What I’ve Been Reading: The Rise of Cosmetic Gynecology and the Uber-Brand


A couple of things I’ve read recently really blew my mind. The first one was a long-form piece in Refinery29 with the eyebrow-raising title, “The ‘Vagina Whisperer’ Will See You Now,” by Amelia Harnish.

It describes the fast-growing trend of cosmetic gynecology, which addresses problems from the strictly cosmetic to those that cause functional problems. A substantial percentage of women (about two-thirds of middle-aged women) suffer from problems like incontinence.

The author’s journey reminds me of my own: when I first started working in content for healthcare, I thought that a lot of cosmetic procedures were vain and superficial. But I’ve come to see that there are real problems that affect women’s quality of life, and that in many cases they’re not being addressed by mainstream medicine or covered by insurance.

To hear Dr. Marashi describe it while he’s actually doing the procedure, women choose this surgery mostly for functional reasons: to make sex better, the way it was before they had a baby or three, and to stop peeing their pants (even just a little bit) when they sneeze or lift weights. So, why on earth is the best way Dr. Marashi can think to market himself a grotesque showcase that frames everything in terms of how the vagina looks? More importantly: Why is this woman paying out-of-pocket for a one-time tune-up for her perineal body, when her partner could easily get insurance to cover his lifetime supply of Viagra?

A lot of this has to do with the insurance companies and doctors as arbiters of what is a “real” problem, instead of listening to women themselves.

The truth is that gynecologists have always done vaginoplasties and labiaplasties, but historically they would only do them for women with “true” medical problems, such as uterine prolapse (when the pelvic muscles collapse completely and the uterus descends into the vagina) or labial hypertrophy, which is when the labia minora or majora are extremely long or uneven. Outside of that, most doctors deemed them unnecessary, says Marco Pelosi, III, MD, a pioneer in the field. “There has always been a chasm between what doctors consider a problem and what women consider a problem when it comes to their sex lives,” he says.

But is it us as women who are really deciding? On the one hand, why shouldn’t a woman have her body the way she wants it? But on the other hand, where does this urge to change our bodies come from? The culture that surrounds us also shapes our desires and what we see as ideal.

“I tell my patients: ‘All vaginas, all labias, they’re all beautiful in their own way,’” [Dr. Marashi] says. “I always tell people, ‘Do not ever do this for anybody else. You own your vagina.’”

As right as he is about that, it’s impossible to completely untangle the desire for these procedures from the pressures women face simply being alive in a youth- and beauty-obsessed culture. What’s also impossible to ignore, though, is that women’s sexual function has never gotten the same amount of research — or respect — as men’s.

The entire piece is well worth reading; I highly recommend it.


The other thing I couldn’t stop highlighting was the transcript of Kara Swisher’s interview with Professor Scott Galloway on Recode Decode. It has so many great things in it, for example the “perfect storm in retail,” with too many square feet of stores, stagnant middle-class wages, and people spending more money on coffee and experiences.

(Although, as a side note, while Starbucks does a great job of experience-based marketing, I think they’re also hurting from the retail slowdown. Because people mainly stop at Starbucks when they’re already out and about, and if they’re not going to the mall, then they’re not stopping for coffee either.)

And of course, Prof. Galloway made the news for predicting Amazon’s purchase of Whole Foods. But the main point that struck me was the end of branding. “When you start buying via Alexa you’re effectively obviating…the billions of dollars and decades brands have spent on things like eye-level packaging,” says Galloway. “A lot of people don’t even hear the pricing or know the pricing when they order on Alexa…”

The four P’s of marketing are price, product, promotion, and place. If what Galloway says is correct, Alexa is making price and promotion irrelevant, as well as many product aspects (packaging, branding, and returns). Amazon and e-commerce in general already made place irrelevant to the buyer.

Galloway still sees a future for stores, especially those like Apple and Sephora: “People are no longer going to stores for product, they’re going for people. If they’re going to go in a store they want amazing service, amazing expertise, insight, navigation to the right product right away.” This is very similar to what retail analyst Kevin Hillstrom has been saying on Twitter:

As well as what Jonathan Salem Baskin has been writing for years. Baskin says that brands are a twentieth-century invention, but to me, a brand answers a fundamental human question. People want to know who they’re buying from. In the past, the answer has been “Johnson & Johnson” or “Unilever”—in the future, the answer may be simply “Amazon.” Perhaps if the uber-brand is strong enough, nobody will care about the “little guys” who are actually making the product.

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