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modification and cosmetic surgery in Brazil, the significance of the body as an individual means of expression, possible parallels between female genital mutilation and female genital cosmetic surgery and their view of cosmetic surgery as “psychotherapy by scalpel”.* Findings Motivation for undergoing cosmetic surgery Many of the women patients mentioned a long period of suffering and discontent with their own bodies before they finally made the decision for cosmetic surgery. After pregnancy, their dissatisfaction with their bodies usually increased because their breasts and belly were no longer as flat and tight as before. The majority reported general discomfort about parts of their bodies being “flaccid”. For many, getting rid of this perceived negative bodily change was a priority for feeling comfortable with themselves. Returning to a “normal” body, which they felt they had had before pregnancy, was of major importance. As has been shown in much research on cosmetic surgery,23,24 these patients generally said that their decision to undergo cosmetic surgery was not for their partner’s or husband’s sake, but only for themselves, for their own psychological Waiting room, plastic surgery department, Santa Casa de Misericórdia, Rio de Janeiro, 2008 DANIELA DORNELES DE ANDRADE *Psychological problems such as an “inferiority complex” gave cosmetic surgery a therapeutic rationale.21 The idea of striving for happiness by recreating oneself, which emerged in 19th century philosophy of Enlightenment (still) represents the justification for cosmetic surgery.22 D Dorneles de Andrade / Reproductive Health Matters 2010;18(35):74–83 78 well-being. In most cases, in fact, their partner or husband was totally against the surgery. There was only one woman among my respondents who felt pressured by her husband to have a facelift and eyelid surgery because of his “obsession with beauty and juvenile appearance”. “He wants me to repair everything,” she said. Some of the main reasons for cosmetic surgery were: “I do it to gain more self-esteem.” (Age 26, business administrator, breast reduction) “Everything will change afterwards… everything.” (Age 40, nanny, abdominoplasty) “I wanted to be normal.” (Age 32, cashier, breast augmentation and abdominoplasty) “I have been dissatisfied with my own body since I was 19. Now I have the money and want to change something… I also hope to find a better job.” (Age 40, housemaid, breast reduction) “I do it to boost my self-esteem and to feel a sense of joy again.” (Age 73, retired, facelift) “Now I can buy and wear the clothes I want to wear.” (Age 50, secretary, breast augmentation, liposuction, abdominoplasty) Two of the three women who had not yet decided whether to have surgery mentioned that as they were ageing, they felt a lot of social pressure to enhance their looks and bodies: “At my age, I have to do it. I have to undergo cosmetic surgery and have a facelift so as to look younger, more beautiful. All my friends are doing it.” (Age 59, language teacher) Female genital cosmetic surgery FGCS has become very common in Brazil in the last ten years. This was confirmed by all the plastic surgeons I interviewed. Three different types of female genital cosmetic surgery were being conducted in Brazil: the reduction of the labia minora (called labiaplastia or sometimes nynfoplastia in Portuguese), the filling or replenishing of the labia majora (preenchimento in Portuguese), and the narrowing/tightening of the vagina (vaginoplastia), which is often done after women have given birth vaginally. Only two of the 12 surgeons said they did not get involved in this type of surgery; seven were doing the surgery themselves, and three had been present at one such procedure. “It is a very simple and harmless surgery with almost no risk or undesirable side-effects at all.” (Plastic surgeon, male, age 42) “I do the labia minora. Sometimes they are too big, annoying the patient. I think it is valid to do that kind of surgery. Other surgery, such as on the hymen, I don’t agree with and won’t do. The patients asking for labia minora surgery are usually between 30 and 40 years old.” (Plastic surgeon, female, age 36) “We do it, it is common. And I think the reason that it has increased is because people speak nowadays more directly. It means they have found out it is possible to fix minor problems which, in the past, they kept hidden, especially women. Reducing the labia minora is pretty common.” (Plastic surgeon, male, age 45) The reasons why these surgeons might advise female genital cosmetic surgery included cases of pain (while playing sports or having sex), and aesthetic or medical reasons. However, the vast majority of the patients do it for aesthetic reasons. The question about what they think women’s motivations are for having FGCS was answered by them in different ways. Some thought there must be a severe underlying psychological problem that the patient wanted to resolve through surgery. “Women who undergo this kind of surgery usually have a masculinity complex.” (Plastic surgeon, male, age 55) “I think if something really bothers the person, then they should get it done, I think it is a kind of a psychological problem as well.” (Plastic surgeon, female, age 34) Others thought it was just “normal” cosmetic surgery like any other, and that women’s reasons for doing it were strongly influenced by the wish to be “normal”, not to differ
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