GENITAL COSMESIS: WHEN DO WE CROSS THE LINE?

The last few days have been abuzz with the controversial case of a doctor filing a petition in the High Court to decriminalize the female genital cut. The case has generated a heated debate raging among the medical practitioners holding extreme opinions about it. The universal agreement is that children must be protected from the cut against all costs but divergence comes in the mature consenting adult woman who opts to undergo the procedure.

As the discussions go on, few are paying attention to genital procedures that are on-going that have even been medicalized within our country and beyond. These procedures involve both men and women and are mostly done riding on the background of cosmesis. In Kenya, the rate at which we are catching up with the western world is alarming.

Vajazzling

This is a genital adornment rave that was popularized by actress Jeniffer Love Hewitt in her book “The Day I Shot Cupid”, further cementing it in subsequent television show appearances. Its promotion was further supported by United Kingdom Beautician, Amy Childs. It is a form of genital decoration involving shaving off pubic hair followed by adorning the pubic region with crystal jewelry stuck on the skin using bonding glue.

With the current nature of many a young woman idolizing celebrities and looking to ape their lifestyle, it is no wonder many would be taking on this new method of body adornment as the latest craze. Brace yourselves for the Instagram wave of adorned mons pubis showing up on Instagram!

Meanwhile, the United Kingdom NHS is reporting a rise in complications arising from the procedure, especially those that are done by the individual instead of a trained beautician. These include infection, bruising, allergic reactions and trauma during sexual intercourse arising from poorly located crystals.

Genital Piercings

Body piercing is not a new phenomenon. It has been demonstrated among many cultures for ages, and carries an underlying meaning. However, in the modern day, this is done more for aesthetics than anything else. Piercings have been done all over the body, including earlobes, the brow, nose, lips, tongue, nipples, belly button, and the genital area.

Genital piercings are coming to the fore as we discuss the implications on sexual and reproductive health. Piercings are done on the clitoris, the labia majora and the labia minora and bullrings and barbells inserted through.

The Prince Albert is a male piercing that starts in the urethra at the penile tip and exits on the underside of the penis at the top of the glans penis (the naked part of the penis after the foreskin) with a curved barbell type of jewelry running through. The Princess Albertina is the female version where the piercing goes through the urethra and comes out in the vagina.

These piercings are done with the intention of improving genital cosmesis, improvement of sexual satisfaction and sometimes just as a hype. However, they remain largely discouraged by the reproductive health authorities, especially the American College of Obstetricians and Gynaecologists (ACOG). Even worse is that the providers of these piercings remain largely unregulated.

Complications of these procedures abound though not enough data has been collected to inform their frequency. These include infections, bleeding, allergic reactions to the jewelry, chronic pain, scarring and keloid formation. In a country where infections transmitted through sharps abound, the possibility of getting HIV, Hepatitis B and Hepatitis C is real.

Vaginoplasty

This is a medical procedure done by medical professionals in the field of gynaecology and plastic surgery. Vaginal surgery to repair congenital abnormalities in young adolescents born with genital tract malformations is not a new concept. Repairs for vaginal fistulae in women sustaining them during neglected labour keeps specialists and supporting partners busy all year long. Repair of perineal tears is a routine procedure done by doctors and midwives for women delivering.

However, now we have vaginoplasty taking a different tangent. Doctors are now marketing vaginal surgery as a cosmetic procedure. Under the guise of improved sexual experience, improved aesthetics and improved confidence, doctors are now asking women to take up the service.

Some women want to tighten their vaginas after vaginal births, others want the shape and size of their labia altered while others want enhancement of the G-spot done with collagen injections. These are services currently available right here at home, provided by our very own gynaecologists. So far there aren’t enough studies done yet to convince the scientific world on the effectiveness of these procedures especially in guaranteeing sexual satisfaction and most international professional bodies remain cautious.

In the face of these procedures, does Dr. Tatu Kamau have a case in court? Is this what women would want decriminalization of the female genital cut for? What is the cost benefit?

A study done by Myrna Armstrong, a professor at the Texas Tech University Health Sciences Center School of Nursing, in Lubbock, Texas, showed that most nurses did not have any idea on how to deal with the piercings in the face of emergency. In the event that an incapacitated patient in the emergency department needing surgery, removing a tongue barbell is no mean feat.

I can only imagine the trauma a young man with a Prince Albert piercing would go through if he did not realize the importance of mentioning its presence to a radiologist before going for an MRI test. His penile tip will be well and truly fried!

These things are not foreign to us here at home. Five years ago, I had a mom in labour with bilateral piercings on her labia majora complete with a neat row of barbells on either side. Thankfully, my skills at removing them was not tested as she ended up needing a caesarian section!