“Western society considers itself free, liberal and nurturing of gender equality, yet genitalia remains a taboo subject. We rarely say the word "vulva", and instead, describe their external genitalia using a vast array of different terms, often using euphemisms (e.g. ‘down below’) or incorrectly calling it ‘vagina’” [1].

This article includes:

• What is the ‘ideal’ vulva
• Genital Appearance dissatisfaction in connection to sexual esteem and sexual pleasure
• Objectification theory

• Female Genital Cosmetic Surgery
• Vulvariation - about the diversity of vulvas through sex education and art

There has been and still is, a lot of shame imbued with talking or even thinking about one’s "private parts". With so much stigma around learning or even talking about these topics, many of us still refer to their vulva incorrectly as the vagina. However, the vagina actually refers to the internal muscular tube, which is about 7.5 to 10 cm long when unaroused [3] whereas the vulva covers everything visible from the outside; including but not limited to the clitoral hood, clitoris, inner and outer lips, urethral opening and vaginal opening [3, see picture]. The obvious difference between female and male sex organs is that the female external genitals are less visible whereas males can just view their genitals by looking down and thus are often more familiar with their genitals in comparison to females [4]. These physical aspects, insufficient sex education as well as the stigma present have left many people literally in the dark about their own biology.

However, we are also constantly being bombarded with images of naked female bodies in porn and advertisement. In these images, however, we only see a narrow representation of the real diversity of vulvas. This is because over time the aesthetic ideal of female genitalia has become that of a clean slit. The ideal vulva has labia that are identically symmetrical and the vulva is neat and hairless [1,5]. In general, the desirable vulva is represented similar to that of a young girl or a barbie doll [5]. Maybe most compellingly in the ideal vulva, the labia does not protrude, showing only a narrow opening [1,5]. These images of “hairless, minimalist pudenda” are affecting the views of people’s when it comes to their own genital normality and these images are also affecting the expectations of men [6]. Moreover, even if sex education in the Netherlands has received a lot of praise for its inclusivity and modern, sex-positive approach there is still room for improvement in the Netherlands and especially elsewhere [7]. The challenge with sex education is that it often focuses on reproduction and its risks and topics such as the natural variety of genitalia receive less attention. This lack of attention, in turn, leads to unnecessary stress for people whose genitalia does not match that of pornographic representation.

This narrow representation of vulvas as well as the insecurities it evokes affects the sexual satisfaction of people with a vulva. It has been found that body image self-consciousness during sex makes people highly aware of how their body looks in the eyes of their sexual partner. This leads to being distracted from the immediate moment and the physical sensations, leading to less pleasurable sexual encounters [8]. This is also referred to as cognitive interference, which has to do with the thoughts that are distracting the person from enjoying the erotic experience [4]. These thoughts could be anything from insecurities about how certain body part looks to worrying about the kind of sounds one makes when having sex. Moreover, body image self-consciousness can lead to spectatoring, which is a kind of cognitive interference [4]. More specifically, spectatoring is about being a spectator to one’s own sexual performance and the way it appears to the partner. While spectatoring, a person is mentally inspecting their own sexual performance "from the outside" and is limited in their capability to simultaneously enjoy it [4].

‍

Objectification theory

One theory to explain this need to observe oneself is called the objectification theory by Fredrickson and Roberts [8]. It analyzes the psychological effects of constant physical evaluation that people experience from our appearance-centred society. As an effect of this judgement on their looks, people also start to observe their own bodies from the outside: as an object. This kind of self-objectification is seen to lead to many negative health outcomes such as eating disorders, depression and decreased sexual pleasure [8].

Moving from the general to more particular, let’s zoom in to the issues surrounding the vulva for a second. Similarly to body image self-consciousness, there is also genital appearance self-consciousness. In a study with a sample of 217 undergraduate women in the US, who filled in a 5- item Vulva Appearance scale, genital appearance dissatisfaction has been linked with higher genital image self-consciousness during physically intimate encounters. This self-consciousness has, in turn, been linked with lower sexual esteem and lower sexual satisfaction [8]. To put simply, people who have insecurities about their genitals might also feel more insecure while being physically intimate with others and this can, in turn, lower their own sexual satisfaction. As stated by Shick and others: “women’s cognitive preoccupation with the appearance of their bodies during sexual activity may compromise the quality of their sexual experiences indirectly by impeding their sexual esteem”.

Similarly to this, Berman et al. have also found that positive genital self-image negatively correlates with depression, sexual distress and positively correlates with sexual desire signifying the importance of genital appearance satisfaction as a component in female sexuality and sexual satisfaction [9].

Surgery: Wanting that clean slit

As mentioned earlier, in recent years the standard of female genital appearance has become very narrow, resulting in negative psychological consequences, because any fluctuation from the norm is seen as unattractive [10]. Peoples’ concerns about their genital appearance, even if not warranted by medical facts, can be indications of deeper insecurity, problems with self-esteem or even a mental disorder such as body dysmorphic disorder (BDD). In Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) BDD is described as:

“extreme preoccupation with minor or nonexistent defects or flaws in physical appearance associated with intrusive thoughts, persistent distress, significant impairment in social and occupational functioning, and repetitive behaviors, such as mirror checking, seeking reassurance from others, and even requesting unnecessary cosmetic surgery” [10].

As a result of the lack of diversity in vulva representation and the insecurity, it creates more and more people who are considering turning to Female Genital Cosmetic Surgery (FGCS) for help. FGCS procedures include “labioplasty of the labia minora or majora, clitoral hood size reduction, perineoplasty, vaginoplasty, hymenoplasty, and G-spot augmentation” and these operations are done to improve aesthetics and/or performance [11]. The authors of the article about FGCS remind us that there is a great variation in the normal anatomy of female genitalia [11] and that people who are considering this surgery have to always be well informed about the risks of the surgery. These risks include, but are not limited to bleeding, infection, scarring, dyspareunia, alteration in sensation, pain, wound dehiscence, decrease in sexual pleasure [11]. So it has become clear that the limited representation of vulvas creates unrealistic expectations which in turn create insecurity, dissatisfaction in sexual pleasure and the need, for some, to turn to surgery.

Vulvariation

As our society becomes more open towards sexuality, we must also stop ignoring the female genital parts. Educators, as well as health professors, should “encourage a positive and unembarrassed relationship with the vulva” and educate people about the immense variety in size, shape and colour of perfectly normal genitalia [3]. However, there are currently mixed messages being sent to us by media; where on the one hand, popular press acknowledges that variation is normal but on the other hand we are almost only being shown images of the minimal clean slits, which do not represent the wide range of variety that exists in reality [1]. As explained by the authors of Read my lips: The inner labia (labia minora) are actually the most diverse part of the vulva with differing shapes, sizes and colours [3]. So how do we make sure that vulva insecurity can be turned into an appreciation of vulva diversity? As mentioned earlier, sex education should pay more attention to educating young people about the fact that variety in genitals is the norm. Moreover, vulva art can be one way to make diversity more visible. Vulva art is about representing vulvas through art in various ways. For example, a website called The Vulva Gallery features a diverse cast of vulvas drawn in bright colours and aims to educate and empower people. The Vulva Gallery aims to be a safe space to learn about vulva diversity in an inspiring setting. Susi Kummer, a cultural anthropologist, who did her bachelor thesis on the topic of vulva diversity explains that many of her participants saw vulva art as a way to display and normalize vulva diversity [12]. Her participants explained that seeing vulvas similar to their own represented in art felt good and comforting. Moreover, her participants were also not fully satisfied with their formal sex education and that is why they sought sex education and information about vulvas independently. These independent sources included different podcasts, body positive and sex educational Instagram pages as well as Vulva art pages [12]. Kummer concludes that vulva art can be an educational tool and can help normalising vulva diversity [12].

In conclusion...

In this article, I have discussed how the limited representation of vulvas can have a negative impact on people’s sexual esteem and sexual satisfaction. I have talked about how body image dissatisfaction and spectatoring decrease sexual pleasure and how genital appearance dissatisfaction has similar negative effects on sexual pleasure. I have also discussed the increasingly popular female genital cosmetic surgery and its repercussions. I have ended with recognizing the need to bring about more open discussion about the diversity of the external genitalia through sex education as well as through art, in order to normalize all kinds of vulvas and grant a better, more pleasurable life for us all. Moreover, this article focuses more on vulva appearance dissatisfaction and not on penises as this is a less common stance. We can imagine, however, that people with penises also experience similar insecurities especially in relation to size. This can have detrimental effects on their self and sexual esteem. We hope we can become more open to the beauty of genital diversity.

Additional sources

https://www.thevulvagallery.com/

http://www.labialibrary.org.au/

https://www.instagram.com/vulvadraw/

https://jamiemccartney.com/the-great-wall-of-vagina/vulva-library/

​​https://jacquelinesecorart.com/category/diversity-of-nature/

https://www.huffpost.com/entry/stephanie-sarley-vagina-drawings_n_56e8912fe4b0860f99dae1a2

Reference

1. McDougall, L. J. (2013). Towards a clean slit: How medicine and notions of normality are

shaping female genital aesthetics. Culture, Health & Sexuality, 15(7), 774-787.

2. Douglas, M. (2003). Purity and danger: An analysis of concepts of pollution and taboo.  

Routledge.

3. Herbenick, D., & Schick, V. (2011). Read my lips: A complete guide to the vagina and Vulva.

Rowman & Littlefield Publishers.

4. Hyde, J. S., & DeLamater, J. D. (2017). Understanding human sexuality. McGraw-Hill

Higher Education.

5. Schick, V. R., Calabrese, S. K., Rima, B. N., & Zucker, A. N. (2010). Genital appearance

dissatisfaction: Implications for women's genital image self-consciousness, sexual esteem, sexual satisfaction, and sexual risk. Psychology of Women Quarterly, 34(3), 394-404.

6. Cox, L. J. (2016). Ethics, aesthetics and euphemism: The Vulva in contemporary society.

Journal of Family Planning and Reproductive Health Care, 42(3), 226-229.

7. Ferguson, R. M., Vanwesenbeeck, I., & Knijn, T. (2008). A matter of facts… and more: An

exploratory analysis of the content of sexuality education in The Netherlands. Sex Education, 8(1), 93-106.

8. Schick, V. R., Calabrese, S. K., Rima, B. N., & Zucker, A. N. (2010). Genital appearance

dissatisfaction: Implications for women's genital image self-consciousness, sexual esteem, sexual satisfaction, and sexual risk. Psychology of Women Quarterly, 34(3), 394-404.

9. Berman, L. A., Berman, J., Miles, M., Pollets, D. A. N., & Powell, J. A. (2003). Genital

self-image as a component of sexual health: Relationship between genital self-image, female sexual function, and quality of life measures. Journal of Sex & Marital Therapy, 29(sup1), 11-21.

10. Barbara, G., Facchin, F., Meschia, M., & Vercellini, P. (2015). “The first cut is the deepest”:

a psychological, sexological and gynecological perspective on female genital cosmetic surgery. Acta obstetricia et gynecologica Scandinavica, 94(9), 915-920.

11.  Shaw, D., Lefebvre, G., Bouchard, C., Shapiro, J., Blake, J., Allen, L., ... & Simmonds, A.

(2013). Female genital cosmetic surgery. Journal of Obstetrics and Gynaecology Canada, 35(12), 1108-1112.

12. Kummer, S (2021) Vibrant and Unapologetic, a Love-letter on Variety and Acceptance

[Unpublished bachelor’s thesis]. Vrije Univeriteit Amsterdam.