Bbc Young Preteen Girls

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By Jean Mackenzie
Victoria Derbyshire programme
Girls as young as nine are seeking surgery on their genitals because they are distressed by its appearance, the Victoria Derbyshire show has been told.
Dr Naomi Crouch, a leading adolescent gynaecologist, said she was concerned GPs were referring rising numbers of young girls who wanted an operation.
Labiaplasty, as the surgery is known, involves the lips of the vagina being shortened or reshaped.
The NHS says it should not be carried out on girls before they turn 18.
In 2015-16, more than 200 girls under 18 had labiaplasty on the NHS. More than 150 of the girls were under 15.
Some experts fear that pornography and images viewed through social media are leading young girls to have unrealistic perceptions of how their genitals should look.
Dr Crouch, who chairs the British Society for Paediatric and Adolescent Gynaecology, said in her work for the NHS she was yet to see a girl who needed the operation.
Anna - not her real name - considered having labiaplasty from the age of 14.
"I just picked up from somewhere that it wasn't neat enough or tidy enough and I think I wanted it to be smaller.
"People around me were watching porn and I just had this idea that it should be symmetrical and not sticking out.
"I thought that was what everyone else looked like, because I hadn't seen any normal everyday [images] before then.
"I remember thinking, 'If there's surgery for it, then clearly I'm not the only one who wants this done, and maybe it won't be that big a deal.'."
She later decided not to pursue having an operation.
"I'm totally glad I didn't get it done. I didn't need it. I look totally normal. Completely and utterly normal."
Paquita de Zulueta, a GP for more than 30 years, said it was only in the past few years that girls had started coming to her with concerns over the appearance of their labia.
"I'm seeing young girls around 11, 12, 13 thinking there's something wrong with their vulva - that they're the wrong shape, the wrong size, and really expressing almost disgust.
"Their perception is that the inner lips should be invisible, almost like a Barbie, but the reality is that there is a huge variation. It's very normal for the lips to protrude."
She blames the unrealistic images girls are being exposed to through pornography and social media.
"There isn't enough education and it should start really quite young, explaining that there is a range and that - just as we all look different in our faces - we all look different down there, and that's OK."
NHS England said it did not carry out the operation for cosmetic reasons, only for clinical conditions.
For the past few years clinical commissioning groups have been able to refer only patients who are experiencing physical pain or emotional distress.
But Dr De Zulueta says some girls know they need to overstate their physical symptoms to get the surgery.
"There is awareness that they're more likely to get the operation if they say it's interfering with sex, with sport, they feel that will tick that box."
Dr Crouch believes labiaplasty should be given only to girls who have a medical abnormality.
"I find it very hard to believe there are 150 girls with a medical abnormality which means they needed an operation on their labia," she said.
She added there were uncomfortable parallels between this surgery and female genital mutilation (FGM), which is illegal in the UK.
"The law says we shouldn't perform these operations on developing bodies for cultural reasons. Current Western culture is to have very small lips, tucked inside. I see this as the same thing".
Dr Gail Busby, lead adolescent gynaecologist at St Mary's Hospital, says it is important for girls and their parents to remember:
In adolescence, the labia are still growing - with the inner lips growing first - so it is normal for them to appear prominent. Girls should not compare themselves to adult women
By age 18, the outer lips will have grown. If girls can hold off seeking an operation until adulthood, their genitals' appearance will have changed - removing the initial reason for wanting surgery
Surgery will probably lead to scarring and - as the labia are still developing - could lead to it becoming asymmetrical in adulthood
Do not feel alone. Half the girls in your class will be in the same position, it is a normal part of development - it is just that no-one talks about it openly
If parents wish to allay fears, take your daughter to a GP
In some instances, if there are deeper concerns regarding body image, it may help to create some coping strategies
The majority of labiaplasties are done by private cosmetic surgeons on women over 18.
The industry has been criticised for normalising the procedure.
Plastic surgeon Miles Berry defended the surgery, saying it could improve women's lives.
"It can change people fundamentally, the feelings they have about themselves, their confidence and self-esteem.
"I have seen patients aged between 16 and 21 who have never had a boyfriend because they are so concerned about this."
The Royal College of Obstetricians and Gynaecologists said the operation should not be performed until a girl had finished developing, after the age of 18.
Watch the Victoria Derbyshire programme on weekdays between 09:00 and 11:00 on BBC Two and the BBC News Channel.
The BBC is not responsible for the content of external sites.
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In Kenya, more and more young women are using sugar daddies to fund a lifestyle worth posting on social media.

Transactional sex was once driven by poverty, says film-maker Nyasha Kadandara. But now, increasingly, it's driven by vanity.

(Warning: Contains adult themes and graphic images)
Eva, a 19-year-old student at Nairobi Aviation College, was sitting in her tiny room in shared quarters in Kitengela feeling broke, hungry, and desperate. She used the remaining 100 Kenyan shillings she had in her wallet and took a bus to the city centre, where she looked for the first man who would pay to have sex with her. After 10 minutes in a dingy alley, Eva went back to Kitengela with 1,000 Kenyan shillings to feed herself for the rest of the month.
Six years ago, when she was at university, Shiro met a married man nearly 40 years her senior. At first, she received just groceries. Then it was trips to the salon. Two years into their relationship, the man moved her into a new apartment because he wanted her to be more comfortable. Another two years down the line, he gave Shiro a plot of land in Nyeri county as a show of commitment. In exchange, he gets to sleep with Shiro whenever he feels like it.
Eva's experience is transactional sex in its most unvarnished form - a hurried one-off encounter, driven by desperation. Shiro's story illustrates an altogether more complex phenomenon - the exchange of youth and beauty for long-term financial gain, motivated not by hunger but by aspiration, glamorised by social media stars, and often wrapped in the trappings of a relationship.
Older men have always used gifts, status, and influence to buy access to young women. The sugar daddy has probably been around, in every society, for as long as the prostitute. So you might ask: "Why even have a conversation about transactional sex in Africa?"
The answer is that in Kenya, and in some other African countries, "sugar" relationships seem to have become both more common and more visible: what once was hidden is now out in the open - on campuses, in bars, and all over Instagram.
Exactly when this happened is hard to say. It could've been in 2007 when Kim Kardashian's infamous sex tape was leaked, or a little later when Facebook and Instagram took over the world, or perhaps when 3G internet hit Africa's mobile phones.
But somehow, we have arrived at a point where having a "sponsor" or a "blesser" - the terms that millennials usually apply to their benefactors - has for many young people become an accepted, and even a glamorous lifestyle choice.
You only have to visit the student districts of Nairobi, one recent graduate told the BBC, to see how pervasive the sponsor culture has become. "On a Friday night just go sit outside Box House [student hostel] and the see what kind of cars drive by - drivers of ministers, and politicians sent to pick up young girls," says Silas Nyanchwani, who studied at the University of Nairobi.
Until recently there was no data to indicate how many young Kenyan women are involved in sugar relationships. But this year the Busara Centre for Behavioural Economics conducted a study for BBC Africa in which they questioned 252 female university students between the ages of 18 and 24. They found that approximately 20% of the young women who participated in the research has or has had a "sponsor."
The sample size was small and the study was not fully randomised, so the results only give an indication of the possible numbers, they cannot be taken as definitive. Also, only a small percentage openly admitted to having a sugar daddy; the researchers were able to infer that a number were hiding the truth from answers they gave to other questions, using a technique called list randomisation. But interestingly, when talking about others, not about themselves, the young women estimated on average that 24% of their peers had engaged in a transactional sexual relationship with an older man - a figure very close to that reached by the researchers.
Jane, a 20-year-old Kenyan undergraduate who readily admits to having two sponsors, sees nothing shameful in such relationships - they are just part of the everyday hustle that it takes to survive in Nairobi, she says.
She also insists that her relationships with Tom and Jeff, both married, involve friendship and intimacy as well as financial exchange.
"They help you sometimes, but it's not always about sex. It's like they just want company, they want someone to talk to," she says.
She says that her religious parents brought her up with traditional values, but she has made her own choices. One of her motives, she says, is to be able to support her younger sisters, so they won't need to rely on men for money. But she has also been inspired by Kenya's celebrity "socialites" - women who have transformed sex appeal into wealth, becoming stars of social media.
Among them are the stars of the reality TV show Nairobi Diaries, Kenya's own blend of Keeping up with the Kardashians and The Real Housewives of Atlanta. The show has launched several socialites out of Nairobi's slums and on to yachts off the coast of Malibu or the Mediterranean.
"Nairobi Diaries is like the Kardashians playing out [on screen] in real time. If I look hot, I look good, there has got be some rich guy who will pay good money to possess me," says Oyunga Pala, Nairobi columnist and social commentator.
The best known of the Kenyan socialites is probably Vera Sidika, who went from dancing in music videos on to the set of the Nairobi Diaries, and from there launched a business career based on her fame and her physique.
"My body is my business - and it is a money maker," she said back in 2014, when discussing her controversial skin-lightening procedures. Nowadays, Vera is keen to promote herself as an entrepreneur, and runs a successful brand of "detox" herbal infusions called Veetox Tea.
Equally famous is model and socialite Huddah Monroe, who also rose to fame on reality TV - in her case Big Brother Africa, in 2013 - and who now runs a well-established line of cosmetics. "If you have to expose your body, make money out of it," she was reported as saying, referring to the semi-nude images that she shows off to her 1.3 million Instagram followers.
In the past, some of Kenya's socialites have styled themselves as #SlayQueens, and have been quite upfront about the financial benefits that have come from dating tycoons. Having made it to the top, though, they often begin to cultivate a different image - presenting themselves as independent, self-made businesswomen and encouraging Kenyan girls to work hard and stay in school.
The millions of fans scrolling through their Instagram posts, though, are not blind. The sudden emphasis on entrepreneurship does not hide the fact that these women used their sex appeal to create opportunities in the first place. And many - quite understandably - are attempting to apply this methodology to their own lives.
One of those who has succeeded is Bridget Achieng, a woman from the sprawling Nairobi slum of Kibera, who worked as a domestic servant - a house girl - but who gained a social media following on the back of a sexy photoshoot, and then found her way on to the cast of Nairobi Diaries.
Her message to aspiring socialites, though, is that nothing is free. "You want a million bucks, you will do something that is worth a million bucks."
If one end of the sugar spectrum features young women with their sights set on a hot pink Range Rover, a luxury condo and first-class tickets to Dubai, at the other are women angling for little more than some mobile phone credit and maybe a lunch at Java coffee house.
But the gulf between them may not be so deep as it seems.
"Should I leave all these Gucci Prada? Na which young girl no dey fear hunger?" sang the Ghanaian singer Ebony Reigns, encapsulating the mixture of social aspiration and economic anxiety that many young women feel. The desire not to go hungry and the desire to taste the good life can easily run side by side. And the fortunes of a woman dependent on a sponsor can change in an instant - either for better or worse.
Grace, a 25-year-old single mum from northern Nairobi, has a regular sponsor, but is actively seeking a more lucrative relationship with a man who will invest in her career as a singer.
She is poor by the standards of middle-class Kenyans, often living hand-to-mouth, dancing for cash in a nightclub, and struggling to put her daughter through school. But her determination to feed and educate her child coexists with a naked ambition to become rich and famous through modelling and music.
"I need to be a star," she says, citing not just Vera Sidika but also Beyoncé. Is she driven more by vanity or poverty, aspiration or desperation? The lines are blurred.
Both Grace and Jane have come of age in the last decade, bombarded since childhood with images of female status built on sex appeal. But according to Crystal Simeoni, an expert on gender and economic policy, Kenyan society encourages sugar relationships in other ways too.
If women have become more willing to profit financially from their youth and beauty, she says, it's partly because of Kenya's gross economic inequalities, lack of social mobility, and widespread corruption.
"The way things are constructed in this country makes it so much harder for a smaller person to make ends meet," she argues. Hard work won't get them anywhere. "They have to get a sponsor, rob a bank, or win a tender."
Michael Soi, a well-known artist whose paintings satirise Kenya's culture of transactional sex, takes a similar but more cynical view, attributing the phenomenon more to laziness and a get-rich-quick mentality than to structural injustice.
The days of waking up early and working from morning to night are behind us, he says: "Right now the ass is the new brain, and this is what you use to get what you want."
The phenomenon isn't confined to women.
George Paul Meiu, who studies transactional relationships between men of Kenya's Samburu tribe and older European women, has described how their youth and good looks have become valuable commodities in Kenya's beach resorts.
Thanks to a set of "African warrior" stereotypes and myths about tribal sexual prowess, the Samburu and others like them are particularly appealing to both local and foreign sugar mummies. Some Samburu villages, he says, claim they have been unable to defend themselves against cattle raids from neighbouring tribes because so many young men have migrated to the coast to become beach boys.
"A beach boy is someone who gets up in the morning, smokes a joint, lies under a coconut tree waiting for bikini-clad white woman passing on the beach and runs after them," says artist Michael Soi.
But as most of those dependent on sugar relationships are female, they have dominated the public debate. There are concerns about the morality of their lifestyle, but also about its consequences for their health.
Kerubo, a 27-year-old from Kisii in Western Kenya, maintains that she has control of her relationship with her sugar daddy, Alfred. But when I ask her about safe sex, this illusion quickly evaporates.
Both Alfred and her other sponsor, James, prefer not to use condoms, she says. In fact she has had unprotected sex with multiple sugar daddies, who then have sex with other women, as well as with their wives, exposing all of these partners to the risk of sexually transmitted diseases.
Dr Joyce Wamoyi from the National Institute for Medical Research in Tanzania says girls and young women between the ages of 15 and 24 have consistently been at higher risk of HIV infection than any other section of the population in sub-Saharan Africa.
Sugar relationships, she says, are contributing to these risks because the women who engage in them do not have the power to insist on the use of condoms. "With sex work, men are more likely to use condoms because it's more explicit that this is selling and buying."
A look at the Kenyan tabloids also suggests that women are at risk of violence from their sponsors.
It's not hard to find headlines such as "Stabbed to death by a man who has been funding her university education," "Kenyan 'sponsor' threatens lover, posts COFFINS on Facebook and she DIES afterwards," "Pretty 22-Year-Old Girl Killed By Her Sugar Daddy." These articles all describe, sometimes in graphic detail, sugar relationships that led to murder.
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