Women seeking genital surgery to reduce the size of their labia minora do not have large or misshapen labia, and also tend to be relatively young, a small U.K. study has found.
Of the 33 women in the prospective study, published Aug. 24 in BJOG, 30 had labia with dimensions within the normal published limits, yet sought surgery anyway. The women’s average age was 23 years, although a quarter were 16 years or younger, with the youngest being 11 years old.
This points to the psychological or cultural appeal of cosmetic genital surgery among young women and girls, the study’s authors say, which may be influenced by grooming trends that expose the vulva – two-thirds of women in the study had removed their pubic hair – and by widespread advertising of the surgical procedures using before-and-after photos, which about one-third of subjects reported having consulted (BJOG 2011 Aug. 24 [doi:10.1111/j.1471-0528.2011.03088.x]).
"We noticed that more young women were coming in saying, ‘we’re not normal,’ " said Dr. Sarah Creighton, a gynecologist at University College London’s Elizabeth Garrett Anderson Institute of Women’s Health and the corresponding author of the study, in an interview. "And yet there is little information about what is normal."
For their research, Dr. Creighton and colleagues at a London hospital clinic (which performs the surgeries on women whose genitalia are outside normal measures) interviewed women referred to them by primary care physicians. Two-thirds of the women seeking surgery identified themselves as students, only 15% had given birth, and two-thirds reported being single. Most (84%) were white.
The women did not appear to be guided by sexual concerns, as a majority (61%) reported having never been sexually active.
Dr. Creighton and colleagues interviewed the women on their reasons for seeking surgery, and found that most (78%) were motivated by concerns about the appearance of their genitals. Although discomfort, such as that caused by rubbing or chafing, was reported by 57% of them, only 18% said that they thought surgery would help.
The investigators also measured the women’s labia, finding all but three to be within normal published limits, with a mean (SD) of 26.9 (12.8) mm on the right side, and 24.8 (13.1) mm on the left. Surgeries were offered only to those women whose labia were outside that range.
The investigators were surprised, they wrote, to find "that all of the study participants and their referring doctors should have felt that surgery was an appropriate treatment," when the women’s labia were normal. Moreover, 40% of the 30 participants who were denied surgery by the clinic "remained keen to pursue surgery by any other available route."
About 2,000 women now receive the surgeries every year through NHS clinics, a fivefold increase from a decade ago, Dr. Creighton and colleagues noted, with privately performed procedures likely accounting for a far greater number. Yet despite the expanding availability of the procedure, a U.K. law prohibits female genital surgeries for cultural or nontherapeutic reasons, even on adult women.
Thus far, Dr. Creighton said, no lawsuit has challenged the legality of the procedure, which some NHS trusts offer on the grounds of alleviating psychological distress.
"There are no guidelines. The NHS is not publicly discussing it," Dr. Creighton said, adding that professional surgical associations have not issued clear guidelines for treating women seeking labial surgery, leaving clinician discretion as the norm.
"National care standards are urgently needed," Dr. Creighton and colleagues wrote in their analysis. The investigators also urged the publication of data on normal labial measurements "based on a large adult general population sample stratified according to age, ethnicity and parity."
The study was funded by the Elizabeth Garrett Anderson Institute of Women’s Health at University College London. None of its authors declared conflicts of interest.