Introduction

FGCP include a range of procedures: labiaplasty, clitoroplasty, and introitoplasty aim to reshape or reduce the size of the inner or outer labia, clitoris, and vaginal opening, respectively. Hymenoplasty involves the reconstruction of the hymen; vaginal rejuvenation refers to tightening the vaginal canal and/or increasing its thickness and elasticity through surgical or laser techniques; and intimate peeling refers to the chemical bleaching of skin in the genital area (Goodman 2022). Unlike gynaecological surgeries that address health issues, such as uterine prolapse, incontinence, or the removal of vaginal tumours, FGCP are typically pursued for aesthetic reasons or functional enhancement rather than medical necessity. Reliable data on the prevalence and geographical spread of FGCP are limited due to inconsistent reporting and lack of standardised surveys. However, data from the International Society of Aesthetic Cosmetic Surgery (ISAPS) indicate a rising trend in countries such as the USA, UK, Brazil, Mexico, Germany, Argentina, Turkey, India, and Iran (ISAPS 2023). Clinics offering these procedures are also present in countries where FGM/C is prevalent, such as Egypt, Ghana, and Kenya. Feminists have linked the rise of FGCP to unrealistic beauty standards propagated by traditional and social media, pornography, and sex education materials (e.g. Maki et al. 2023). The idealised vulva is typically depicted with small, symmetrical labia minora tucked within the labia majora, with an evenly coloured, smooth appearance. Medicine reinforces these standards by medicalising genital variations, framing them as abnormalities in need of correction (Braun 2019). Cosmetic surgeons promote labiaplasty as a solution to ‘excessive’ labia, further pathologising natural diversity. This interplay between beauty norms and medicalisation has fuelled demand for FGCP, as many women come to perceive their genitalia as not only unattractive but also abnormal.

FGCP technically fall under the WHO definition of FGM/C as the total or partial removal or any injury to female genitalia for non-medical reasons (WHO 2018). Yet they are not treated or criminalised as FGM/C by governments and development agencies, nor are they generally perceived as such in public opinion. Since the 1990s, feminist scholars have criticised this selective condemnation and argued that it reflects racism and colonial legacies, rather than inherent differences (Pedwell 2007). They highlight that FGM/C shares significant similarities with Western beauty practices and genital surgeries as all involve modifying the body to conform to socio-cultural ideals around gender, identity, and sexuality (Boddy 1998, 2016; O’Neill et al. 2020). Some have drawn direct parallels between FGM/C and FGCP, noting that both seek to create a ‘neat’ and ‘feminine’ appearance by removing parts considered excessive or masculine, such as the clitoris or longer inner labia (Boddy 2020). Others, such as Gruenbaum (2005), link both practices to dominant expectations of female sexuality, arguing that they serve cultural ideals of attractiveness for male pleasure. Shahvisi and Earp (2019) further argue that FGM/C and FGCP are anatomically comparable, as FGCP – such as clitoroplasty, labiaplasty, and vaginal tightening – correspond directly to the WHO’s FGM Types 1, 2, and 3 respectively. Given these similarities, scholars have questioned why FGM/C and FGCP are treated so differently. Defenders of this distinction claim that FGM/C is patriarchal, affects children, is non-consensual, and unsafe, but Shahvisi (2023) challenges these assumptions, arguing that FGM/C serves multiple functions beyond controlling female sexuality, that similar procedures are performed on minors in Western countries, and that FGCP is just as embedded in cultural pressures. She further notes that the increasing medicalisation of FGM/C in some regions has narrowed the safety gap between the two practices. These observations have led scholars to conclude that the moral and legal distinction between FGM/C and FGCP is not based on inherent differences but reflects a double standard rooted in ethnocentric, racist, and colonial assumptions (Ahmadu 2017; Earp and Johnsdotter 2021). A key aspect of this bias is the assumption that African women are passive victims of patriarchal cultures, while Western women are portrayed as autonomous agents unaffected by culture (Mohanty 1988). Scholars have challenged this dichotomy, arguing that all women – African and Western – make bodily choices within structures that shape, constrain, or normalise certain practices. They reject the idea that Western women’s choices are entirely autonomous. Boddy (1998), for example, discusses the social and economic penalties for failing to meet beauty standards.

The simultaneous rise of medicalised FGM/C and FGCP, alongside a zero-tolerance policy toward the former and the acceptance and even promotion of the latter as modern and empowering, make this double standard increasingly apparent. This has created a new dynamic where women can undergo elective genital surgeries that are not medically necessary but are performed by healthcare professionals, often driven by motivations and desired outcomes similar to those of FGM/C. Furthermore, FGCP are increasingly available in African urban centres, resulting in a situation where both FGM/C and FGCP are offered side by side in the same geographical areas – yet only one is criminalised. This contrast also highlights how race and class shape access: FGCP are typically accessible to white Western women and wealthier urban Africans, while medicalised FGM/C, though costlier than traditional methods, remains more widely accessible.

As medicalised FGM/C and FGCP become more common, debates over their unequal treatment have moved from academia into policy, medical, and legal arenas. Drawing on case studies from The Netherlands (Van Bavel), Kenya (Van Bavel and Kimani), and Egypt (Van Eekert), this chapter shows that what was once seen as a theoretical concern is now clearly untenable in real-world contexts.