Medicalization, Colonization of the Female Body and Investment in Women’s Genital Anxiety: The Case Study of Labiaplasty

Abstract
Cosmetic surgeries, including labiaplasty, are increasing in Iran. Because genitalia is not expose to public supervision and judgment, and this surgery cannot be for gaining social acceptance and inclusion. therefore, increasing its demand is thinkable and needs to be investigated separately. This study conducted with the aim of investigating the role of gynecologists in construct the ideal female genitalia and normalizing and expanding cosmetic medical interventions with an emphasis on labiaplasty. The study method was qualitative with a content analysis approach. Data were collected from advertising videos on the subject of labiaplasty that were published on the Instagram pages of 12 Iranian gynecologists. The number of samples was determined based on the theoretical saturation method. Then data were converted to texts, encoded, and classified into subcategories and then main categories. This study’s findings show that gynecologists describe dark, long and asymmetrical labia minora as ugly؛ and they pathologize non-ideal labia as a condition that needs treatment. They promote labiaplasty as a solution for women’s problems and portray themselves as women’s heroes and saviors who solve women’s physical, psychological and social problems with surgery. In these videos, the role of the treating doctor has changed to a cosmetic doctor and the patient to a beauty seeker, and a new model of doctor-patient relationship has been created. In labiaplasty advertisements, medicine is seen as a business in which doctors, moving away from professionalism, are engaged in promoting beauty commode, altruism is replaced by commercial behavior, and they follow the rules and requirements of the market. The study indicates that the medicalization of the female body has provided the conditions for the colonization of the women’s body; And with the rise of commercial medicine, surgeons invest on women’s genital anxiety by pathologizing non-ideal labia minora. 
Keywords: Cosmetic Surgery, Labiaplasty, Female Body, Medicalization.
 
1. Introduction
Cosmetic surgeries are on the rise in Iran, and various parts of the body are the target of manipulation and medical interventions. Surgery of the external female genitalia is also one of the cosmetic interventions that applicants are increasing for. As at the time of writing this introduction, searching for the word labiaplasty (in Persian) on Google yielded more than 1.7 million, results in 0.16 seconds. On Instagram, as one of the most popular social networks in Iran, content production about cosmetic interventions for female genitalia is also on the rise, and some pages are specifically about this topic. The increase in cosmetic surgery for female genitalia is different from other cosmetic interventions because this part of the body cannot be media-generated or visualized, and is not subject to public supervision and judgment, and gaining social acceptance and inclusion with this surgery is not relevant. Therefore, its increase in demand is worth considering, and it may require a different study and analysis than other types of cosmetic interventions to understand it. In Iran, statistics on cosmetic surgeries are not recorded and the number of these surgeries cannot be estimated, but a significant number of doctors advertise these types of procedures on their websites and social media pages, one of which is labiaplasty. In fact, the content that doctors publish on these pages can be considered part of the medical function in normalizing and expanding labiaplasty. The role of doctors is important because they are the only authority in Iran who, relying on medical knowledge and professionalism, are permitted officially, legally, and legitimately comment on the female genitalia and genitalia and therefore participate in shaping beauty standards and promoting cosmetic interventions. the aim of this study is to investigate the role of gynecologists in creating the ideal female genitalia and normalizing and expanding cosmetic medical interventions with an emphasis on labiaplasty.
 
2. Materials and Methods
This qualitative study was conducted using the method of content analysis. The Instagram pages of 12 Iranian gynecologists who practice labiaplasty were purposefully selected, and the advertising content they produced was examined. The method of determining the sample size was based on theoretical saturation. The method of doing the work was as follows: first, videos published on gynecologists’ pages that were on the topic of labiaplasty were watched several times, then their content was converted into text. Then, the text of each video was subjected to qualitative content analysis. The data was coded, similar codes were placed together, and subcategories and categories were extracted from similar codes.
 
3. Data
Four categories and 16 subcategories were extracted from the data content analysis (See: Table 1).
 
4. Discussion
The female genitalia have been brought to the attention of physicians as a new area for medical intervention. gynecologists present a certain shape of the labia as normal, beautiful, and acceptable. With the medicalization of female genitalia, doctors have turned to the construction of ideal genitalia and have defined the normal and abnormal anatomy of the female genitalia. They describe ugly labia as a disease. By constructing an ideal of beauty, they create anxiety about the genitalia in women and lead them to become candidates for surgery to conform to the standard of beauty and get rid of ugliness as a disease or disorder.
According to gynecologists’ advertisements, since labia minor hypertrophy occurs in all women due to aging or pregnancy and childbirth, large, dark, and asymmetrical labia is a female disorder that everyone should seek treatment for. gynecologists use negative language when describing the labia, which can lead to shape negative body image in women. They define size, color, and symmetry as components of desirable and normal labia minor, and frame large, asymmetrical, and dark labia as undesirable and abnormal.
In the advertisements of gynecologists, it is emphasized that labiaplasty is an easy, comfortable and uncomplicated intervention that can be performed in a short time. They present labiaplasty as a solution to problems that actually have social or psychological backgrounds and causes. 
Gynecologists’ practice is conformity with patriarchal culture. By performing labiaplasty at the husband’s request, they recognize the male’s right over the woman’s body and endorse the patriarchal assumption that the woman’s body belongs to the man and that the woman has no control over her body.
What is seen in the videos is the emergence of the clinic as female beauty salon. The “front of the stage”. which according to Erving Goffman includes the environment and personal appearance, is different from the front of the stage expected in a medical setting. appearance of doctor, such as her medical uniform, and doctor’s manner, has transformed.
The entry of medicine into the field of beauty is a manifestation of the commercialization of medicine. The doctor advertises and sells labiaplasty as a beauty commode. because medicine has the authority to diagnose and classify diseases, it uses this opportunity to add to its profit margin. The medicalization of beauty expands and prospers the business of doctors. Medicine as a business has the following components and characteristics: construction and advertising beauty commode, violating of professionalism, a businesslike manner instead of altruism, and following the rules of the market.
 
5. Conclusion
Based on the findings of this study, it seems that the trend of commercialization of medicine and commodification of healthcare has led private sector doctors to apply their professional skills to the beauty market and, by exploring new areas, offer new products to customers. By participating in the medicalization of female genitalia, they are actually paving the way for the colonization of women’s bodies in a patriarchal culture that reduces women to their bodies and their biological characteristics. By using the power and legitimacy of medical discourse in addressing the body, doctors take the lead in constructing the ideal genitalia and actively participate in pathologization of ugly labia minora. While cosmetic surgeons present themselves as saviors of helpless women with abnormal genitalia, they are in fact agents of a patriarchal cultural system that imposes male desire on women’s bodies.