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from others. I did not manage to meet any women who had had FGCS during my research. The majority of patients I interviewed were at the public hospital Santa Casa de Misericordia, where FGCS is not conducted. However, although one of my key informants, a male gynaecologist, contacted some of his patients who had had FGCS to invite D Dorneles de Andrade / Reproductive Health Matters 2010;18(35):74–83 79 them to talk with me, none of them agreed to do so. Most of my respondents also refused to discuss it and were deprecating about this type of cosmetic surgery. My impression was that cosmetic surgery on the female genitals is still taboo, at least as a topic for conversation. The majority of the key informants, when asked about any parallels between FGM and FGCS, responded that they did not consider themselves to have any “expertise about the practice of FGM.” One answered: “Yes, I do see a relationship between these two practices… They both represent a tremendous aggression against one’s own body.” (Psychologist, woman) In contrast, one (female) sociologist said she thought the two practices differed in intention: one aims to diminish sexual desire (FGM) in women, in conformity with the community’s norms, whereas the other (FGCS) is performed to enhance or improve sexuality, the woman is searching for sexual pleasure as an individual. The (male) gynaecologist I talked to was also convinced that female genital cosmetic surgery could help to enhance women’s sexual pleasure and that advanced techniques in genital surgery could be used with African women who had had FGM, to regain their sexual pleasure. During my field work, I could not find any published scientific research conducted in Brazil on female genital cosmetic surgery. What I did find were a large number of advertisements in magazines and newspapers claiming the advantages of cirurgia intima (“intimate” surgery). One article reported on the popularity of a plastic surgeon from Rio de Janeiro whose patients are celebrities, claiming that one of his clinic’s major successes was the biomodulação (biomodification) of the female genital organs. This special treatment, it was said, aimed to increase the volume and diminish the flaccidity of the female genitals, which would help to enhance self-confidence and pleasure.25 Adolescents and cosmetic surgery In the last ten years, the number of adolescents who have undergone cosmetic surgery has increased dramatically, from about 5% to 15% of the total number of such surgeries each year, as estimated by the Sociedade Brasileira de Cirurgia Plástica, 13 and confirmed by specialists. The plastic surgeons interviewed had differing opinions on the subject of adolescents and cosmetic surgery. Half of them were strongly against conducting cosmetic surgery on adolescents and the other half said that they were doing it, but only in cases of strong asymmetries (for example, of the breasts) and in cases where the level of psychological suffering was very high (e.g. a big nose or sticking-out ears). “Sometimes it’s necessary, you must weigh up and evaluate each case. I mean, as we have a beach culture here and sun exposure, some girls come here with huge breasts at the age of 14, which I know is not the right age to perform surgery. But they feel inferior, they become isolated, they do not socialise. So I think it’s important, even at that age, to make their breasts smaller. As long as it does not interfere with the development of the breasts.” (Plastic surgeon, male, age 45) “Today, by 13–14 years of age, they are practically adults. These adolescents are able to make these decisions. I have a 14-year-old son and he knows everything already. He knows more than me.” (Plastic surgeon, male, age 55) “So, when they reach 12 or 14, they are already behaving like adults and they want to have more responsibility… And they often say to me: ‘I need this surgery, it’s terrible, I cannot go out of the house, I cannot go to the beach, I can’t do anything. I cannot live with my tits.’ But I think it’s terrible to have an adolescent girl making this decision on her own… I don’t think they are ready for that.” (Plastic surgeon, female, age 34) According to Brazilian legislation, up to the age of 18 an adolescent needs parental consent for surgery. The five psychologists I interviewed agreed that there were two main risks that should be considered before conducting cosmetic surgery on adolescents. First, the person has to be “ready”, in the sense that they feel mature enough to make such a change, which will be a non-reversible modification of his or her body. On these grounds, the psychologists argued that this was usually not the case with adolescents, due to their young age. Second, many adolescents may be trying to “cure” themselves of anxieties and insecurities concerning their own bodies and their physical development by undergoing cosmetic surgery. Plastic surgeons confirmed that in some cases adolescents come to their clinic inquiring about a cosmetic D Dorneles de Andrade / Reproductive Health Matters 2010;18(35):74–83 80 “correction” of their genitals. However, surgery may well not change anything in relation to any underlying psychological causes of their concerns. In some cases, adolescents who feel they are not “cured” with the first surgery go on to try more, and in some of these
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