Menstuff® has information on Labiaplasty which is a surgical procedure that removes excess tissue from the labia, making it smaller either for hygienic or cosmetic reasons. In some women, the labia can become enlarged and elongated, causing discomfort when wearing certain clothing. Average Price: $3,975. When combined with vaginoplasty, this procedure may also be known as vaginal rejuvenation. (Editor's note: Why would any woman want her vagina to look like that of a 13 year old? And look like a porno stars vagina? Where does she other vaginas? Does she watch too much porno? If it is for a man, I might question how much pornography he watches and even if she does it, will he be satisfied? Especially as she gets older, and her vagina naturally changes, with or without having kids. Will he leave her for a younger vagina? And how would be if every woman's vagina looked the same. No individuality. Like they got them at a mannequin factory. Boring. It's just one more way that the cosmetic industry exploits psychologically insecure women. Just saying. - Gordon Clay


The Labiaplasty Boom: Why Are Women Desperate for the Perfect Vagina?
Labiaplasty Pictures

Labiaplasty The brave new womb.

Also known as labioplasty, labia minora reduction, and labial reduction, or "roast beef curtains", is a plastic surgery procedure for altering the labia minora (inner labia) and the labia majora (outer labia), the folds of skin surrounding the human vulva. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their genitals because they believe they do not fall within a normal range.[1]

The size, colour, and shape of labia vary significantly, and may change as a result of childbirth, aging and other events.[1] Conditions addressed by labiaplasty include congenital defects and abnormalities such as vaginal atresia (absent vaginal passage), Müllerian agenesis (malformed uterus and fallopian tubes), intersex conditions (male and female sexual characteristics in a person); and tearing and stretching of the labia minora caused by childbirth, accident and age. In a male-to-female sexual reassignment vaginoplasty for the creation of a neovagina, labiaplasty creates labia where once there were none.

A 2008 study in the Journal of Sexual Medicine reported that 32 per cent of women who underwent the procedure did so to correct a functional impairment; 31 per cent to correct a functional impairment and for aesthetic reasons; and 37 per cent for aesthetic reasons alone.[2] According to a 2011 review, also in the Journal of Sexual Medicine, overall patient satisfaction is in the 90–95 percent range.[3] Risks include permanent scarring, infections, bleeding, irritation, and nerve damage leading to increased or decreased sensitivity. The Observer wrote in 2011 that medical experts had "sounded the alarm" about the procedure and its soaring rates, blaming increased exposure to pornography images on the Internet. Linda Cardozo, a gynaecologist at King's College Hospital, London, told the newspaper that women were placing themselves at risk in an industry that is largely unregulated.[4]

Size of the labia

The labia minora vary considerably in form and size between women

The external genitalia of a woman are collectively known as the vulva. This comprises the labia majora (outer labia), the labia minora (inner labia), the clitoris, the urethra, and the vagina. The labia majora extend from the mons pubis to the perineum.


The size, shape, and color of women's inner labia vary greatly.[5] One is usually larger than the other. They may be hidden by the outer labia, or may be visible, and may become larger with sexual arousal, sometimes two to three times their usual diameter.[6]

The size of the labia can change because of childbirth. Genital piercing can increase labial size and asymmetry, because of the weight of the ornaments. In the course of treating identical twin sisters, S.P. Davison et al reported that the labia were the same size in each woman, which indicated genetic determination.[7] In or around 2004, researchers from the Department of Gynaeology, Elizabeth Garret Anderson Hospital, London, measured the labia of 50 women between the ages of 18 and 50, with a mean age of 35.6:[1]



Mean [Standard deviation]

Clitoral length (mm)

5.0 – 35.0
19.1 [8.7]

Clitoral length (mm)

5.0 – 35.0
19.1 [8.7]

Clitoral glans width (mm)

3.0 – 10.0
5.5 [1.7]

Clitoris to urethra (mm)

16.0 – 45.0
28.5 [7.1]

Labia majora length (cm)

7.0 – 12.0
9.3 [1.3]

Labia minora length (mm)

20 – 100
60.6 [17.2]

Labia minora width (mm)

7.0 – 50.0
21.8 [9.4]

Perineum length (mm).

15.0 – 55.0
31.3 [8.5]

Vaginal length (cm)

6.5 – 12.5
9.6 [1.5]

Tanner Stage (n)


Tanner Stage (n)


Color of the genital area compared to the surrounding skin (n)

Same color

Color of the genital area compared to the surrounding skin (n)

Darker color

Rugosity of the labia (n)

Smooth (unwrinkled)

Rugosity of the labia (n)

Moderately wrinkled

Rugosity of the labia (n)

Markedly wrinkled



Labia reduction surgery is relatively contraindicated for the woman who has active gynecological disease, such as an infection or a malignancy; the woman who is a tobacco smoker and is unwilling to quit, either temporarily or permanently, in order to optimize her wound-healing capability; and the woman who is unrealistic in her aesthetic goals. The latter should either be counselled or excluded from labioplastic surgery. Davison et al write that it should not be performed when the patient is menstruating to reduce potential hormonal effects and the increased risk of infection.[7]

Sex reassignment surgery

Further information: Sex reassignment surgery (male-to-female)

In sexual reassignment surgery, in the case of the male-to-female transgender patient, labiaplasty is usually the second stage of a two-stage vaginoplasty operation, where labiaplastic techniques are applied to create labia minora and a clitoral hood. In this procedure, the labiaplasty is usually performed some months after the first stage of vaginoplasty.


Labial reduction can be performed under local anaesthesia, conscious sedation, or general anaesthesia, either as a discrete, single surgery, or in conjunction with another, gynecologic or cosmetic, surgery procedure.[8] The resection proper is facilitated with the administration of an anaesthetic solution (lidocaine + epinephrine in saline solution) that is infiltrated to the [labia minora to achieve the tumescence (swelling) of the tissues and the constriction of the pertinent labial circulatory system, the hemostasis that limits bleeding.[7]


Edge resection technique

The original labiaplasty technique was simple resection of tissues at the free edge of the labia minora. One resection-technique variation features a clamp placed across the area of labial tissue to be resected, in order to establish hemostatis (stopped blood-flow), and the surgeon resects the tissues, and then sutures the cut labium minus or labia minora. The technical disadvantages of the labial-edge resection technique are the loss of the natural rugosity (wrinkles) of the labia minora free edges, thus, aesthetically, it produces an unnaturally “perfect appearance” to the vulva, and also presents a greater risk of damaging the pertinent nerve endings. Moreover, there also exists the possibility of everting (turning outwards) the inner lining of the labia, which then makes visible the normally hidden internal, pink labial tissues. The advantages of edge-resection include the precise control of all of the hyper-pigmented (darkened) irregular labial edges with a linear scar that can also be used to contour the redundant tissues of the clitoral hood, when present.[9][10][11][12][13][14]

Central wedge resection technique

Labial reduction by means of a central wedge-resection involves cutting and removing a full-thickness wedge of tissue from the thickest portion of the labium minus.[10] Unlike the edge-resection technique, the resection pattern of the central wedge technique preserves the natural rugosity (wrinkled free-edge) of the labia minora. Yet, because it is a full-thickness resection, there exists the potential risk of damaging the pertinent labial nerves, which can result in painful neuromas, and numbness. F. Giraldo et al. procedurally refined the central wedge resection technique with an additional 90-degree Z-plasty technique, which produces a refined surgical scar that is less tethered, and diminishes the physical tensions exerted upon the surgical-incision wound, and, therefore, reduces the likelihood of a notched (scalloped-edge) scar.[15][16] The central wedge-resection technique is a demanding surgical procedure, and difficulty can arise with judging the correct amount of labial skin to resect, which might result in either undercorrection (persistent tissue-redundancy), or the overcorrection (excessive tension to the surgical wound), and an increased probability of surgical-wound separation. Moreover, as appropriate, a separate incision is required to treat a prominent clitoral hood.

De-epithelialization technique

Labial reduction by means of the de-epithelialization of the tissues involves cutting the epithelium of a central area on the medial and lateral aspects of each labium minus (small lip), either with a scalpel or with a medical laser. This labiaplasty technique reduces the vertical excess tissue, whilst preserving the natural rugosity (corrugated free-edge) of the labia minora, and thus preserves the sensory and erectile characteristics of the labia. Yet, the technical disadvantage of de-epithelialization is that the width of the individual labium might increase if a large area of labial tissue must be de-epithelialized to achieve the labial reduction.[17]

Labiaplasty with clitoral unhooding

Labial reduction occasionally includes the resection of the clitoral prepuce (clitoral hood) when the thickness of its skin interferes with the woman’s sexual response or is aestetically displeasing.[18][19]

The surgical unhooding of the clitoris involves a V–to–Y advancement of the soft tissues, which is achieved by suturing the clitoral hood to the pubic bone in the midline (to avoid the pudendal nerves); thus, uncovering the clitoris further tightens the labia minora.[20]

Laser labiaplasty technique

Labial reduction by means of laser resection of the labia minora involves the de-epithelialization of the labia. The technical disadvantage of laser labiaplasty is that the removal of excess labial epidermis risks causing the occurrence of epidermal inclusion cysts.[21]

Labiaplasty by de-epithelialization

Labial reduction by de-epithelialization cuts and removes the unwanted tissue and preserves the natural rugosity (wrinkled free-edge) of the labia minora, and preserves the capabilities for tumescence and sensation. Yet, when the patient presents with much labial tissue, a combination procedure of de-epithelialization and clamp-resection is usually more effective for achieving the aesthetic outcome established by the patient and her surgeon. In the case of a woman with labial webbing (redundant folding) between the labia minora and the labia majora, the de-epithelialization labiaplasty includes an additional resection technique — such as the five-flap Z-plasty (“jumping man plasty”) — to establish a regular and symmetric shape for the reduced labia minora.[7]

Post-operative care

Post-operative pain is minimal, and the woman is usually able to leave hospital the same day. Usually, no vaginal packing is required, although she might choose to wear a sanitary pad for comfort. The physician informs the woman that the reduced labia are often very swollen during the early post-operative period, because of the edema caused by the anaesthetic solution injected to swell the tissues. She is also instructed on the proper cleansing of the surgical wound site, and the application of a topical antibiotic ointment to the reduced labia, a regimen observed three times daily for two days after surgery.[7]

The woman’s initial, post-labiaplasty consultation with the surgeon is recommended one week after surgery. She is advised to return to the surgeon’s consultation room should she develop hematoma, an accumulation of blood outside the pertinent (venous and arterial) vascular system. Depending on her progress, the woman can resume physically unstrenuous work three to four days after surgery. To allow the wounds to heal, she is instructed not to use tampons, not to wear tight clothes (e.g. thong underwear), and to abstain from sexual intercourse for four weeks after surgery.[7]

Medical complications to a labiaplasty procedure are uncommon, yet occasional complications — bleeding, infection, labial asymmetry, poor wound-healing, undercorrection, overcorrection — do occur, and might require a revision surgery. An over-aggressive resection might damage the nerves, causing painful neuromas. Performing a flap-technique labiaplasty occasionally presents a greater risk for necrosis of the labia minora tissues.[7]


Further information: Body dysmorphic disorder, Female genital mutilation and Labia pride movement

Labiaplasty is a controversial subject. Critics argue that a woman's decision to undergo the procedure stems from an unhealthy self-image induced by their comparison of themselves to the prepubescent-like images of women they see in commercials or pornography.[22]

In the United States, a labiaplasty surgeon can earn up to $250,000 a month. Simone Weil Davis, professor of American studies, told Shameless magazine in 2005 that surgeons are perpetuating the idea that there is a right way for women's genitalia to look; because most women see only their own vaginas or pornographic images, it is easy to make them doubt themselves.[23] The feminist organization, the New View Campaign, has spoken out against the existence of unregulated cosmetic surgery clinics as business enterprises, which it says trade on women's sexuality by appealing to their low self-esteem, thereby creating health risks.[24]

Although female genital mutilation – the practice of cutting off a woman's labia and sometimes clitoris, and in some cases creating a seal across her entire vulva – is illegal across the Western world, Davis argues that "when you really look carefully at the language used in some of those laws, they would also make illegal the labiaplasties that are being done by plastic surgeons in the U.S." The World Health Organization (WHO) defines female genital mutilation as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons."[25] The WHO writes that the term is not generally applied to elective procedures such as labiaplasty.[26]

The American College of Obstetricians and Gynecologists (ACOG) published an opinion in the September 2007 issue of Obstetrics & Gynecology that several "vaginal rejuvenation" procedures were not medically indicated, and that there was no documentation of their safety and effectiveness. ACOG argued that it was deceptive to give the impression that the procedures were accepted and routine surgical practices. It recommended that women seeking such surgeries must be given the available surgical-safety statistics, and warned of the potential risks of infection, altered sensation caused by damaged nerves, dyspareunia (painful sexual intercourse), tissue adhesions, and painful scarring.[27]

In the UK, Lih Mei Liao and Sarah M. Creighton of the University College London Institute for Women's Health wrote in the British Medical Journal in 2007 that "the few reports that exist on patients’ satisfaction with labial reductions are generally positive, but assessments are short-term and lack methodological rigour." They wrote that the increased demand for cosmetic genitoplasty (labiaplasty) may reflect a "narrow social definition of normal." The National Health Service performed double the number of genitoplasty procedures in the year 2006 than in the 2001–2005 period. The authors noted that "the patients consistently wanted their vulvas to be flat, with no protrusion beyond the labia majora ... some women brought along images to illustrate the desired appearance, usually from adverts or pornography that may have been digitally altered."[28] The Royal Australian and New Zealand College of Obstetricians and Gynæcologists published the same concern about the exploitation of psychologically insecure women.[23]

The International Society for the Study of Women’s Sexual Medicine produced a report in 2007 concluding that, while the surgery is a woman's right, she should be counseled beforehand, because variations in the appearance of the vulva are normal; and that, based on the four principles of ethical practice of medicine, such surgery is not always ethical, but not always unethical.[29]

See also

Anal bleaching
Clitoral hood reduction
Elongated labia
Labia stretching


1.Lloyd, Jillian et al. "Female genital appearance: 'normality' unfolds", British Journal of Obstetrics and Gynaecology, May 2005, 112(5), pp. 643–646. PMID 15842291

2.Miklos J.R. and Moore R.D. "Labiaplasty of the Labia minora: Patients’ Indications for Pursuing Surgery", Journal of Sexual Medicine, 5(6), 2008, pp. 1492–1495.

3.Goodman, M.P. "Female genital cosmetic and plastic surgery: a review", Journal of Sexual Medicine, 8(6), June 2011, pp. 1813–1825.

4.Davis, Rowenna. "Labiaplasty surgery increase blamed on pornography", The Observer, 27 February 2011. Also see Navarro, Mireya. "The Most Private of Makeovers", The New York Times, 28 November 2004.

5. Masters, William H.; Johnson, Virginia E.; and Kolodny, Robert C. Human sexuality. HarperCollins College Publishers, 1995, p. 47.

6. Sloane, Ethel. Biology of women. Cengage Learning, 2002, p. 32.

7. Davison S.P. et al. "Labiaplasty and Labia Minora Reduction",, 23 June 2008.

8. Nevárez Bernal R.A. and Meráz Ávila, D. "Fusion of the Labia Minora as a Cause of Urinary Incontinence in a Postmenopausal Woman: a Case Report and Literature Review," Ginecología y Obstetricia de México, 77(6), June 2009, pp. 287–290.

9. Hodgkinson, Darryl J.; Hait, Glen (1984). "Aesthetic Vaginal Labioplasty". Plastic and Reconstructive Surgery 74 (3): 414–6. doi:10.1097/00006534-198409000-00015. PMID 6473559.

10. Alter, Gary J.; Alter, G J (1998). "A New Technique for Aesthetic Labia Minora Reduction". Annals of Plastic Surgery 40 (3): 287–90. doi:10.1097/00000637-199803000-00016. PMID 9523614.

11.Alter, Gary J. (2005). "Central Wedge Nymphectomy with a 90-Degree Z-Plasty for Aesthetic Reduction of the Labia Minora". Plastic and Reconstructive Surgery 115 (7): 2144–5; author reply 2145. doi:10.1097/01.PRS.0000165466.99359.9E. PMID 15923876.

12. Rouzier, Roman; Louis-Sylvestre, Christine; Paniel, Bernard-Jean; Haddad, Bassam (2000). "Hypertrophy of labia minora: Experience with 163 reductions". American Journal of Obstetrics and Gynecology 182 (1 Pt 1): 35–40. doi:10.1016/S0002-9378(00)70488-1. PMID 10649154.

13. Alter, Gary J. (2007). "Aesthetic Labia Minora Reduction with Inferior Wedge Resection and Superior Pedicle Flap Reconstruction". Plastic and Reconstructive Surgery 120 (1): 358–9; author reply 359–60. doi:10.1097/01.prs.0000264588.97000.dd. PMID 17572600.

14. Maas, Sylvester M.; Hage, J. Joris (2000). "Functional and Aesthetic Labia Minora Reduction". Plastic & Reconstructive Surgery 105 (4): 1453–6. doi:10.1097/00006534-200004040-00030. PMID 10744241.

15. Giraldo, Francisco; González, Carlos; de Haro, Fabiola (2004). "Central Wedge Nymphectomy with a 90-Degree Z-Plasty for Aesthetic Reduction of the Labia Minora". Plastic and Reconstructive Surgery 113 (6): 1820–1825; discussion 1826–1827. doi:10.1097/01.PRS.0000117304.81182.96. PMID 15114151.

16. Alter GJ. A New Technique for Aesthetic Labia Minora Reduction. Annals of Plastic Surgery. 1998 March;40(3);287–290

17. Choi, Hee Youn; Kim, Kyung Tai (2000). "A New Method for Aesthetic Reduction of Labia Minora (the Deepithelialized Reduction Labioplasty)". Plastic & Reconstructive Surgery 105: 419–422; discussion 423–424. doi:10.1097/00006534-200001000-00067.

18. Hamori, Christine A. "Postoperative clitoral hood deformity after labiaplasty." Aesthetic Surgery Journal 33.7 (2013): 1030-1036. doi:10.1177/1090820X13502202

19. Hunter, John G. "Commentary on: Postoperative Clitoral Hood Deformity After Labiaplasty." Aesthetic Surgery Journal 33.7 (2013): 1037-1038.doi:10.1177/1090820X13503476

20. Alter GJ. Aesthetic Labia minora and Clitoral Hood Reduction using Extended Wedge Resection. Plastic and Reconstructive Surgery. December 2008. 122(6):1780–1789.

21. Pardo J, Solà V, Ricci P, Guilloff E. Laser Labioplasty of Labia minora. International Journal of Gynaecology and Obstetrics. 2006 April;93(1)38–43

22. Veale, D. and Neziroglu, F. Body Dysmorphic Disorder: A Treatment Manual. John Wiley and Sons, 2010, p. 104.

23. Cormier, Zoe. "Making the Cut", Shameless, Fall 2005. Davis, Simone Weil. "Loose lips sink ships", Feminist Studies, 28(1) (Spring 2002), pp. 7–35.

24."Female Genital Cosmetic Surgery (FGCS) Activism", New View Campaign, press release, 10 November 2008.

25. "Female genital mutilation", World Health Organization, February 2010.

26. "Eliminating Female Genital Mutilation", World Health Organization, 2008. For a discussion of elective procedures and their relationship to FGM, see Annex 2, p. 24.

27. "ACOG Advises Against Cosmetic Vaginal Procedures Due to Lack of Safety and Efficacy Data", American College of Obstetricians and Gynecologists, 1 September 2007. "Vaginal 'Rejuvenation' and Cosmetic Vaginal Procedures", American College of Obstetricians and Gynecologists, 2007, p. 2.

28. Liao, Lih Mei, and Creighton, Sarah M. "Requests for Cosmetic Genitoplasty: How Should Healthcare Providers Respond?", British Medical Journal, 334(7603), 26 May 2007, pp. 1090–1092.

29. Goodman, M.P. et al. "Is Elective Vulvar Plastic Surgery ever Warranted and What Screening Should be Done Preoperatively?", Journal of Sexual Medicine, 4(2), March 2007, pp. 269–276.

Further reading

Boston Women’s Health Book Collective. Our Bodies, Ourselves, Simon and Schuster, 2005.

Revill, Jo. The new nose job: designer vaginas, The Observer 17 August 2003.

Rogers, Lisa. The quest for the perfect vagina, The Guardian 15 August 2008.

Rogers, Lisa. The Perfect Vagina, Channel 4 documentary, 17 August 2008, accessed 18 September 2011.

The Labiaplasty Boom: Why Are Women Desperate for the Perfect Vagina?

One of the U.S., U.K., and Australia's fastest growing plastic surgeries is propagating the notion that not all vaginas are equal.

Throughout the Western world, for much of human history, women’s vaginas have been uber-reliable life partners: timeless companions that, as with all things in nature, wrinkled and drooped with age, but otherwise remained largely unchanged. While cosmetic solutions – from facelifts to liposuction – were used to tauten and tighten various other body parts, vaginas faithfully hung in there, often bravely weathering pubescence, childbirth and menopause. Labiaplasty, the surgery that cuts off “excess” parts of the labia minora, or inner vaginal lips, appeared in medical literature as early as 1971, but solely as a corrective measure for congential abnormalities. Otherwise, vaginas came in all shapes, colors and sizes, and there was no singular mainstream vulvar ideal. If you were into vagina, you were just happy when someone invited you to be near theirs. And if you possessed one, you simply played with the vagina you were dealt.

That began to change in 1984, when the first description of a purely aesthetic form of labiaplasty appeared in a scientific journal. The surgery didn’t immediately become an overnight sensation, but the cultural shifts that likely contributed to its ascent were beginning to fall into place. By the mid-1990s, the Internet had helped take pornography – and its generous close-ups of (overwhelmingly female) genitalia – from shrink-wrapped dirty secret to free and discreet ubiquity. Porn stars of both sexes were increasingly removing their pubic hair, providing fully unobstructed views of the goods, and celebrities like Victoria Beckham, Eva Longoria, and Sex and the City’s fictional Carrie Bradshaw championed the Brazilian wax. Laser hair removal got both better and cheaper. Women’s streetwear expanded to include clothes formerly reserved for the gym, including snug, crotch-contouring items like leggings and yoga pants. Photoshop became an often used, and often overused, tool, literally erasing the line between real and fake “beauty.” Our cultural obsession with youth prompted unprecedented spending on every newly developed, youth-preserving cosmetic surgery. As Dr. Norman Rowe, a Manhattan board certified plastic surgeon told me when I spoke with him, “People have gotten to the point where they’re not just happy with their face being lifted...They want their eyes done, brows done, face done. They want their breasts lifted. They want their arms rejuvenated. They want their labia lifted. They want everything lifted. Everything.”

In 2013, the most recent year for which statistics are available, more than 5,000 labiaplasties were performed in the United States. That may not seem like a huge number, but it’s an astounding 44% increase over just one year prior, making labiaplasty the second fastest growing plastic surgery that year. (The top gainer, by the way, was butt augmentation.) In the United Kingdom in 2014, the National Health Service reported a fivefold increase in the number of labiaplasties performed over the decade prior – which doesn’t include private practice surgeries, the most common kind. Australia’s national health care system noted in 2012 that claims for labiaplasty in the country had doubled since 2002. Sharon Osbourne discussed her “excruciating” labiaplasty on a talk show, and porn star Houston auctioned off the bits from her labiaplasty for $50,000. (Sydney Leathers, Anthony Weiner’s sexting partner, attempted the same but had trouble attracting buyers.) When I asked Dr. Rowe if he thought the surgery would continue to skyrocket, he suggested it had more recently become “the fastest growing procedure out there.” He added: “I don’t see any stopping it.” Vaginal rejuvenation – which can also include vaginal tightening, perineoplasty (focused on the skin between the vagina and the anus), reduction of the clitoral hood, laser vaginal bleaching, and injections to increase the size and sensitivity of the g-spot – is, officially, a booming business.

And an incredibly profitable one, too. While many medical procedures require tremendous amounts of time and offer diminishing returns in insurance reimbursements, doctors can consistently expect healthy profits from labia reduction and other forms of vaginal rejuvenation. An Atlanticarticle notes that “a labiaplasty can be done in just a few hours, in-office, for a fee upwards of $5,000 and no “income socialism” to spread the proceeds among hospitals, insurers, and group-practice partners.” In other words, cosmetic labiaplasty – and the whole suite of “designer vagina” surgeries – can be performed in-office and isn’t covered by health insurance. For practitioners, time investment is minimal, anesthesia is applied locally, and profits from the surgery go straight into the pockets of the doctors who perform them. This has led the industry to attract all kinds of doctors, including those with no previous surgical expertise. A development which has, predictably, resulted in a few problems.

Labiaplasty requires no special certification requirements, a consequence of the fact that “cosmetic gynecology” remains unrecognized by the very accrediting bodies which would determine those requirements. In 2007, The American Congress of Obstetricians and Gynecologists released an opinion essentially stating its opposition to all forms of vaginal rejuvenation. “[T]he appearance of the external genitalia varies significantly from woman to woman,” the opinion offered, and the “safety and effectiveness of these procedures have not been documented” due to lack of “adequate studies.” Similarly, The American Board of Obstetrics and Gynecology has thus far refused to designate cosmetic gynecology a legitimate subspecialty. Though there are many training programs for doctors hoping to earn the skills to enter the field, with none actually legally mandated, botched surgeries are not unheard of. In fact, corrective labiaplasty surgery has virtually become a speciality area unto itself. (Do a quick Google search for “labiaplasty revision” and you’ll get thousands of hits, almost all for clinics offering reparative surgeries.) It’s no wonder that when I asked Dr. Rowe the most important concern a woman planning to have labiaplasty should consider, he suggested that she ensure that her doctor is a board certified, experienced surgeon. “Make sure you go to somebody who’s qualified. There’s a time to cut corners – this isn’t one of them. It’s very difficult to fix something that’s botched, as opposed to getting it right the first time.” He noted that botched surgeries can lend to a whole host of fairly gnarly issues, from chronic yeast infections to painful bleeding to more serious problems.

Even well-known clinicians seem to be developing versions of the surgery that are ever more invasive. In fact, one the most popular types of labiaplasty doesn’t just reduce the labia minora, it cuts them clean off. Dr. Red Alinsod, a California urogynecologist whose previous claim to fame was branding a woman’s name into her uterus after removing it, is today best known as the developer of “The Barbie.” If the surgery’s nickname conjures up the image of the completely smooth crotch of its fashion-doll namesake, you’re not too far off. With the labia minora completely removed, patients emerge with a vagina whose lips appear to be sealed, so to speak, with nothing peeking out from inside. “I kept getting patients who wanted almost all of it off,” Alinsod said in an 2013 interview with Guernicamagazine. “They would come in and say, I want a ‘Barbie.’ So I developed a procedure that would give them this comfortable, athletic, petite look, safely.”

Make no mistake: Not every patient is going under the knife to get a miniaturized, “beautified” vagina. Long labia are a genuine physical problem for some women, and oversized inner (and more rarely, outer) lips can cause discomfort, particularly during rigorous activities such as exercise or sex. British filmmaker Ellie Land’s 2012 animated documentary, “Centrefold,” features interviews with women who’ve undergone labiaplasty. One describes her old inner labial skin as having had “mobility issues,” and says it often got in the way during penetrative vaginal sex. Another woman recounts dealing with problems such as soreness and chafing. “The labia would rub and cause me a lot of pain,” she says. “Sometimes I even had little blisters.”

But overwhelmingly, labiaplasty is a cosmetic solution. According to a 2011 study conducted by the International Society of Sexual Medicine, a stunning – though hardly surprising – 87 percent of women who opted for vaginal rejuvenation did so purely for cosmetic reasons. I spoke with Lily Harper (not her real name), whose 2006 labiaplasty was performed by Dr. Gary Alter, a titan in the industry who’s appeared TV shows like “Dr. 90210.” “My whole life, one side hung out, whereas the other side was neat, and was within the outer lip,” Harper told me. “So when I would look in the mirror, I didn’t like the way it looked. No boy ever mentioned it. It wasn’t like people said, ‘Oh that’s weird.’ Or even that I thought it was weird. It was that I didn’t like the way it looked. It was a purely cosmetic decision.” She says the surgery gave her a vagina she could be unselfconscious, and even confident, about. “Now I just feel less like, the first time a guy sees it, I don’t have that little passing feeling of, “Oh, I hope he doesn’t mind that thing.’”

Not that most guys would likely have noticed. In 2013, Dr. Lauren Streicher, Associate Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, conducted a survey in which she asked heterosexual men, “Do you wish your partner’s labia were shorter?” Ninety-eight percent of respondents answered in the negative. (She didn’t ask, but the other two percent probably live with their parents.) Yet, as Streicher points out, nearly 30 percent of women feel their labia are too long – an idea they’re clearly getting from somewhere. As Harper puts it, “When women look in pornographic magazines or watch porno movies, they see these [vaginas] that are very tiny and the lips are really small. Or everything is symmetrical and perfect.” And there are other sources sending the message that vaginas should be high and tight. A 2011 Dutch study found that “90 percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents society's ideal.” The same study also found that male doctors are “more inclined to opt for a surgical reduction procedure” for their female patients. What’s more, plastic surgeons are more likely than gynecologists and general practitioners to consider large labia “distasteful and unnatural” and, regardless of the size of a woman’s labia minora, more apt to consider labiaplasty a go-to solution.

The myriad controversial aspects of the surgery have earned it more than a few comparisons to female genital cutting, a millennia-old practice in 29 Sub-Saharan African and Middle Eastern countries, as well as parts of Latin America and South and Central Asia. While the UN has become increasingly intolerant of FGC, it’s difficult not to recognize some kinship between labiaplasty and the practice, which the World Health Organization broadly summarizes as “procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.” The relationship between the two is strengthened by the fact that FGC has been medicalized – meaning performed in sterile environments by doctors and other healthcare practitioners – in countries such as Egypt. Obviously, the adult women undergoing labiaplasty and other forms of vaginal rejuvenation live in the world’s richest countries and not only volunteer for the surgery, but pay significant sums for it. Conversely, those subjected to FGC are overwhelmingly young women under the age of 15, almost none of whom have a choice in the matter. Still, if outdated cultural attitudes are to be blamed for the persistence of FGC – as they so often are by human rights organizations and the media – perhaps we should carefully consider the driving forces behind so many labiaplasties. At the very least, there’s a certain irony to the alarm over news that female genital mutilation cases have recently doubled in the U.S., given that they’re happening in the shadow of labiaplasty’s rapid expansion.

In recent years, there’s been a backlash against the surgery among women opposed to the beauty standards they believe stigmatize labia lengths. The “labia pride” movement dovetails with numerous other feminist efforts to oppose notions of beauty that disempower or otherwise objectify women. In late 2011, the movement led to the “Muff March,” a street protest organized by London’s UK Feminista, specifically in response to the growing popularity of surgical vagina redesigning. The Large Labia Project, a site that is very NSFW, btw, invites women to send commentary along with pictures of their labia, where site administrators assure subjects their vaginas are both normal and beautiful. And the New View Campaign, which proclaims its mission to be simply “challenging the medicalization of sex,” has organized a broad range of international conferences and political actions that pushback against the growth of cosmetic gynecology.

Is there really any surprise that labiaplasty is growing in a period when popular media and culture keep cranking up the crazy about what women should do to their vaginas? Recent suggestions have included giving your vulva a facial, feeding it breath mints, getting it high and – per Gwyneth Paltrow – steaming it clean, because obviously, that thing is just toxic. Capitalism relies on insecurity as a profit driver, and this is yet another example that proves that rule. And really, who among us has fully avoided buying into the smoke and mirrors of media manipulation and cultural notions of what is and isn’t beautiful? The reality is, for some women, labiaplasty has made all the difference between a life of chronic anxiety and doubt and one of pleasure and confidence. As Harper told me when I spoke to her, “If there’s something about the way you look there that’s making you feel not sexy, there are things you can do about it. If you’re stopping guys from going down on you because you’re scared they’re gonna be weirded out, research the surgery. Because you’re missing out on something.” In other words, do you. “You’re never gonna have a [vagina] like the girls in the dirty movies. Forget that. And mine doesn’t look like that. But to me now, it’s beautiful.”

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