Designer vagina NHS operations unwarranted
Women seek labial reduction surgery for cosmetic reasons
Published on 24/08/11Women with normal sized labia minora still seek labial reduction surgery for cosmetic reasons finds new research published today in BJOG: An International Journal of Obstetrics and Gynaecology.
Women with normal sized labia minora still seek labial reduction surgery for cosmetic reasons finds new research published today (24 August) in BJOG: An International Journal of Obstetrics and Gynaecology.
Female cosmetic genital surgery is increasingly popular and the number of labial reduction procedures in the National Health Service has increased five fold in the past 10 years.
This is the first study looking specifically at the labial dimensions of women seeking cosmetic surgery. It looked at 33 women who had requested labial reduction surgery and who had been referred by their general practitioner. The average age of the group was 23.
All of the women were examined by a gynaecologist and the width and length of the labia minora were measured and compared with published normal values.
The study found that all women seeking surgery had normal sized labia minora, with an average width of 26.9 mm (right), and 24.8 mm (left).
Three women out of the total number were offered surgery to address a significant asymmetry. Of the women who were refused surgery, 12 (40%) of the women still remained keen to pursue surgery by another route, 11 women accepted a referral for psychology and one participant was referred to mental health services.
The women were asked what they would like to achieve with surgery and 20 women (60%) wished to make the labia smaller to improve appearance. Other reasons included reducing discomfort, improving confidence and wanting to improve sexual intercourse.
The study also looked at how old the women were when they first became dissatisfied with the labia minora. Twenty-seven women (81%) were able to pinpoint this. Of these, 5 women (15%) reported this to be under the age of 10, 10(30%) between the ages of 11 and 15, 5 (15%) between 16 and 20, 4 (12%) in their twenties, and 3 (9%) in their thirties.
Reasons for this dissatisfaction included an increasing self awareness of the genital area, physical discomfort, comments from a partner and watching TV programmes on cosmetic genital surgery.
Sarah Creighton, UCL Elizabeth Garrett Anderson Institute of Women’s Health and lead author said:
“It is surprising that all of the study participants had normal sized labia minora and despite this nearly half were still keen to pursue surgery as an option.
“A particular concern is the age of some of the referred patients, one as young as 11 years old. Development of the external genitalia continues throughout adolescence and in particular the labia minora may develop asymmetrically initially and become more symmetrical in time.”
BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added:
“Many women who are worried may have normal sized labia minora. Clear guidance is needed for clinicians on how best to care for women seeking surgery.”
About 2,000 genital cosmetic operations are paid for by the NHS each yearGPs should not refer women who are well but worried for female genital cosmetic surgery on the NHS, say experts.
Specialists at a Central London teaching hospital say they received 30 such referrals, mainly from family doctors, over the past three years.
This included eight schoolgirls - one as young as 11 - the British Journal of Obstetrics and Gynaecology reports.
Experts say doctors need clear guidance on how best to care for women who mistakenly believe they need surgery.
The British Association of Aesthetic Plastic Surgeons says medics need to determine whether a problem exists or whether an alternative solution may be preferable, but offers no advice on how to judge the problem, say the researchers from University College London's Women's Health Institute.
“Start Quote
End Quote Lead investigator Dr Sarah CreightonIt's shocking, particularly because we are seeing girls who are really young”
They say it may be simpler to ban the procedure in the NHS altogether, leaving it to private practices. Some Primary Care Trusts do this.
And private provider Bupa says the procedure is purely cosmetic and does not offer financial cover for the procedure.
The NHS has no such restriction.
The experts who carried out the latest work said: "A private medical insurance company seems to be able to come to a conclusion when professional bodies are reluctant to act.
"National care standards are urgently needed."
Boom industryDr Sarah Creighton and colleagues believe the future demand for so-called "designer vagina" operations or labial reductions is potentially infinite and is driven by society's wider and growing desire for cosmetic surgery in general and changing expectations about what is a desirable appearance for women.
"It's shocking, particularly because we are seeing girls who are really young. They are asking for surgery that is irreversible and we do not know what the long-term risks of the procedure might be."
She said latest figures for England show about 2,000 of the procedures are paid for by the NHS each year.
"That's probably just the tip of the iceberg. It's a massive boom industry in the private sector."
For the study, they reviewed all 33 women referred to their clinic between 2007 and 2010 with requests for a labial reduction.
Most of the women were seeking help because they were concerned about appearance. Only a fifth wanted the surgery to reduce discomfort. One woman said she felt compelled to have the surgery after seeing a television programme on cosmetic genital surgery.
“Start Quote
End Quote Paul Banwell British Association of Aesthetic Plastic SurgeonsIf the concerns are aesthetic, that should probably be seen in the private sector”
A third of the women said they had looked at advertisements about the surgery before seeing a doctor.
Upon examination, all of the women were deemed to have "normal" genitalia by the doctors. But three were offered surgery to address "a significant asymmetry". The remaining 30 were refused any procedure.
All of the women were offered the options of sessions with a clinical psychologist to explore issues leading to their request for surgery.
Twelve of the women said they would be seeking a second opinion and would consider going private to get the surgery if they still could not get it on the NHS.
Paul Banwell, of the British Association of Aesthetic Plastic Surgeons, said the operation was merited for some women, particularly those with functional concerns like discomfort.
"But if the concerns are aesthetic, that should probably be seen in the private sector."
He said he often dissuades patients from having the surgery and explains to them that there is a spectrum of 'normal' when it comes to female anatomy.
"We welcome the opportunity to be involved in suggesting guidelines and help for healthcare professionals seeing patients who are interested in labiaplasty."
