by Naomi Wolf
Healing doctors respect the healthy body and invade the diseased only as a last resort; cosmetic surgeons call healthy bodies sick in order to invade them. The former avoid operating on family members; the latter are the first men to whom technology grants the ancient male fantasy of mythical Pygmalion, the sculptor who fell in love with his own creation: At least one surgeon has totally reconstructed his wife. Healing doctors resist being manipulated by addicts; there is already a class of women who are addicted to surgery, reports Newsweek, “scalpel slaves” who “indulge . . . in plastic surgery the way some of us eat chocolate—compulsively. Neither cost, pain nor spectacular bruising lessen [the] desire for a little more whittling.” One surgeon gives an addict a discount for repeat operations. Addicts “go from doctor to doctor, seeking multiple operations. . . . Their self-scrutiny becomes microscopic. They start complaining about bumps the average person doesn’t see.” And the surgeons operate: one in particular has cut up one woman at least half a dozen times, “and expects to keep up the remodelling work. ‘I guess it’s all right,’ he says, ‘as long as her husband doesn’t complain.’”
Safeguards
Medical coercion in service of a vital lie is less regulated than legitimate medicine. In the nineteenth century, sexual surgery was risky and unscientific, with few legal checks. Patients were more likely, until around 1912, to be harmed by medical intervention than helped. Little, according to today’s standards, was known about how the body worked, and strange experiments on women’s reproductive organs were common. The American Medical Association had no legal control over who could call himself a doctor. Doctors had virtually free rein to peddle opiate-based, addictive snake oils, and miracle cures for vague female maladies.
The new atrocities are flourishing without intervention from the institutions that promise to safeguard the welfare of citizens. In a sexual double standard as to who receives consumer protection, it seems that if what you do is done to women in the name of beauty, you may do what you like. It is illegal to claim that something grows hair, or makes you taller, or restores virility, if it does not. It is difficult to imagine that the baldness remedy Minoxidil would be on the market if it had killed nine French and at least eleven American men. In contrast, the long-term effects of Retin-A are still unknown—and the Food and Drug Administration has not approved it; yet dermatologists are prescribing it to women at a revenue of over $150 million a year.
The silicone injections of the 1970s, never approved by the FDA, have hardened “like a sack of rocks,” as one doctor puts it, in women’s breasts. The long-term carcinogenic effect of silicone is unknown, but surgeons are still injecting it into women’s faces. In the US “peeling parlors” have appeared where operators with no medical training at all use acid to cause second-degree burns on women’s faces. It wasn’t until 1988 that the FDA cracked down on quack cures for weight loss aimed at women, a $25-billion-a-year business. For the forty years before the crackdown, disreputable physicians prescribed, for “medically approved” weight-loss treatment: amphetamines and related addictive drugs, high doses of digitalis, a highly toxic heart drug, injections from pregnant women’s urine, extended fasting, brain surgery, jaw wiring, and intestinal bypass. Though all were promoted by doctors, none was backed by long-term animal studies or clinical trials for safety or effectiveness. Mass-market diet formulas still place dangerous stresses on the body when normal eating is resumed; PPA (phenylpropanolamine), present in diet pills and herbal weight-loss remedies, causes danger to the heart, but need not be labeled on the product. Women are still prescribed addictive cocaine- and amphetamine-derived drugs for weight loss, but this does not merit the attention of the President’s task force on drugs. This lack of regulation is itself a message to women, a message that we understand.
In Great Britain, objective-sounding organizations have sprung up which specialize in cosmetic surgery—and make use on their literature of the winged staff and serpents of Asclepius, god of healing and of the medical profession, giving women the impression that they will get impartial information, when what the organisations do is lobby over the phone, through medically untrained “counselors,” for new patients. In the United States, it was not until 1989, ten years into the Surgical Age, that a congressional hearing was convened by Congressman Ron Wyden (Democrat, Oregon), to investigate what one witness called “the last refuge of freebooters charging what the market will bear” and their advertising, which is “often misleading and false . . . preying on the insecurities of American women.” Testimony accused the Federal Trade Commission of a failure to regulate the “profession,” and blamed it for permitting advertising in the 1970s and then abandoning responsibility for what the ads had wrought. An M.D/D.P.S. is “board-certified” by the American Board of Plastic Surgery, and therefore trained; but an American woman who is told that it is her burden to ensure that the surgeon is “board-certified” is unlikely to know that there are over one hundred different “boards” with official-sounding names that go unregulated. Fully 90 percent of cosmetic surgery in the United States is performed in unregulated doctors’ offices. Finally, asserted the congressional testimony, “there is no standard method for preoperative screening,” so any woman is operable. What did Congress do about the situation once it was staring them in the face? Nothing: the legislation proposed after Congress saw 1,790 pages of shocking testimony is, says Dr. Steve Scott, spokesman for Congressman Wyden’s office, more than a year afterward, “on hold.” Why? Because it happens to women for beauty, so it is not serious.
Sexual Surgery
It is particularly not serious if it is sexual. The industry expanded in the 1980s in response to beauty pornography. When AIDS curbed heterosexual promiscuity, men and women had fewer real-life sexual experiences to make them secure in the knowledge that good sex looked all sorts of ways. When there were fewer authentic images of sexuality in people’s heads with which they could counteract the influence of commercial images of sexuality, “body sculpting” took on a life of its own, driving the sexes apart into a complementary narcissism no longer even aimed at seduction. Women lifted weights and “got hard”; but it is men who “get hard,” and “beauty” is necessary in women to apologize for masculine power: When they were hard all over, they had incisions opened under the folds of their breasts and clear sacs of gel inserted. The muscles were the hypermasculine iron fist; the artificial breasts, the hyperfeminine velvet glove. This ideal was no longer a “naked woman,” that vulnerable being. Its breasts made of clear chemicals, it had got rid of as much of the “naked” and the “woman” that could go.
Anywhere from 200,000 to 1 million American women have had their breasts cut open and sacs of chemical gel implanted. Journalist Jeremy Weir in Self magazine puts the number at over a million, and the profits at between $168 million and $374 million. (The operation costs from $1,800 to $4,000.) The breast, he writes, is the part surgeons are cutting into most: 159,300 breast operations in a year, compared with 67,000 face-lifts. The surgery leads to a hardening of scar tissue around the implants in up to seven cases in ten, when the breasts become rock-hard and must be reopened and the implants removed, or the lumps torn apart by the full weight of the surgeon using his bare hands. Saltwater implants deflate and must be extracted; implant manufacturers provide surgeons with routine insurance to cover replacements (surgeons buy the sacs in packs of three pairs of different sizes). Silicone implants leak the substance into the body to unknown effect, medical journals predicting immune-system problems and toxic shock syndrome. Implants make it harder to detect cancer: In a study at the Breast Center in Van Nuys, California, of twenty cancer patients with implants, none of the breast tumors had been detected early, and by the time the disease could be discovered, the cancer had spread to the lymph nodes of thirteen of the women. Dr. Susan Chobanian, a Beverly Hills cosmetic surgeon, says that “very few women withdraw after hearing the risks.”
A risk never mentioned in sources available to most women is the d
eath of the nipple: According to Penny Chorlton, “Any surgery on the breast can and probably will adversely affect any erotic stimulation a woman has hitherto enjoyed, and this should be pointed out by the surgeon in case it is important to the patient” (italics added). Breast surgery, therefore, in its mangling of erotic feeling, is a form of sexual mutilation.
Imagine this: penis implants, penis augmentation, foreskin enhancement, testicular silicone injections to correct asymmetry, saline injections with a choice of three sizes, surgery to correct the angle of erection, to lift the scrotum and make it pert. Before and after shots of the augmented penis in Esquire. Risks: Total numbing of the glans. Diminution of sexual feeling. Permanent obliteration of sexual feeling. Glans rigidity, to the consistency of hard plastic. Testicular swelling and hardening, with probable repeat operations, including scar tissue formation that the surgeon must break apart with manual pressure. Implant collapse. Leakage. Unknown long-term consequences. Weeks of recovery necessary during which the penis must not be touched. The above procedures are undergone because they make men sexy to women, or so men are told.
Civilized people will agree that these are mutilations so horrible that a woman should not even be able to think them. I recoiled when I wrote them. You, if a woman, probably flinched when you read them; if you were a man, your revulsion was no doubt almost physical.
But since women are taught to identify more compassionately with the body of a man or a child—or a fetus or a primate or a baby seal—than with our own, we read of similar attacks on our own sexual organs with numbness. Just as women’s sexuality is turned inside out so that we identify more with male pleasure than female, the same goes for our identification with pain. One could protest that breast and penis are not parallel terms, and that is valid: Breast surgery is not exactly a clitoridectomy. It is only half a clitoridectomy.
But it is not like real genital mutilation, one could argue, because women choose it. In West Africa, Muslim girls with uncircumcised clitorises can’t marry. The tribe’s women excise the clitoris with unsterilized broken bottles or rusty knives, leading often to hemorrhrage and infection, sometimes to death. Women are the agents there. One could say with as much insight that those women “do it to themselves.”
An estimated twenty-five million women in Africa are sexually mutilated. The common explanation is that it makes women more fertile, when the opposite is true. Foot-binding in China also had a sexual rationale, as Andrea Dworkin has noted: Chinese foot-binding was believed to alter the vagina, causing “a supernatural exaltation” during sex, so, as a Chinese diplomat explained, the system “was not really oppressive,” though, Dworkin writes, “the flesh often became putrescent during the binding and portions sloughed off from the sole” and “sometimes one or more toes dropped off.” It was the essence of desirability: No Chinese girl “could bear the ridicule involved in being called a ‘large-footed demon’ and the shame of being unable to marry.” The rationale for breast surgery is also sexual desire and desirability.
Like breast surgery, genital mutilation was trivialized: Atrocities that happen to women are “sexual” and not “political,” so the U.S. State Department, the World Health Organization, and UNICEF called them “social and cultural attitudes” and did nothing. At last, though, WHO monitored the practice. Daniel Arap Moi, president of Kenya, banned it in 1982, after he learned that fourteen girls had died.
Western sexual surgery is not new. Normal female sexuality was a disease in the nineteenth century, just as normal breasts are operable today. The role of the nineteenth-century gynecologist was the “detection, judgment and punishment” of sexual disease and “social crime.” Pelvic surgery became widespread as a “social reflex,” since “orgasm was disease and cure was its destruction.”
Victorian clitoridectomy made women behave. “Patients are cured . . . the moral sense of the patient is elevated . . . she becomes tractable, orderly, industrious and cleanly.” Modern surgeons claim they make women feel better, and that, no doubt, is true; Victorian middle-class women had so internalized the idea of their sexuality as diseased that the gynecologists were “answering their prayers.” Says a face-lift patient of Dr. Thomas Rees’s, “The relief was enormous.” One of Victorian Dr. Cushing’s patients, relieved by the scalpel of the “temptation” to masturbate, wrote, “A window has been opened in heaven [for me].” “It’s changed my life,” says a rhinoplasty patient of Dr. Thomas Rees’s: “As simple as that.”
Victorian medical opinion varied on whether female castration worked in returning women to their “normal” role. A Dr. Warner conceded, as do modern surgeons, that the results were probably psychological, not physical. A Dr. Symington-Brown conceded that, but insisted that the operation was still valid because it worked by “shock effect.” The Surgical Age likewise reinforces women’s submissiveness to the beauty myth with the unspoken background fear: If she is not careful, she will need an operation.
Like the criteria for modern surgery, in which face-lift patients in their twenties are subject to a “preventive” operation that is, in the words of one doctor, “pure marketing hype,” the criteria for clitoridectomy were at first narrowly defined but soon became all-encompassing. Dr. Symington-Brown began clitoridectomies in 1859. By the 1860s he was removing labia as well. He became more confident, operating on girls as young as ten, on idiots, epileptics, paralytics, and women with eye problems. As a surgery addict says in She magazine, “Once you start, it has a knock-on effect.” He operated five times on women who wanted divorces—each time returning wife to husband. “The surgery . . . was a ceremony of stigmatization that frightened most of them into submission. . . . the mutilation, sedation and psychological intimidation . . . seems to have been an efficient, if brutal, form of reprogramming.” “Clitoridectomy,” writes Showalter, “is the surgical enforcement of an ideology that restricts female sexuality to reproduction,” just as breast surgery is of an ideology that restricts female sexuality to “beauty.” Victorian women complained of being “tricked and coerced” into treatment, as did the American women who in 1989 described to talk show hostess Oprah Winfrey the genital mutilations inflicted on them without their consent by a surgeon convinced he could improve their orgasms by surgical reconstruction.
It is not coincidental that breast surgery is expanding at a time when female sexuality is such a threat. That was true in Victorian times as well, when doctors treated amenorrhea by placing leeches directly on the vagina or cervix, and cauterized the uterus for discharge with chromic acid. “The operation . . . is not what’s important,” says a rhinoplasty patient, as Victorian women’s “mental agony and physical torture was accounted nothing.” Surgeons are becoming media stars. “Glamour and prestige” came to surround the gynecological surgeon, and doctors often advised surgery where less dramatic measures were enough. Ovariotomy “became a fashionable operation in spite of a mortality rate sometimes as high as 40%. Not only the diseased ovary but the healthy, normal ovary fell prey to the sexual surgeons” (italics added). One has only to open a cosmetic surgery brochure to see how very normal and healthy are the breasts now “prey to the sexual surgeons.”
The modern sexual surgeons display their work with pride; Fay Weldon’s The Life and Loves of a She-Devil reproduces a current fantasy of the completely reconstructed woman shown off to fellow surgeons at a cocktail party. Victorian doctors boasted of the numbers of ovariotomies they had performed and displayed ovaries arranged on silver platters to admiring audiences at meetings of the American Gynecological Society.
The removal of the ovaries was developed in 1872. The next year, it was recommended for “non-ovarian conditions,” especially masturbation, so that by 1906 about 150,000 American women were without ovaries. “Non-ovarian conditions” was a social judgment aimed to prevent the “unfit” from breeding and polluting the body politic. “The ‘unfit’ included . . . any women who had been corrupted by masturbation, contraception and abortion . . . from the 1890s until the Sec
ond World War, mentally ill women were ‘castrated.’”
The “Orificial Surgery Society” in 1925 offered surgical training in clitoridectomy and infibulation “because of the vast amount of sickness and suffering which could be saved the gentler sex.” Ten years ago, an Ohio gynecologist offered a $1,500 “Mark Z” operation to reconstruct the vagina “to make the clitoris more accessible to direct penile stimulation.” A common boast of modern cosmetic surgeons is that their work saves women from lives of suffering and misery.