It’s crucial to understand that labiaplasty is a cosmetic procedure, not a medical one. When a vulva is cut for a medical purpose, the surgery is not called labiaplasty, but vulvectomy.
So, why are so many women and teens seeking this cosmetic surgery?
Some women have long inner labia. It’s not unusual for the labia minora to hang down past the labia majora. Sometimes, this can feel physically uncomfortable. You might experience mild soreness or chafing, especially in tight clothing or when riding your bike.
Physical discomfort is a real concern; however, many women are seeking a permanent surgical solution for minor discomfort that should be addressed with a simpler approach.
Psychological Discomfort and Low Self-Confidence
Psychological discomfort—shame, embarrassment, worry, self-criticism, etc.—over the size, shape, and color of their vulva is an issue many women describe.
A contributing factor to this discomfort is that many women with long or asymmetrical labia have never seen another pair of labia that looks like theirs, making them feel different
Another factor that can cause psychological discomfort is hearing cruel comments or off-color jokes making fun of female genitalia. They may come from coworkers, friends, family members, or romantic partners. Such comments are hurtful. Because we rarely talk about our genitals unless using derogatory or demeaning language, speaking back to such hurtful words and deflecting the talk can be difficult.
Such comments can contribute to lowered self-confidence and lead to feeling shame about your body, especially your genitals. You may be overwhelmed, hating your labia and feeling alone, broken, or abnormal.
These distressing emotions are valid. It’s painful to feel “different” and to hear negative comments or remarks from others. Low self-esteem and poor body image affect many of us. They certainly don’t make it easy to feel good in your skin.
Many others seeking labiaplasty share your feelings.
According to a study published in the October 2016 issue of Aesthetic Surgery Journal, “[Female genital cosmetic surgery] patients tested at baseline showing body dissatisfaction, negative genital self-image, and poorer indices of sexual satisfaction. Preoperative body image of study patients was in a range considered to be mild to moderately dysmorphic.”
Another study, this one published in Psychological Medicine, also found that women seeking FGCS struggled with low body image. In fact, “Of the 55 women seeking labiaplasty, 10 met diagnostic criteria for body dysmorphic disorder.”
Body dysmorphia causes fixation on real or perceived physical flaws. Because of it, you become obsessed with the slightest “imperfection”—making it extremely difficult to see your body as it really is.
Negative, dysmorphic body image and labiaplasty seem to go hand-in-hand. Many women and girls are convinced that they’re just not “normal.”
So, what’s warping women’s genital self-image?
Societal Expectations and the Illusion of “Normal”
There is no one “normal” vulva. It’s understandable if you’ve never heard that before reading this guide.
Images portrayed as representations of a singular “normal” are everywhere—on television, in the movies, spread across magazines and billboards.
Those images , however, do not reflect reality. They are retouched, airbrushed, cropped, and blurred.
Even if you know that the retouching was done, when you only see “perfect” bodies, no matter how altered they might be, they start to look normal to you. They start to look like the body you should have—like the ideal.
The idea of the “designer vagina” has been perpetuated by the media, especially by the media that puts it on display.
Pubic Hair, Porn, and Problematic Images
Thanks to the Internet, porn is more easily accessible than ever before.
Unfortunately, the people seen in pornography certainly do not depict realistic bodies or female genitalia.
In mainstream pornography, it seems that almost every vulva is hair-free, which means more vulvas are visible. As a result, making comparisons is easier than ever.
Removing pubic hair via shaving, waxing, and laser is currently very popular, especially for women. A 2015 study of college students found that 50% of the female participants were “typically hair-free,” versus 19% of the male.
Why is that a problem?
Just like the images in magazines, the images in porn do not accurately reflect the expansive diversity of human bodies or vulvas.
In fact, in Australia, the law demands that every vulva must be digitally altered.
Kristen Drysdale, an Australian Journalist, challenges her readers to find an “outie”—or a visible labia minora—in a soft-core magazine.
“You won’t. And it’s not because they’ve chosen to only photograph women with ‘innies.’ Many of those models actually have outies in real life, which have been ‘healed to a single crease’ (that’s the charming term used in the magazine industry) with the aid of image editing software. Think of it as ‘digital labiaplasty.’”
While digital labiaplasty is legally mandated in Australia, its use is widespread in other countries. .
As this study shows, when women are exposed to images of modified vulvas, they don’t question the picture—they question their own bodies. Without other images for comparison, they believe what they see must be normal. Which means their own genitals must not be.
And, it’s not just adults watching porn. Children, preteens, and teens are viewing it too—and absorbing troubling lessons about sexual health. This includes “unrealistic beliefs and expectations in relation to female orgasm,” as well as confusion about “natural” genital appearance and function.
Take this account from a girl in England, who started wanting the procedure when she was 14: “I just picked up from somewhere that it wasn’t neat enough or tidy enough… 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.”
In the long run, this girl did not get labiaplasty. Later, she expressed her relief. “I’m totally glad I didn’t get it done. I didn’t need it. I look totally normal. Completely and utterly normal.”
Many other women and teens, however, do go through with the procedure.
Many women chose to add labiaplasty as an add-on surgery while under general anesthesia for other cosmetic procedures, such as a tummy tuck or breast enhancement.
Some women request this add-on specifically. Some agree to it after being encouraged by their doctors. Many surgeons suggest labia reduction because they—in their own opinion—think the woman’s vulva will look better once it’s surgically altered.
When looking to have an elective, cosmetic procedure, it’s imperative that you do your own research before agreeing to any add-on surgery.
As mentioned above, some women seek labiaplasty because they believe it will solve a medical issue, or that it will reverse effects of childbirth or aging (including vaginal dryness after menopause).
Labiaplasty is not a treatment for medical conditions or disorders. It does not reverse the effects of childbirth or aging. In fact, it can increase issues with vaginal dryness, as many glands that create natural lubrication are in the labia.
Both the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) have published their concerns about female genital cosmetic surgery.
ACOG states, “It is deceptive to give the impression that vaginal rejuvenation, designer vaginoplasty, revirgination, G-spot amplification, or any such procedures are accepted and routine surgical practices.”
In 2017, ACOG also published specific recommendations for girls under 18 who request labiaplasty. They strongly suggest that teens do not have surgery, except in extreme cases.
Why have organizations like these taken such a hard stance? Read on.
The Designer Vagina Problem
You likely have your own unique reasons for considering labiaplasty, or for searching to learn more. Maybe you are worried that there are no other alternatives—there is no other way to feel happy in your body.
Googling “labiaplasty” and related terms is likely to bring you to pages of plastic surgery offices. Too many plastic surgeons’ websites do their best to cement the belief that FCGS is the best and only option. In addition, they often use shifting terminology or vague language to describe surgeries, making it difficult to know what exactly you are selecting.
Seeking the advice of a medical physician might not be entirely helpful either. In fact, a 2016 study shows that “75% of general practitioners rated their knowledge of FGCS as inadequate,” and that “nearly half reported they had insufficient knowledge of risks of FGCS procedures” to provide counseling to their patients.
Ultimately, the decisions you make about your mental and physical health are yours. What we hope is for you to get the education and information you deserve in order to make a careful, informed choice.
That means keeping in mind surgery’s potential benefits and its problems.
What “Should” Labia Look Like? No Surgical Standards and No True “Ideal”
As we’ve discussed, there is no such thing as one “normal” vulva, let alone one “ideal” vulva.
The major reason women have surgery is entirely cosmetic. And, while your opinions about your body are valid, it’s important to consider how they’ve developed. If you think your labia aren’t “normal,” we encourage you to consider where and how you learned this. At the end of this guide, you’ll find valuable and extensive information about genital diversity to assist you in developing a more objective understanding of “normal.”
According to ePlasty, an online journal of plastic surgery, “There are no widely accepted guidelines for labiaplasty, and it is carried out for a variety of reasons… What constitutes labial hypertrophy [enlargement] is poorly defined in the literature…there is no established anatomic standard.”
Without a standard, what prompts surgeons’ recommendations?
A study published in The Journal of Sexual Medicine shows that physician’s personal opinions and preferences regarding genital appearance play a large role in whether or not they’ll recommend labiaplasty.
According to the study, “More plastic surgeons regarded the picture with the largest labia minora as distasteful and unnatural, compared with general practitioners and gynecologists.” And, “Male physicians were more inclined to opt for a surgical reduction procedure than their female colleagues.”
In other words, a plastic surgeon might recommend labiaplasty based purely on their subjective aesthetic preferences—not on the preferences of their patients.
Pressure from Surgeons
Many women enter a plastic surgeon’s office without knowing exactly what they want. For example, you might see a surgeon because you’ve noticed something that concerns you, or because you have questions about your genital health. Instead of getting objective answers, you may be misinformed and pressured into having a surgery you don’t need.
Unfortunately, “Aesthetic vaginal surgeons may unintentionally blur legitimate female pelvic floor disorders with other aesthetic conditions.”
That means some women follow their surgeon’s recommendations, only to have surgery to correct a condition that they don’t actually have. And even if they did have a condition, FGCS more than likely will not correct it.
Further, women often compare their labia to “before” images on plastic surgeon’s websites. They do not view these as advertisements, but as “valid representations” of what’s flawed versus what’s normal. They seek surgery to follow the presented example of women with labia like theirs, believing that they, too, must “correct” features advertised as flaws.
More and More Reduction and Removal
Labiaplasty is becoming more complex, and surgeons are cutting away more and more tissue.
This includes urogynecologist Dr. Red Alinsod, who claims he invented “The Barbie Procedure” as a response to patients “who wanted almost all of it off.” Remember, this procedure aims to shape women’s vulvas so they look like those of a child or a Barbie doll.
Dr. Alinsod says that “The Barbie” is safe, and that it’s his most-requested surgery. However, he also says, “The problem with this surgery, frankly, is that it looks easy, but there’s a lot of finesse involved. If you don’t know those nuances, you’re going to have dog-ears, or complete removal of the labia when that’s not what’s requested. That’s when the lawsuits occur.”
Remember: Labia, once removed, do not grow back. When the surgery is over, it is irreversible.
O’Regan also spoke to urologist and plastic surgeon Dr. Gary Alter, a physician often sought be women whose labiaplasty procedures were less than satisfactory. According to Alter, “Many women are given Barbie-style surgeries without their consent, resulting in the amputation of the entire inner labia.”
That means there’s a chance you go in to surgery for the procedure you requested and leave with a part of your body permanently altered because the surgeon performed a different one without your consent. That puts you at risk for added complications—complications you did not expect.
Surgical Complications, Scarring, and Loss of Pleasure
There are many consequences that can potentially follow any kind of cosmetic surgery.
It’s important here to note that complications from FGCS do happen. According to a 2015 study by The American Society for Aesthetic Plastic Surgery on the safety of aesthetic labiaplasty, 13% of patients reported “swelling, bruising, and pain” and 3.5% required “revision surgery” or another surgery to “correct” issues from the first.
The British Society for Paediatric & Adolescent Gynaecology reports, “Wound dehiscence [rupturing] has been reported in up to 30% of cases [of labiaplasty] depending on the surgical technique used.”
Other complications include loss of sensitivity, nerve damage, decreased lubrication, increased pain, scarring, irregular shape, texture, and color, bleeding, infection, and necrosis (the death of the tissue).
There are also serious concerns about diminished sexual pleasure. Labia are sex organs. Getting rid of them means losing a part of the body that directly contributes to arousal and orgasm.
The RCOG also discusses the lack of data about medium- and long-term outcomes. There is simply not enough information available to determine whether labiaplasty is safe.
As the labiaplasty industry has grown, so too has an unintended side industry: that of correcting botched surgeries. Dr. Alter “estimates that 20% of his labiaplasties are performed to rectify the mistakes of previous surgeries.”
Labiaplasty when performed by a qualified, experienced, and skilled surgeon will certainly be safer than if performed by an unqualified surgeon. Do your research—unqualified surgeons are more common than you might think.
Lack of Credentials and Regulations
Overall, there is little to no regulation when it comes to labiaplasty. There are no official guidelines for when and why labiaplasty should be performed. And, because labiaplasty is expensive, usually not covered by insurance, and in-demand, many surgeons perform the procedure without any specified training or ability to properly assess for possible disease processes that may affect recovery from the procedure.
International plastic surgery pop-up shops are another modern phenomenon. The Internet is full of websites offering “plastic surgery vacation packages” at discount prices. However, it’s often difficult to tell if those bargain plastic surgeons have legitimate certifications, or if their certifications come from accredited institutions. Undergoing labiaplasty at the hands of an unqualified surgeon heightens the risk of complications.
Don’t gamble the health of your vulva with an unqualified surgeon! Know what you’re getting into and with whom before making any decisions that permanently alter your body.
High Cost and Slow Recovery
Labiaplasty is expensive. According to one plastic surgery website, it can cost anywhere from $3,000–$8,000. In some US locations, the price tag is significantly higher. And because it is elective and cosmetic, most insurance carriers do not cover the surgery.
One surgeon states that her patients can expect to perform the following ritual two to three times a day, for two weeks after surgery: sit in a small tub of warm salt water and then use a hair dryer to dry the wound.
Patients should also take antibiotics, avoid penetrative sex for at least six weeks, and do their best to avoid putting any pressure on the wounds. They can expect “impressive swelling that can follow [and] take weeks for resolution.” It’s necessary that patients see their surgeon for post-surgical follow-up to monitor healing.
All told, it takes around six months to completely heal and recover from labia reduction
Teen Labiaplasty: Permanent Changes to Developing Bodies
Organizations like ACOG and RCOG are particularly concerned about the dramatic rise of teen labiaplasty. Nearly 40% (159) more girls under 18 underwent labiaplasty in 2016 than in 2015. And, the upward trend is not slowing. Some gynecologists who work with adolescents report they receive requests for genital cosmetic surgery every week.
Having this irreversible procedure at such a young age can have serious consequences that are worth your attention.
The bodies of adolescents and young adults are still developing. According to Dr. Gail Busby, lead adolescent gynecologist at St. Mary’s Hospital in Manchester, England, “In adolescence, the labia are still growing—with the inner lips growing first—so it is normal for them to appear prominent.”
Studies show that teenage girls often struggle with body image, more than teenage boys. But permanently amputating sexual tissue is a poor solution for low self-esteem most likely developed due to beauty trends that are bound to change with time.
It’s no wonder that the British Society for Paediatric & Adolescent Gynaecology echoes ACOG’s recommendations for teenage girls. In their position statement, they write, “There is no scientific evidence to support the practice of labiaplasty and, for girls under the age of 18 years, the risk of harm is even more significant.”
Promises of Self-Confidence
Reports indicate that some women are satisfied with the results of all types of FCGS. Remember the study published in the October 2016 issue of Aesthetic Surgery Journal, in which women reported mild to moderately dysmorphic self-image? Two years after FCGS, those women no longer reported “sexual dissatisfaction or negative genital self-image.”
However, their overall body image did not change.
But that’s FCGS overall. For labiaplasty alone, the findings are a little different.
According to a study published in the Aesthetic Surgery Journal in September 2016, “Over half the women reported that their postoperative labial appearance did not quite meet their expectations.”
These women reported that their labia were asymmetrical, or that they were not as small as they’d imagined. They often then seek out additional procedures, costing them more money and time.
Some women were also distressed to find that more of their inner labia had been removed than they’d expected, even though they had not given their surgeon their consent.
Overall, plastic surgery should not be a recommended treatment for poor body image or body dysmorphia. In fact, according to Dr. Katharine Phillips, the director of the Body Dysmorphic Disorder program at Rhode Island Hospital/Brown University, “Sometimes, patients get a lot worse.”
What if you’re still torn between doubts about labiaplasty and the belief that you’d feel better and like yourself more if you had a designer vagina? You don’t want to run the risks—but you also don’t know what to do about the dislike you feel for your body.
How can you possibly learn to feel comfortable with your labia?
It can happen. We know personally and through work with our clients. In Part 3: Getting to Know Your Unique Vagina and Vulva, we teach you just that. Not only will you be guided through exercises to know yours up close and personal, we also provide links to books, videos and other resources that are filled with all things vulva. We trust you’ll enjoy the adventure!