

One example given by Jones is the use of image correction softwares such as Photoshop (or more user-friendly apps for mobile phones that do not require technical skills) to ‘adjust’ nude images of women and make them less ‘obscene’. The visible part of the labia minora is removed, so the vulva is reduced to the labia majora and a vertical crease (Jones, 2017: 36). Although consumers of popular culture are able to separate what is seen in the media from reality, manipulated images are partially responsible for the construction of beauty ideals. Jones argues that although women know that bodies and faces on screens and magazines are heavily edited they still wish to have their features altered to look like two-dimensional images (Ibid). She says that ‘In an image-saturated world where people wish they could be Photoshopped in real life and where scalpels can be aligned with digital tools, there is an under-examined tension between two and three dimensions’ (Ibid: 36-37). Here, I would like to make a link to the aforementioned app Princess Plastic Surgery, in which scalpels are literally digital tools, already constructing a notion that the two-dimensional and three-dimensional can merge.

Jones also taps into the Kardashian effect mentioned in the previous section. She focuses on Kim Kardashian-West’s nude photographs for a Prada advertising campaign produced not long after Kardashian-West gave birth. In this series of photographs, one stands out: ‘a photograph shot from below, emphasizing her hairless, oiled vulva rather than her face’ (Ibid: 39). Jones labels Kardashian-West’s vulva as ‘mainstream’ (Ibid), as it is symmetric, flat and smooth. There is an obvious paradox between the ‘seen on screen’ vulva on the series of photographs and the fact that Kardashian-West had recently given birth. Jones says that ‘In giving birth her vulva’s capacity as a (…) expandable, three-dimensional, living object had been utterly proven. And yet she was most keen (…) that it still satisfied notions of beauty in context of a two-dimensional surface’ (Ibid).

The desire for a body as a representation of a screen – becoming screen rather being skin – is not simply a result of the rise of technology. Jones highlights that the pursuit of the flattened vulva has been constructed since European colonizers highlighted the ‘extraordinary physicality of African women’ (Ibid: 37). The features of the vulva of the African women, such as elongated labia minora, were associated with race as a biological difference between the women colonized (wild, black and savage) and the women related to colonizers (civilized, white and docile). This inherited racist notion fits into the essentialized views of culture explained by Merry and explored in the first part of this essay. Colonizers were already creating a separation of what is accepted and what is not in women’s bodies (Ibid: 38-39). Jones affirms that ‘Such historical and contemporary entanglements help foster a powerful urge to modify (…), to smooth and diminish and reduce to a single surface’ (Ibid: 39).

Green highlights another historical factor, the clitoridectomies performed since the second century to ‘combat’ any subversion of the female sexuality, such as lesbianism and masturbation (2005: 160). Clitoridectomies were particularly popular among middle-class women in England during the Victorian Era in order to ‘preserve their energy’ and fulfil their ‘primary role in life; that of wife and mother’ (Ibid: 161). Green quotes of historian Ann Dally, who states that ‘clitoridectomies were practised during the nineteenth and early twentieth centuries on ‘women and girls of whose behaviour middle-class men disapproved’ (Ibid: 163). I want to link this quote with the explanation Green provides about the extra vaginal stitch performed in women which had tears or episiotomies after giving birth. The ‘extra stitch’ is also known as the ‘husband’s knot’ (Ibid: 170). Therefore, the medicalization of women’s bodies, more specifically women’s vulvas and vaginas, continues to be a tool to control women and mould their sexuality around the desires of heterosexual men. Moreover, the pressure to conform – which has been discussed in the previous section – is based in a patriarchal and heteronormative view about gender roles and the existence of only two sexes (Ibid: 177).

Once again I want to draw a parallel with the work of Rosemarie Garland-Thompson on feminist disability theories, which I previously mentioned in the first paragraph of this essay. She questions the ‘insistent narrative that one must overcome an impairment rather than incorporating it into one’s life and self, even perhaps as a benefit’ (2002: 27). For the context of this essay, the impairment can be understood as the unmodified body, leading us to reflect on the insistent narrative of living with our natural bodily features rather than ‘overcoming’ – transforming, altering, erasing, flattening – and understanding this as a benefit, which can be even interpreted as a political act and a way of changing culture, linking to Merry’s ideal of culture as contentious (2006: 14-16).

Labiaplasty x FGM x Culture and Human Rights

FGM is ‘often labelled a “harmful traditional practice” as well as a form of violence against women and violation of human rights. The human rights framework does not see consent as diminishing the violation. Even if a woman chooses to have this surgery, it is still a human rights violation. The critique of FGC incorporates concerns about health consequences, loss of sexual pleasure, violence against women, and gender oppression’ (Levitt and Merry, 2011: 85). James affirms that FGM ‘must be recognized as a patriarchal practice embedded within the complexity of gender hierarchy’ (2002: 99). However, it is imperative to consider that, in the case of FGM, ‘the opposition between guilty perpetrator and innocent victim is not so clear-cut (…). Those who carry out FGM, and who have done it to their children, do it for reasons of love, not hate. The reasons people give for continuing the practice are tied up with the belief that a girl cannot become a proper woman without the ritual of FGM’ (Nash, 2015: 132).

Levitt and Merry raise the question about plastic surgery in countries like the US ‘where these practices are common’ (2011: 85). In fact, 5070 women in the US had cosmetic vaginal surgery in 2013. Although cosmetic procedures can have debilitating bodily consequences they are not accepted as human rights violations (Ibid). Therefore, when we talk about cultural change and consequently the eradication of practices identified as violence against women, we must acknowledge that ‘there is a selection taking place in which other practices harmful to women are ignored’ (Ibid: 87). Although, as previously discussed, cosmetic surgery is perceived by western societies as choice and the women that undergo cosmetic procedures are considered to have agency, plastic surgery is a product of a culture that objectifies women and pressures women to achieve impossible beauty standards. According to Garland-Thompson, ‘the beautiful woman of the twenty-first century is sculpted surgically from top to bottom, generically neutral, all irregularities regularized, all particularities expunged’ (2002: 12). By drawing a parallel between labiaplasty and FGM, my intention is not to say that FGM practices are excusable and not a violation of human rights, but to highlight the issue that able-bodied women going through surgical interventions is not considered violence against women or a product of culture although it is inherent in patriarchal traditions and structures (Coomaraswamy and Kois, 1999: 190).

Surgical intervention for bodily modifications is an acceptable form of violence against women. Merry says that most societies have a boundary between what is acceptable and unacceptable, and ‘redrawing this boundary is at the heart of the human rights project concerning violence against women’ (Merry, 2006: 25). Hodgson agrees: ‘“culture” is often depicted as an obstacle to “progress”, thereby, at times, undermining women’s power and autonomy by ignoring cultural practices and beliefs that serve to empower women, while stigmatizing others, like FGM, that are often central to rites of passage or ritual transformations’ (2011: 140).

As the critiques towards FGM have started based on the health hazards associated with it but in the past few years focused on gender oppression – ‘a practice justified by custom and culture and redefined as an act of violence and a breach of human rights’ (Merry, 2006: 25) – we conclude that other forms of violence against women that are also a consequence and a symptom of gender oppression must be analysed through cultural lens and be included as human rights violations. The forms of violence against women ‘not labeled as harmful cultural practices’ (Ibid) include cosmetic surgery.

Conclusion

Each of the institutions that perpetuate gender inequality, as well as the understanding of gender, functions and is embedded in communities – therefore, cultures – in different ways. The complexity of the mechanisms of each and every one of the institutions cannot be accepted as perennial, uniform or static. If gender itself is not perennial or a given but a socially constructed performance (Butler, 1990), all the structures constructed to support and maintain gender oppression – such as the beauty industry and its range of cosmetic surgeries for the purpose of achieving contemporary beauty standards – need to undergo transformation. Lionnet says that ‘different cultures, for better or for worse, impose similar constraints on the bodies of their members, especially when those bodies are already marked by the sign of the feminine’ (1992: 8, quoted in Green, 2005: 178 ). These constraints are practised in different ways within different contexts – whether within communities in small villages in the global South or requested by women seeking a designer vagina in the global North – but we continue to witness a control over women’s bodies based on suitable essentialized interpretations of culture that deny gender equality.

I want to finish this essay borrowing Green’s words one more time: ‘The genital ideal may differ historically and cross-culturally, yet the fact remains, to be a woman is to have a specific culturally prescribed and approved form of genitalia. Indeed, her most ruthless critic may be herself’ (2005: 177).

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