Understanding motivations to seek and carry out female genital plastic surgeries to contribute to better informed decision-making of girls/women and to support medics in developing ethical practices

Project Information

FGPS

Grant agreement ID: 101107119

DOI

10.3030/101107119

Project closed

EC signature date 14 March 2023

Start date 1 April 2023

End date 30 September 2025

Funded under

• Marie Skłodowska-Curie Actions (MSCA)

Total cost

No data

EU contribution

€ 175 920,00

Coordinated by

VRIJE UNIVERSITEIT BRUSSEL
Belgium

Periodic Reporting for period 1 - FGPS (Understanding motivations to seek and carry out female genital plastic surgeries to contribute to better informed decision-making of girls/women and to support medics in developing ethical practices)

Reporting period: 2023-04-01 to 2025-09-30

Summary of the context and overall objectives of the project

Female genital cosmetic procedures (FGCP) are increasing rapidly across Europe, prompting growing concern among medical and women’s organisations about both potential health risks and the normalisation of surgically “correcting” healthy genitalia. As demand rises, research has expanded across plastic surgery, public health, psychology, and feminist scholarship. Yet these fields often study FGCP in isolation, emphasising clinical outcomes, individual decision-making, or gendered critique separately. What remains missing is an anthropological and holistic understanding of how women come to view their genital appearance as problematic in the first place, and when and why FGCP is taken up as a perceived solution.

This project addresses that gap by examining genital self-image among cisgender women in Belgium and the Netherlands, and investigating how they cope with feelings of shame, discomfort, or uncertainty regarding their genitalia—with FGCP emerging as only one of several strategies. The empirical research combines focus group discussions with women from the general population, and in-depth interviews with women who have undergone FGCP and with healthcare professionals providing these procedures.

Using an empirical bioethics approach, the findings will be integrated with ethical analysis to develop practical, gender-sensitive decision-support tools for healthcare professionals, and public awareness materials that highlight genital diversity and challenge stigma. By reframing FGCP as a socially shaped phenomenon rather than an entirely individual choice, the project contributes to more informed and equitable clinical practice, while supporting wider cultural and policy change that promotes women’s bodily autonomy and wellbeing. Its anticipated impact is therefore significant: improving healthcare responses in the short term and reducing harmful social pressures on women’s bodies in the longer term.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

During the fellowship, I established a new international collaboration with Prof. Dr Anne-Mette Hermans and Dr Marjolein de Boer at Tilburg University (the Netherlands). While I led data collection in Belgium, Prof. Dr Hermans and Dr de Boer coordinated complementary data collection in the Netherlands. We jointly analysed the data and have co-authored — and continue to co-author — multiple academic publications resulting from this collaboration.

The empirical research consisted of three core components:
• Focus Group Discussions (FGDs): Ten FGDs were held with cisgender women — seven in Belgium and three in the Netherlands — ranging in age from 18 to 72. Two additional FGDs were conducted with men (one in each country). These discussions explored perceptions of genital aesthetics, genital self-image, sociocultural and interpersonal influences, and the social and emotional dimensions of genital embodiment.
• In-depth Interviews with Patients: Ten interviews were conducted with cisgender women who had undergone FGCS, primarily labiaplasty (six in Belgium, four in the Netherlands). These interviews examined participants’ motivations, expectations, and experiences before and after surgery, including the role of medical consultations and the complexities of agency and consent.
• In-depth Interviews with Medical Professionals: Eleven interviews were carried out with gynaecologists and plastic surgeons (nine in Belgium, two in the Netherlands) who perform FGCP. These interviews provided insight into how healthcare professionals assess patients’ requests, navigate ethical considerations, and frame FGCP in functional, medical, or aesthetic terms.

Scientific outputs from the project to date include several peer-reviewed journal articles and academic book chapters:
• Van Bavel, Hannelore. “Cisgender Women Navigating Genital Insecurities: Coping, Genital Cosmetic Surgery, and the Role of Medical Encounters.” Archives of Sexual Behavior, in press.
• Van Bavel, Hannelore. “Beyond ‘Autonomy’: Re-Evaluating Female Genital Cosmetic Surgery through a Feminist and Decolonial Bioethics Lens.” International Journal of Feminist Approaches to Bioethics, accepted with revisions.
• Van Bavel, Hannelore, and Anne-Mette Hermans. “Functional Need or Personal Choice: Medical Professionals’ Understanding and Framing of Performing Female Genital Cosmetic Procedures.” Women’s Health, under review.
• Remmerie, Lore, Hannelore Van Bavel, and Danielle Fernandes. “Participatieve methoden in onderzoek naar seksuele en reproductieve gezondheid.” In Feministische en queer onderzoeksmethoden in het recht, edited by Pieter Cannoot, Elise Goossens, and Marie Spinoy. Larcier Intersentia, 2025.
• Van Bavel, Hannelore, Samuel Kimani, and Nina Van Eekert. “Contested Boundaries: Debates on the Differential Treatment of Female Genital Mutilation/Cutting and Female Genital Cosmetic Procedures in the Netherlands, Kenya, and Egypt.” In FGM/C in Africa and the Diaspora: Issues, Debates, and Challenges, edited by Lotte Hughes, Mark Lamont, Katy Newell-Jones, and Damaris Parsitau. Boydell & Brewer, in press.
• Van Bavel, Hannelore. “‘Operating Genitals for Cultural Reasons, I Find That Horrific!’: Public, Patient, and Clinical Perspectives on (the Distinction between) FGM and FGCS in Belgium and the Netherlands.” In Mutilation or Modification? Changing Perspectives on Genital Surgeries and Their Socio-Legal Contexts, edited by Sarah O’Neill and Janice Boddy. University of Toronto Press, accepted.

Three additional articles are currently being co-authored with Hermans and de Boer and will be submitted in 2026.

Research findings were also disseminated through invited talks and academic events, including:
• Invited talk "The danger of the single story on female genital modifications" (Pharos, the Dutch Centre of Expertise on Health Disparities, September 2025)
• Organised panel “Genital Expectations: A Cross-Cultural Exploration of Gendered Meanings, Norms, and Practices Surrounding Genitalia” and workshop “Lab5. Meet Vulvarium and Enter a Gallery of Vulva Statues Medical Anthropology Europe Conference (University of Vienna, September 2025);
• An invited presentation at the Symposium on Quality Healthcare for Women with a Migration Background (Vrije Universiteit Amsterdam, March 2025);
• A guest lecture at the launch of the Bristol Research on Female Genital Modifications (University of Bristol, April 2024).

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

This project has advanced knowledge on female genital cosmetic surgery (FGCS) by situating it within a broader, comparative, and interdisciplinary framework that remains largely absent from existing research. While most studies tend to examine FGCS either from within plastic surgery, gender studies, or public health perspectives – and often focus exclusively on women who have undergone the procedure – this project adopted an anthropological and ethnographic approach aimed at understanding FGCS as a social and cultural phenomenon embedded in everyday life.

The project is innovative in several key ways. First, it includes the perspectives of women who have undergone FGCS as well as women who have not, allowing for a more holistic understanding of genital self-image and the various ways women navigate bodily dissatisfaction, shame, and social expectations, with surgery being only one of many possible coping strategies. This approach shifts the focus away from individualised decision-making toward the wider norms, narratives, and pressures that shape these choices.

Second, the project also incorporates the perspectives of healthcare professionals who perform FGCS. By examining how surgeons and gynaecologists assess patient requests, frame the procedures (e.g. as aesthetic, functional, or psychological), and communicate risk and consent, the research sheds light on how clinical encounters can contribute to the medicalisation of genitalia, and in some cases, may reinforce or amplify women’s sense of abnormality. This dual focus, on both the patient and provider side, is rare in FGCS research and allows for a more complete understanding of how gendered and medical norms interact.

Third, the project introduced a creative, participatory research method to support open conversation around sensitive topics. In focus group discussions with women, participants were invited to paint vulva portraits while talking. This activity provided a visual focus that helped reduce discomfort associated with eye contact, and allowed participants to manage their level of verbal engagement. Developed specifically for this project, this approach fostered a respectful and non-judgmental space and enabled rich, thoughtful reflection on genital aesthetics, emotional wellbeing, and social expectations. It offers a novel methodological contribution to arts-based and feminist research, particularly in sexual and reproductive health.

The researcher has been awarded a prestigious and highly competitive FWO Senior Postdoctoral Fellowship to extend this work. The next phase of the research will study FGCS in Kenya, making it the first project to explore this topic in an African context. This will enable further comparative insights into how cultural, economic, and healthcare systems shape understandings of genital surgery globally.

Panel on Genital Expectations at the Medical Anthropology Europe conference in Vienna

Vulva painting made during one of the focus group discussions

Snapshot during a focus group discussion with painting