Despite the implication of photo euphemisms, not all vulvas look like symmetrical coin purses or pretty orchids. Yet teen girls are increasingly asking gynecologists and plastic surgeons to trim their labia minora, or the inner lips. The requests are mostly for cosmetic reasons, though some girls do deal with pain or irritation during exercise or sex.
The American Society of Plastic Surgeons said it does not track labiaplasty numbers in teens or adults but the American Society for Aesthetic Plastic Surgery says that 400 girls 18 and younger had the procedure in 2015, up 80 percent from the 222 in 2014. Those are not huge numbers, but they don’t include procedures done by gynecologists, if any.
Still, interest in teen labiaplasty is enough of a trend that it prompted the American College of Obstetricians and Gynecologists to release new guidelines that address the procedure for the first time, and say that there’s no consensus definition for enlarged labia (a.k.a. labial hypertrophy) or for surgical treatment thereof.
As Julie Strickland, MD, the chairwoman of ACOG’s committee on adolescent health care, told the New York Times, labiaplasty isn’t a minor surgery: It can lead to numbness, pain, scarring, or decreased sexual sensation. ACOG advises that doctors first assure patients that variation is normal — akin to the mission of the Tumblr-based Large Labia Project — and offer nonsurgical treatment options in addition to screening patients for body dysmorphic disorder.
The guidelines don’t rule out cosmetic labiaplasty or recommend waiting until a specific age (like 18 for breast reduction or augmentation). Rather, Dr. Strickland said, consideration of surgery should wait until “growth and development is complete.” That sounds to us like waiting until 18. ACOG has already advised against labiaplasty in adults, saying it hasn’t been proven to be safe or effective and can cause complications.
The gyno group doesn’t claim to know exactly why interest in labiaplasty has increased, but they think it’s a combination of awareness of the procedure itself, the fact that there are “idealized” images of vulvas online, the trend in pubic-hair removal, and, public enemy No. 1, tight pants. (For what it’s worth, Debby Herbenick, a professor and researcher at the Kinsey Institute at the University of Indiana, previously told the Cut that she thinks the opposite might happen in adult women when it comes to pubes — perhaps removing hair helps women like their genitals more.)
These guidelines are certainly helpful but there will still be women and girls who head directly to a plastic surgeon before talking to their gyno — or after getting an answer they don’t want to hear.