BEIRUT: In Lebanon, the vagina is shrouded in taboo, leading many people - especially women - to speculate about their anatomy and what their body should look like. “The vagina is the equivalent of He Who Must Not Be Named,” said a 24-year-old woman who asked to remain anonymous, citing privacy reasons.
“Nothing about it is discussed except in relation to periods. We don’t talk about it at school, not with friends - zero.”
But despite the taboo - or perhaps because of it - the vagina and vulva (the external female genitalia that includes the labia) regularly go under the knife, in many cases for reasons that are not medically necessary.
Vaginoplasties (tightening the vaginal walls), labiaplasties (changing the shape of the labia) and hymenoplasties (reconstructing the hymen to create a perception of virginity, the least common procedure) - all of these services are available in Lebanon, carried out by either plastic surgeons or gynecologists.
Official statistics aren’t available on the number of women who seek these procedures in Lebanon, or why.
But anecdotally, experts say women in Lebanon commonly undergo cosmetic vaginal and vulvar operations.
What is driving women to modify the most hushed part of their body?
For some, the decision to cosmetically alter the vagina or vulva is about boosting inner confidence, says Caroline Osman, a gynecologist based in Beirut who regularly performs these surgeries.
“They want to be beautiful for themselves and for their partners, so they come for my services,” Osman told The Daily Star.
Osman’s patients, in other words, are not necessarily driven to her office because of stigma, shame or a controlling spouse.
“It’s not always the case the husband has made his wife come to my office. These women are doing it for themselves, to improve their lives.”
Elie Abdelhak, a plastic surgeon at St. Georges Hospital in Beirut’s Rmeil and the president of the Lebanese Society of Plastic, Reconstructive and Aesthetic Surgery, also says his patients’ decision to get a vaginal or vulvar surgery is one of emancipation rather than repression.
Abdelhak works with older women, many of whom have given birth to multiple children, and he says that for them the decision to alter the vagina is about reclaiming their body and sexuality for themselves.
“First of all, sexual activity for women does not stop when they’re 40 years old; women’s libidos are still strong as they grow older,” he said.
“And in Lebanon, the average child per woman is ... higher than that in the West. After multiple children, the vagina becomes loosened,” and some women seek a vaginoplasty “to make sex interesting again for themselves and their partners.”
Other women may suffer from incontinence after giving birth to multiple children, another reason some of his patients want to have the surgery, he added.
But while for many women the reasons for cosmetic vaginal and vulvar surgery stem from pragmatism and empowerment, for others the story is much different.
Two sexual-health professionals interviewed for this article said that women are likely attracted to such procedures as a result of years of taboo, resulting in the idea that the vagina and vulva should look and function a certain way.
In 1995, various United Nations agencies in Lebanon created a sex-education curriculum for 12-to-14-year-olds going through puberty.
While the curriculum was supposed to be introduced in public schools, it faced immediate backlash from religious leaders who found it “inappropriate.”
Today, only a handful of private schools enforce their own curricula.
Consequently, people are still “never taught to look at their vaginas or talk about them,” says Dr. Sandrine Atallah, a psycho-sexologist who works with both women and men to overcome a number of psychological and medical issues.
Atallah does not work specifically with women who have had or plan to get surgery, but she spends much of her time outside the office talking to the public about sex and Lebanon’s undiscussed body parts.
Her Instagram feed is a mix of infographics, memes and videos educating followers about safe sex and our anatomy in a blunt and comedic way. She also encourages her followers to write about their experiences and ask questions.
Misinformation about the female anatomy causing shame is something Atallah says she encounters daily, and that according to her could very well be a reason women are driven to change themselves.
“There is not enough discussion about the diversity among vaginas in size, shape and color,” Atallah says.
“Too many people believe the vagina should be pink, that the labia should be symmetrical and small, but this is not true at all.”
Many find their vulvas to be ugly and dirty and fear it may be unattractive to a man, she says. “They’re shocked by the way it looks.”
Sara Abu Zaki, a project manager at Marsa Sexual Health Center in Beirut, adds that the lack of sexual education and the high stigma across the country, regardless of sect or social class, are so pervasive there is little correlation between a woman’s level of higher education and her sexual education.
The majority of the center’s patients are under the age of 30, sexually active, university educated and living around Beirut, she says.
In other words, someone who graduated from the American University of Beirut could be just as affected by stigma and a lack of proper sexual education as a woman from a rural area who did not go to university.
Marsa offers medical, educational and psychological services such as STD testing, but it doesn’t cater specifically to women who are considering or have undergone a vaginal surgery.
“Still we get questions about the hymen, about the transmission of diseases - everything. It has little to do with education; these are beliefs that are heavily imposed on women across Lebanese society and around the world.”
The stigmatization of sex and the negative attitudes toward a woman’s exploration of her own body, Abu Zaki says, influence how the woman feels she should look “down there,” whether she has a higher degree or not.
In 2014, Marsa published a video of anonymous Lebanese women talking about their vagina.
“I saw a hole, and I got scared,” one woman said.
“I thought to myself, ‘What is this thing? How did it become like that?’” another told the camera.
Abu Zaki says she is sure that fear is a strong enough motivator for women to consider a hymenoplasty in particular.
“Women grow up believing that first-time sex should be painful, and it should be associated with bleeding. Pleasure is never discussed.
“For women who may have had premarital sex, getting married can drive them to get hymenoplasties so their virginity can be ‘proven’ to their husbands,” she says.
Whatever the reason women ultimately choose to surgically modify their vagina or vulva, all four health professionals agree that sex education should be implemented, and women should be empowered to make the best decision for themselves - free from pressure.
“Education should really begin in schools and homes,” Atallah said.
“We should not have to be ashamed to speak about any parts of bodies, especially with close members of our family and educators.”