“I don’t see it as a medical problem”: Clinician’s attitudes and responses to requests for cosmetic genital surgery by adolescents

Merle Spriggs1, Lynn Gillam2

1 Children’s Bioethics Centre, Royal Children’s Hospital / University of Melbourne, Flemington Road, Parkville, Victoria, 3052, merle.spriggs@mcri.edu.au
2 Children’s Bioethics Centre, Royal Children’s Hospital / University of Melbourne, Flemington Road, Parkville, Victoria, 3052 l.gillam@unimelb.edu.au

Labioplasty is a form of genital surgery to reduce large or protruding labia minora. Internationally, the rates of this surgery among women and girls is increasing and people are worried about it.  Medicare data shows that the biggest increase in Australia is among 15 to 24 year olds. This is described in the medical literature as a disturbing trend.

Our focus is under 18s and currently, the main clinical strategy when clinicians are approached by under 18s requesting labioplasty is to reassure them that they are normal. This is done by talking about variation of labia size and appearance and showing pictures demonstrating the wide range of what is normal female genital appearance.

In order to find out on what basis clinicians decide how to treat or manage adolescent patients seeking labioplasty, we interviewed clinicians who are likely to be approached by under 18s requesting this surgery. Our findings support the usual strategies but other interesting issues that have not figured previously in the literature came out as well.  In this paper we discuss the following new issues:

  1. What is the ethically acceptable response to those adolescents who still have major concerns after the standard reassurance strategy? There is a category of girls who persist by saying “Well I don’t like it!”
  2. The ethical significance of the adolescent’s stated reason for wanting labioplasty. Are reasons related to “function” more valid than reasons related to “appearance”?
  3. What is the proper role of medicine in relation to labioplasty? Is surgery ever an ethically justified response to the issues? Does anyone ever “need” this surgery?

Biography

Dr Merle Spriggs is an ARC Research Fellow at the Children’s Bioethics Centre, Royal Children’s Hospital; the Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne; and an Honorary Research Fellow at the Murdoch Childrens Research Institute. She has a PhD in Bioethics and her expertise is in the areas of informed consent, patient autonomy, paediatric ethics, empirical ethics and the ethics of research practice.  Her publications are predominantly in this area and she is author of Autonomy and patients’ decisions. She is currently working on a project titled: ‘The ethics of altering children’.

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The Australasian Association of Bioethics and Health Law (AABHL) was formed in 2009.

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