No need to pretty your privates

Alice came to the sexology clinic to seek a second surgery. She had been operated on a year earlier by one gynaecologist in town. She however felt that the objectives of the surgery were not met.

“My genitals still look ugly,” she complained. “There’s no difference between what they looked like before the surgery,” she explained, disgust painted all over her face. “I hate my body.”

Alice was 35 years old and a mother of one three-year-old girl. She was a finance manager at a food manufacturing company, and doing quite well professionally. As I talked to her she came out as independent minded and opinionated.

“So are you married?” I asked as I delved deeper into her social history.

“The father of my girl took off just before the wedding. He said I was difficult to live with,” she replied. “You men are uncomfortable with a go getter!” she burst out laughing.

I established that Alice, like many girls growing up in religious and conservative families, was taught from a very young age to hide her genitals and never to touch them. She grew up not knowing them. When she started menstruating and soiled her clothes at school, she felt ashamed and cried for many days as her peers laughed at her. This incident made her hate her genitals even more.

NEVER WANTED TO HAVE SEX

When she met the man who would later be the father of her baby, she really never wanted to have sex with him. They dated for over a year but she avoided intimacy. She thought sex was dirty. As they planned their wedding, however, her boyfriend pushed her into having sex. She described it as the worst experience of her life. “The pain was unbearable, then I bled and I felt that my whole body was filthy!” she explained. The next attempts to have sex were marked with resistance. Her boyfriend left in protest. Alice was however already pregnant. It was after the first sexual exposure that Alice looked at her genitals in detail in a mirror. She could not believe what she saw.

“Doctor it was so ugly, I never slept that night, I could not believe that that was part of my body!” she said. Alice searched the internet on how to deal with ugly genitals. She read that many women go through genital cosmetic surgery to make their genitals look beautiful. She made up her mind to have this surgery.

Alice went from one doctor to another until she found one who agreed to do it. She paid dearly for it because her medical insurance did not cover such surgeries. “And yet my genitals are still awful!” Alice said, throwing her hands up in the air.

I examined Alice and other than the scaring from previous surgery, she was perfectly normal. I made a diagnosis of body dysphoria, a condition in which one develops hate for one part of the body or the other. In most cases such hate erodes one’s confidence and ego and interferes with their ability to form constructive intimate relationships.

In Alice’s case, this was closely related to her worldview of sex that was instilled in her as she grew up. The lack of appreciation of the beauty of her genitals had interfered with her ability to be intimate.

“But doctor, can’t you see how ugly I am down there?” Alice asked emotionally. I showed Alice a range of pictures of normal genitals and she could identify many that looked like hers. She sat back holding her chin in her left hand as I explained to her what the diagnosis was.

“You are perfectly and beautifully made but you have a psychological rejection of your own body!” I concluded as I booked her for therapy.

The therapy uncovered a lot of difficult situations in Alice’s childhood that interfered with her perception of her body.

Therapy helped her discover herself and deal with those difficult childhood experiences. It was yet another confirmation that genital cosmetic surgery could be the tip of the iceberg in a complicated psychosocial situation.