Plastic Surgery Trends Parallel Playboy Magazine: The Pudenda Preoccupation

Abstract

Background: Aesthetic vulvovaginal procedures are being performed with increased frequency. Many experts have suggested that the growing demand for these procedures relates to the availability and revealing nature of nude images on the Internet and in other media.

Objectives: The authors examined chronologically organized nude photographs from a popular magazine and objectively measured the position of the vulva relative to the center of focus to observe trends for the past 6 decades.

Methods:Playboy magazine centerfold photographs from 1954 to 2013 were analyzed and categorized. The positions of the vaginal area (V-line) and the breast area (N-line) were measured in relation to the horizontal midline of the photograph. Images also were assessed for degree of grooming and exposure of the breast and pubic areas, as well as visibility of the pudendal cleft, labia majora, and labia minora.

Results: Four hundred ninety images met inclusion criteria for the analysis. Full exposure of the V-line increased from 0 instances in the 1950s to 78.6% of images from 2010 through 2013 (P < .001). Moreover, the V-line position became 41.0% closer to the photographic midline (P = .045).

Conclusions: The results demonstrate a trend toward increased visibility and prominence of the female genitalia as the focal point of popular nude photographs.

As evidenced by artwork such as The Venus of Hohle Fels in 37,000 bc and Courbet’s L’Origine du Monde in 1866, female genitalia have long been subjects of art, culture, and dissension. Modern popularized conceptions of genital aesthetics remain a subject of great controversy. The increased attention to vaginally associated structures is reflected by a doubling of the number of labia minora reduction procedures performed in the United Kingdom between 1998 and 2004 and again between 2004 and 2005.¹ In the United States, few surveys have been conducted, and sufficient information for documenting the true frequency of these procedures is lacking.² According to the American Society for Aesthetic Plastic Surgery, more than 3500 female external genital cosmetic surgery procedures were performed in 2012, representing an increase of 64% from 2011.³

Given the greater demand for these procedures, it is clear that the vulva represents an emerging area of interest for aesthetic surgery seekers. In a study of Dutch women, Koning et al⁴ found that 95% of those surveyed routinely inspect their labia minora, and 43% stated that its appearance is important. Yet, where do perceptions of the “perfect” vagina originate? There is growing evidence that humans have evolved as “cognitive averagers” who determine attractiveness by calculating a mental average of the population as a whole.^5,6 If media-based images of body contours are known to communicate desired goals of normalcy,⁷ then it is natural to conclude that the same influence could apply to perceptions of female genitalia.

Pop culture is both reflective and directive—mirroring our societal attitudes, desires, and philosophic values, while shaping how we think, act, and look.⁸ Furthermore, patients seeking cosmetic surgery cite the media as reinforcing and transmitting the ideal of appearing youthful and attractive.⁷ Adams⁷ reported a consistent theme that cosmetic surgery is expected to accomplish a normal appearance or, more appropriately, an idealized normalcy fostered by popular media.

The concept of idealized normalcy, as opposed to real normalcy, was reinforced further by Crouch et al,⁹ who reported that many females who underwent labia reduction surgery had vulvae preoperatively not unlike the genitalia of women who did not undergo surgery. In a recent study of 50 premenopausal women, labia length ranged from 7.0 to 12.0 cm.¹⁰ The authors concluded that medical professionals should make such data available to patients considering genital surgery to ensure they are aware of the wide variation in dimensions. Although it has been stated that most women who undergo labiaplasty have labia preoperatively not dissimilar to the genitalia of most women,¹¹ some practitioners believe that the absolute length is irrelevant, particularly if a patient’s aesthetic desire is to diminish projection of the labia minora beyond the labia majora.¹² It was recently reported that women’s opinions of normal female genital appearance might be influenced by images of surgically modified vulva.¹³

Many researchers have speculated that the popularity and widespread availability of increasingly graphic nude images on the Internet and in the media have spurred interest in aesthetic vulvovaginal procedures.¹⁴ However, despite widespread subjective commentary regarding the persuasive nature of these images, only a few investigators have objectively analyzed the content of these photographs to support the anecdotal assertions.^15,16 Factors such as the relative importance of the genitalia to the overall photographic composition or emphasis on the pudenda as the central object of focus were not investigated in those studies. Both studies involved a relatively brief time frame; therefore, the findings were not truly reflective of cultural trends or changes in public perception over time.

We explored the increasing popularity of this type of aesthetic surgery by conducting a review of 6 decades of photographs from Playboy magazine. Playboy’s pop culture prominence and its consistent monthly centerfold feature represent an appropriate vehicle for examining the evolution of societal norms for vaginal appearance. The magazine previously served a similar purpose.¹⁶

Methods

The centerfold images of all Playboy issues from January 1954 through December 2013 were examined, and the photographs were standardized with respect to image size and relative position on the page. Each photograph was measured, and the horizontal midline was delineated. Images were classified according to subject position (supine, standing, kneeling, sitting) and pose (anterior, lateral, posterior). Photographs of subjects in the supine position were excluded from the analysis due to the inability to standardize landscape images with portrait images. Photographs were imported and analyzed with Mirror software (Canfield Scientific, Inc, Fairfield, New Jersey).

The position of the lowest visible portion of the areola (or if not visible, the lowest visible part of the breast [N-line]) and the position of the lowest visible portion of the mons pubis (V-line) relative to the photographic midline were calculated and recorded (Figure 1). A modified scale, adapted from Piron and Young¹⁷ (Table 1), was used to grade degrees of exposure of the breasts and pubic area; categories 4 and 5 denote full exposure. The extent of pubic hair grooming also was graded. Exposure of the pudendal cleft, labia majora, and labia minora was classified as either visible or covered.

Statistical analysis by 1-way analysis of variance was performed with Excel (Microsoft, Redmond, Washington).

Results

Of the 720 photographs reviewed, 490 met the inclusion criteria (Table 2). Since first appearing in centerfold images in the 1970s, the V-line has shifted significantly toward the photographic midline, by 41.0%, from a mean position of −0.340 to −0.201 in the 2010s (P = .045) (Table 3 and Figure 2).

The degree to which the V-line was fully exposed increased significantly, from 0 instances in the 1950s to 78.6% of images from 2010 through 2013 (P < .001). There was a similar increase in full exposures of the N-line, from 3.2% of images from the 1950s to 95.7% of those from the 1970s, and increasing to 97.6% of images from the 2010s (P < .001).

The prevalence of fully exposed, unobstructed V-lines (grade 5 on the exposure scale) has increased dramatically, from 22.9% of images from the 1970s to 54.8% of those from the 2010s. Likewise, the amount of pubic hair grooming, defined as minimal to no hair and therefore prominent visibility of the mons pubis, increased from only 11.4% of images from the 1990s (grades 5 and 6 on the grooming scale; Table 2) to 78.5% of those from 2010 through 2013 (P < .001).

Discussion

A new standard for how women think their vaginas “should” look, as well as the secondary interest in vulvar aesthetic procedures, is apparent from the greater attention paid to this topic by the public and the medical community; however, scientific evidence to support the perception is lacking.¹⁸ The increased public awareness of this topic is commonly attributable to the explosion of pornographic content on the Internet, the grooming habits of celebrities, and/or promotion by the beauty industry.^19-21

Although it is logical to assume that the center of a photograph is intended to be the center of attention, it would be difficult to prove this. It is a commonly held photographic tenet that the subject should be aligned according to the rule of thirds, and some photographers believe that doing so will add importance to the subject.²² Interestingly, the initial position of the vulva in photographs from the 1970s was consistent with the rule of thirds. The vulva and breasts were equidistant from the midline, and therefore the photographic frame could be divided into virtual thirds. However, others believe that this rule simply reflects a balanced photograph and that the principles of centering are appropriate for emphasizing the object of interest.^23,24 Parkhurst et al²⁵ described a strategy whereby viewers may reorient focus on the center of an image at a greater frequency given that interesting objects are often placed in this location, resulting in a bias toward the center of a scene. From a medical standpoint, it is known that gaze and arrow cues are capable of directing the viewer’s eye to the selected objects. In can be inferred that the center of focus is a method of gaze cue.²⁶ This is supported by research demonstrating a center-periphery organization to the brain when visual images are inspected.²⁷

In the present study, we objectively observed the progressive movement of the female genitalia toward the center of focus and attention in the featured images of an iconic popular magazine. Although Playboy debuted in December 1953, the vaginal area was not depicted until the mid-1970s. Once it began to appear in centerfold images, the pubic area has persisted as a focal element throughout subsequent decades (Figure 2). Although in early study images, the pubic area usually was the same distance from midline as the breasts, it subsequently moved closer and more prominently toward the image midline, whereas the breasts tended to move further from the midline.

Further analysis showed that degrees of grooming (shaving) and exposure of female genitalia increased significantly over time, particularly exposure of the pudendal cleft, labia majora, and labia minora. The initial absence, discreet concealment, initial appearance, and then ultimate emphasis on vulvar structures were apparent from examining photographs obtained from various decades. Exposure of pubic structures has increased steadily, beginning with no visibility of the mons pubis (mode = 1) in the 1970s and resulting in 69% of images from the 2010s showing a completely shaven, completely visible mons pubis (mode = 6; P < .001). Moreover, all images from the 2010s that featured a fully nude model with a visible V-line depicted a heavily shaven pubic area, further exposing the mons pubis. The trend toward decreased visibility of the labia minora since 2010 is noteworthy. Compared with the preceding 4 years (2006-2010), partial/full exposure of the labia majora has increased 41.7%, whereas exposure of labia minora has decreased 48.5%. It appears that some centerfold images have been digitally altered to remove the appearance of the labia minora. No specific data were found on the extent to which Playboy practices such modifications; however, photographic manipulation is a common practice in the pornography and beauty industries.

Whether enhanced visibility of the genitalia in images results from editorial preference intended to shape popular opinion or is reflective of pop culture aesthetics can only be inferred. As a highly successful magazine that has endured for decades in a competitive environment, Playboy must comply with customer demands and aesthetic ideals. Moran et al¹³ have demonstrated that images of modified genitalia may alter the viewer’s perception of what is “normal.” In reality, these roles are mutually responsive rather than exclusive, with editors responding to popular demand and the populace responding to what is presented as beautiful.

The observed shift in emphasis from the breasts to the labia in centerfold images is multifactorial. Although Europeans have long considered breasts as essentially anatomic structures rather than sexual or pornographic objects, that perspective is less common in the United States, the primary target market for Playboy. Universally, female genitalia are considered pornographic in the context of popular magazines. However, the increased prevalence and availability of pornography via traditional media outlets as well as the Internet have led to greater competition and have challenged definitions of what is acceptable. Increasingly, the result has been more exposure of the labia, considered the “forbidden fruit.”

Some have characterized the absence of pubic hair and labia in these images as prepubescent in nature and reflective of a warped cultural perception, suggesting sexualization of childlike physical characteristics.¹⁶ However, this characterization seems to negate the obvious editorial inclination toward progressively larger breasts and fails to consider the growing association between women’s sense of cleanliness and hair removal²⁸ and the general trend in hair removal from legs, arms, torsos, and other locations in both women and men.

Clear limitations of the study include the use of a single magazine with a predominantly male audience to reflect the entirety of popular media. However, the viability of Playboy over several decades attests to its popular representation of evolving trends and cultural tendencies and has resulted in its utility as a resource in many investigations.^23-25 In regard to female genitalia and the magazine’s influence on women, Schick et al¹⁶ found Playboy to be an acceptable resource for documenting genital appearance ideals espoused by mass media and have addressed the limitations of using this solitary reference source. More than 19.3% of Playboy subscription holders are female,³² and countless other women have been exposed to the images indirectly. Approximately 32% of undergraduates reportedly have viewed sexually explicit magazines.³³ The consistent publication of centerfold images afforded a constant by which to obtain serial and reliable measurements for decades of photographs.

Playboy is widely accessible, and it is known that women observers pay nearly equal attention to the pelvic and chest regions of nude female subjects, whereas men tend to devote more time to the chest than the pelvis.³⁴ The debate over how the photographer may intentionally steer the viewer’s attention to the intended object of interest is beyond the scope of this discussion. However, our results from comparing the 2 traditional female sexual organs (vulva vs mammary glands) showed distinct movement of the pelvic region toward the image midline. Instances of digital manipulation or airbrushing are well known^35,36 but cannot be quantified specifically with regard to the genitalia because such information is not disclosed by magazine publishers.

Conclusions

These data demonstrate an evolution in Playboy centerfold photographs, with focal emphasis generally shifting from the breasts to the vulva. Not only has the relative position of the vulva changed in these images, the degree to which the components of vulvar anatomy are displayed has been accentuated. Exposure of the vaginal area in centerfold photographs has increased dramatically over time, evident by changes in model positioning and camera angle. Images in popular media likely increase awareness of vulvar appearance and influence the perception of what is normal. It can be inferred that the increase in demand for aesthetic vulvovaginal procedures parallels the societal shift to greater attention on the vaginal area in popular nude imagery.

References