Ladies, We Need To Talk About Your Vaginas

Over the past few years, there has been a marked increase in the number of Australian women undergoing cosmetic genital surgery in a quest for "normal" vaginas. But what exactly is normal? Despite what porn would have you believe, vaginal appearance is just as diverse as any other body part. GPs need to discourage women from undergoing unnecessary and painful procedures stemming from genital-related anxiety. In short, your junk is fine the way it is -- embrace it.

Sad vagina picture from Shutterstock

General practitioners have an important role to play in alleviating women's anxiety about their genital appearance and can help stop the rise in women going under the knife for cosmetic reasons.

Figures show 640 Australian women made Medicare claims for genital cosmetic surgery in 2000. The number grew threefold over the next decade, with 1,565 claiming the same surgeries on Medicare in 2011. There was no accompanying rise in the incidence of congenital or acquired diseases that would need such surgery.

The Medicare statistics reveal surgeries are as common among women between the ages of 15 to 24 as they are among those between 25 to 44. These figures are only the tip of iceberg as most women seek out genital cosmetic surgery through the non-rebatable, private system.

In response, the Royal Australian College of General Practitioners this week introduced world-first guidelines to advise doctors how best to deal with women's rising interest in having genital cosmetic surgery.

When women ask for surgical modification to their genital tissue, they often don't know enough to describe what they want removed, nor do many understand the long-term implications.

What is normal?

As a GP with more than 20 years' experience in women's health, I have seen a marked increase in the number of women embarrassed about their genital appearance. They might hint at their shame during a routine gynaecological procedure, either as an apology for how they look "down there" or as a blatant statement such as: "It's so ugly, I'm so embarrassed, I want it fixed."

Image: Flickr, Ludo

General practitioners are often the first medical professional to see a woman's anxiety over her genital appearance. This embarrassment may be based on an idealised benchmark of stylised, hairless and prepubescent genitals, so often depicted and promulgated through media, pornography and fashion. In real life, though, women and men know very little about genital diversity. And little research has been conducted on what constitutes normal genital appearance.

Marketers of female genital cosmetic surgery make a genital tissue "trim" seem like a simple lifestyle choice. But trimming labia is not the same as trimming one's hair. The labia minora (inner lips) isn't made of ordinary skin but tissue rich with nerve fibres that developed as part of the primordial phallus (what becomes the clitoris during fetal development).

A lucrative industry

Female genital cosmetic surgery comprises a suite of relatively new procedures. Labiaplasty – where the labia minora are "trimmed" to not extend beyond the margins of the labia majora (outer lips) – is the most common, accounting for about 50% of all such surgeries.

Genital-related anxiety seems to have increased over the past decade, along with the use of terms such as "Barbie-plasty", "designer vagina" and "vaginal rejuvenation". Google these and you see a plethora of consumer websites touting "facts" such as: "more than 30% of women have excess genital tissue".

These websites reinforce existing social and cultural messages about the vulva and vagina but offer scant information about the diversity of genital appearance. Nor do they talk about the long-term risks of the surgery, which have not yet been researched.

Such advertisements tap into the dissatisfaction some women feel about not being "normal". But their existence shows a new and lucrative area. Prices in Australia for labiaplasty vary from $3000 to $9000 and can be coupled with clitoral hood reduction or mons pubis reduction (the mounded area above the pubic bone) – specialties women are seeking in high numbers.

These surgeries can be performed by anyone with a medical degree. No formal training is required and there are currently no evidence-based guidelines to support the procedures.

Complications often arise. Surgeons may remove too much genital tissue, exposing the woman's clitoral head to undergarments and causing pain in ordinary clothing. Another common complication is irregularity and scarring along the trimmed labia minora or change in pigmentation of the skin and hypersensitivity.

Worryingly, the complications are so common that one prominent, plastic surgeon in the United States has found a lucrative market for correcting them, dubbing them "botched labiaplasties".

Guidelines for GPs

While few Australian researchers have explored the GPs' role in cosmetic surgery, UK studies have indicated a need for GPs to educate women who express concern about their genital normality or appearance.

The recently launched doctors' resource -- the RACGP guidelines for female genital cosmetic surgery, which I helped develop -- address the lack of balanced information. The guidelines recommend doctors listen to and educate patients about genital normality. Doctors are encouraged to refer women to sites such as the Labia Library to help them understand the diversity of genital appearance.

Guidelines also advise GPs to examine the woman respectfully and explore the reasons for her concern. This is an opportunity to consider the psychological or sexual reasons for her anxiety by discussing personal or relationship issues, past history of sexual abuse or even mental health issues. Anecdotal evidence from GPs and surgeons suggests coercion due to partner criticism is sometimes a factor for women's genital shame.

GPs should refer a woman for a gynaecological opinion if they feel their advice is not sufficiently reassuring. If the patient is under 18, they should refer her to an expert adolescent gynaecologist.

Hopefully the RACGP guide will prompt GPs and other health professionals to take the time to discuss women's concerns about their genital appearance and ultimately reduce the rate of unnecessary and potentially harmful surgery.

Magdalena Simonis is Lecturer, General Practice and Primary Health Care Academic Centre at University of Melbourne

This article was originally published on The Conversation.


Comments

    640 Australian women made Medicare claims for genital cosmetic surgery in 2000.

    Wait? Why is the government funding this?

    And ladies, guarantee you, yours is beautiful and any guy that says otherwise is a giant douche nozzle and deserves to be taken out of the gene pool (by not being allowed near your lovely lady bits)

    Last edited 18/08/15 1:48 am

      Cosmetic surgery should not be able to be claimed under Medicare unless it if fixing an actual problem. From what it sounds like, not many of these are real problems.

      There was an interesting piece on ABC about all of this some time ago, although I can't remember it's name. The presenter was a red headed woman and she talked to adult entertainers, doctors, people having work done and all sorts. Pretty informative. It was Australian made so quite a bit more tasteful than some of the UK shows that make their way to ABC.

    As an art nude photographer, I get a lot of girls talking to me about this, and it's amazing how many want work done. I tell them all that they don't need it done, and that they're all different and beautiful and that it's Australia's stupid censorship laws (to get an R rating for a magazine rather than higher) that distorts the view.

    At least they aren't removing their clitoris's for religious reasons! So long as they aren't being forced into it and they've spoken to an expert, it's their personal choice.

      I don't see what your first statement really has to do with this.

      And as for your second statement, there should be more of a focus on education as to what normal is so that people are not feeling the need to have unnecessary surgery.

        You've never heard of certain religions propensity to cut their female children once they reach puberty?

          I have but its a completely different topic to what is being discussed here which is cosmetic and consensual and nothing to do with religion.

            The point is that it is their choice, they aren't being forced into it and it's no different from breast enhancement or any other cosmetic surgery. I used the cutting of females by certain religions as a counterpoint, so quite relevant imo.

              I'm not in any way trivialising the FGM issue but I think it could be argued that some coercion is involved here too - anxieties fed by unrealistic expectations - hence the need for the writer's initiative.

      let's not forget foreskins.

      It is illegal in Australia to dock the tails of dogs and female circumcision is morally abhorrent, but most people aren't really offended by male circumcision. It all seems the same to me, cutting things off and not having a choice about it.

        You are absolutely right about this absurd hypocrisy!

    I remember reading a story about this a while ago, saying that the only time women really see other women's vaginas (not just what you might see in the shower or changeroom) is in pron movie or magazine, and those things are either airbrushed to hell or the person has had plastic surgery to make it 'more appealing' for film. (Wasn't there also a law that stated no visible labia or something?)

    If they're the only parts you've seen, other than your own, (and I'll say that's probably about right in my case, as I'm a heterosexual female and can't say my friends and I sit around and compare), of course you're going to think that you're 'not normal'. But, unlike the breast implants (which are discussed openly), no-one really discusses (I love this phrase) 'designer vaginas'.

    Medically, there's a couple of reasons surgery should be covered by medicare - e.g. where there is an issue with too much skin and it causes an actual physical issue. But governments shouldn't pay for someone's surgery because they think 'down there' isn't pretty enough.

    Last edited 18/08/15 11:18 am

    Was called 'The Perfect Vagina.'

    Can watch it here:
    https://youtu.be/uMJcGcBc2t8

    Originally broadcast on commercial tv so safe for general viewing although not at work. ;-)

    If women use Medicare to solve painful or uncomfortably long labia I don't see the issue. But it obviously shouldn't be a choice based on aesthetics.

    I get what you're saying, but those are both problems. Unless there is a medical problem such as cancer, problems urinating or even defecting, or if the labia majora are like 3kg, then there is no valid reason for changing anything about a vagina. Australia, we need more pictures of actual vaginas. I can see like 20 wangs a day of varied shapes and sizes, but any vagina you see in the media is photoshopped down to nothing. Girls contemplating surgery, go look at porn, sadly porn is a much better representation of actual vaginas than mainstream media.

      For the sake of accuracy: what we're talking about seeing vulvas. Seeing a vagina requires the vulva to be held open.

    Anything done on a female's genitals in Africa is referred to as female genital mutilation (FGM). Elsewhere it is genital cosmetic (aesthetic) surgery.

    Murigi, You made a good point and it made me smile. . . HOWEVER, in Africa, the girls have no choice, many times the clitoris is removed, too, and the outside is sewn up so much so to ensure "purity", that intercourse is painful. Here, this is done by adult women making their own choices. So, it really is not the same thing.

    Hmm every case is as personal and different as a woman's labia is. Its not a decision made lightly at all...yes all labia are different and therefore all are normal (embrace your pink bits!)...but at the end of the day it all comes down to how you feel about yourself...no one else can decide how to feel for you.

    Some ladies actually obtain a bit more comfort from not having dangly bits chafing between their legs...whilst...others...may not know what their missing when it comes to exposed lady lumps...either way... its personal and who are we to judge another persons decision who has led a completely different life to us, doing the best they can with what they know...if anything a little bit more compassion and understanding would go a long way and it would be great if there was more celebration, exposure and awareness of all the different lovely types of labia out there.

    I prefer a woman with a long Labia ,I guess it gives the vagina character,so to me the bigger the labia the better. Women should be proud of their Labias. To get them cut off is a form of mutilation.

    No woman/person should feel under pressure to change their bodies. But they do. It comes from society, friends, media. We have become very comfortable with breast augmentation, facelifts, hair colouring - labiaplasty is just the next step. There have been plenty of reasons why this is more in demand now - less pubic hair, tighter clothing/active wear and more available images (yes many altered).
    When I have women coming and asking for this surgery I always point out that they are normal and will now link the labia library to my website. But remember that there are the 'tails of the bell curve' many of the women I see are at a more extreme end of normal. Many of the women I see have been refused surgery by Gynaecologist. Some have avoided sexual partners for a decade because of their concerns. Yes I have even suggested they need to see a psychologist rather than have surgery. But.... they are also relieved and happy when someone takes their concern seriously and does not take away their right to choose what to do with their body. If their ears stuck out and caused them this much concern most people would say - fine, get your ears tucked back. But because it is "the vagina" (well close) this is a no go zone. Maybe the problem is not with the patient but with people wanting to tell them that this surgery is not OK but what someone else wants is.
    Now the tattoos that young girls are getting on their thighs and calves - that is getting out of control.

    I'm a 60 y/o male, a musician and general artist; over the years I've been fortunate to have been found attractive (or at least acceptable) by a number of sweet partners. There's absolutely nothing else I'm aware of that even approaches the beauty that women can manifest, and much of that is often personality. Confidence in your own attractiveness goes a long way! So does how and how much you show of how turned on you are. As for looks, well, look at the variety in any other human feature - faces, body shape, you name it! Your "pink bits" as I've heard 'em called are as individual as any other part of you. One lady I knew could tie a knot in her labia, but I've seen others that were barely there at all. I thought both were lovely! Please believe me that you DON'T need to look like a Barbie doll (nor does the area under discussion have to follow some weird, plastic, synthetic perfection). If you truly think you have mutant genitalia, ask an OB/GYN, or if you've an experienced male friend who wouldn't mind telling you his thoughts - he shouldn't mind if you bring a friend for hand holding - there are lots of possibilities. While there ARE some really odd-looking arrangements sometimes, they are VERY rare, and even then it's not always unattractive. If you're unsure, ASK! If you're too shy, well, maybe try that OB/GY or an older, experienced friend. I've done this a few times for female friends (I don't know why women seem to find me trustworthy, but they're right, dammit!), and they were, while outside the average, just fine. You were born with a wonderful body that can be an incredible toy for you and your lucky partner - learn to enjoy it and don't worry about what are usually just minor, normal variations on the main theme!

    One thing for certain: a vagina needs an intact man:
    "The drawbacks of circumcision for women"
    https://www.academia.edu/14759672/The_drawbacks_of_circumcision_for_women

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