In a world where breast augmentation, nose jobs and other cosmetic surgery is growing, the popularity of making your labia more “normal” has turned into a designer demand. The constant need to have the perfect body comes at any cost for some women.
Labiaplasty (a surgical procedure to reduce the size of the labia minora, the skin flaps either side of the vagina) has become the most widely performed genital cosmetic procedure by the National Health Service, increasing fivefold since 2001. Many more are conducted by private healthcare providers.
Worryingly, it is the most popular surgical request by women aged 18-24 years. Of all women undergoing this procedure each year, 1,150 of them want to create a “designer vagina” to conform with what they believe a “normal” vagina looks like.
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. Shockingly, in 2015-16, more than 200 girls under 18 had labiaplasty on the NHS. More than 150 of the girls were under 15.
Dr Naomi Crouch, a leading adolescent gynaecologist 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 and was concerned GPs were referring rising numbers of young girls who wanted an operation. Girls as young as 9 have sought advice about surgery because they are distressed about how they look.
Better sex education in schools which starts at a younger age is essential to prevent these young girls seeking medical intervention for a part of their body that is completely normal.
A recent survey by The Eve Appeal (2016) found that half of young women aged 16-25 couldn’t locate the vagina on a medical diagram. Results also found that 65% of the women surveyed found it difficult to use the word vagina itself.
Every woman’s body is unique, and vulvas vary in colour, shape and size. The vulva is the female’s external genitalia. The labia majora are the outer lips where pubic hair grows, and the labia minora are the inner lips that extend from the clitoris. Some women have small, smooth, pink labia while others have larger, wrinkled and dark labia.
Surgery for purely cosmetic reasons is not offered on the NHS. The procedure comes at a considerable cost, with the average price in the UK currently being £2,564, but can range between £1,300 to £3,700 depending on the clinic.
New findings by Dr Simonis in Australia, lead author of research published in BMJ Open (September 2016) about GPs’ attitudes and knowledge of vulvoplasty found that more than half of the 443 GPs (54%) with an interest in women’s health surveyed had seen patients requesting female genital cosmetic surgery. Of those GPs, almost half (44%) said they had insufficient knowledge of the risks associated with the procedures. Over 50% of the GPs suspected that many of these women were experiencing psychological problems such as depression, anxiety, relationship difficulties and body dysmorphic disorder.
Dr Rebecca Deans, gynaecologist at Sydney’s Royal Hospital for Women and the Sydney Children’s Hospital, said that there was a perception among patients that vulvoplasty was only minor surgery when the side effects can impact upon your sex life and childbirth. Many of the women referred to her for vulvoplasty did not proceed once she had explained that their vulva and vagina were completely normal.
Many women seek a labiaplasty for genuine medical reasons, including vaginal damage following childbirth or surgery and an enlarged labia causing pain and discomfort, especially when horse riding, cycling, exercising or during the ageing process.
Some women in professions where they have to wear revealing garments, such as dancers, models and sportswomen such as swimmers and gymnasts, may feel self conscious about the labia being seen through their clothing.
Some women undergo a labiaplasty following surgical intervention for vulval cancer to refashion their vulva and restore the way in which their labia looks.
Before undergoing a labiaplasty, either on the NHS or privately, counselling must be offered to establish the need for wanting the surgery if not for medical reasons. Surgery should never be performed on girls younger than 18 years unless for medical reasons due to the labia continuing to grow and develop beyond puberty into young adulthood. A good doctor will have no hesitation in turning away women who are not suitable, do not understand the procedure or have unrealistic expectations, but many clinics will perform the surgery to make money.
Little research has been done to establish how effective the procedure is, there is no guarantee of a lasting desired effect and there are long term and short term risks to consider.
As a result of the increase in requests for this surgery, the Royal College of Obstetricians and Gynaecologists (RCOG) have published a paper clarifying best practice guidelines for doctors and surgeons in this field. One of the most important points raised by the authors was the fact that cosmetic genital surgery is ultimately performed blind as the evidence for the efficacy of labiaplasty and its long-term consequences is little known.
There are risks to having a labiaplasty as with any surgery and it can lead to decreased or loss of sensation, bleeding, scarring and infection in the genital area. Sexual intercourse may become painful after the operation and the overall desired effect may not be achieved, leading to a subsequent procedure being required.
A study from the University of Queensland School of Psychology in Australia in 2013 found that women do not seem to be aware of how vagina appearances can vary. When shown surgically enhanced vaginas and non-surgically enhanced vaginas, women were more likely to believe that the surgically modified vaginas were normal and more socially acceptable.
Claire Moran, the study’s lead researcher said that: “The rise in cosmetic genital surgery for women is worrying.”
The exposure of men and women to surgically enhanced vaginas seen in pornographic videos can lead them to believe that this is normal and wish to change the way they look. Moran also cites the advent of airbrushing photographs, lack of exposure to normal women’s genitalia, the practice of Brazilian and genital waxing, exposing the labia and the general taboo about the subject of genitalia and how they look may contribute towards this rising trend.
Celebrity culture impacts upon this trend too, with young women wanting to emulate their favourite celebrity without any thought to the consequences this type of intimate surgery can cause.
A fantastic work of art, “The Great Wall of Vagina” by UK-based sculptor Jamie McCartney, on display in the UK depicts vulvae casts of 400 women aged between 18-76 years. He created this work over 5 years, casting the vulvae of women who were identical twins, transgender individuals, pre and post natal women, all of whom were more than willing to submit their genitalia to plaster in the name of art.
This ingenious piece of art is neither erotic art or pornographic in nature, but an excellent way of educating people about what normal women really look like by grabbing the attention of the nation, both male and female.
McCartney comments that: “For many women, their genital appearance is a source of anxiety and it’s time society grew up around these issues”.
As every one of the 400 labia is different, McCartney has emphasised that there is no “normal” labia and the growing trend of “designer vaginas” is worrying for future generations.
Clinicians at the Royal College of Obstetricians and Gynaecologists at the World Congress in Brisbane have called for more research to understand, in depth, women’s motivations for such surgical interventions.
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