New research aims to examine why more girls are seeking cosmetic surgery on the genitals

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At just 13, Melanie* began to worry about what her vagina looked like after she noticed drawings in books that looked different on her body.


Melanie’s worried mother took her to a doctor, who referred her to the Royal Melbourne Children’s Hospital, where she was assured she was perfectly normal.


Girls as young as 11 are seeking cosmetic surgery on their genitalia, according to University of Melbourne researcher Emma Barnard.


“Something has changed in the last 10-15 years to make women and girls more aware of the appearance of their genital anatomy,” Ms Barnard said.


“In the 10 years to 2014, there were 12,190 [labiaplasty] procedures billed to Medicare.


“And only a quarter of that number … happened to women under the age of 25.”


Ms Barnard interviews young women who sought medical advice about their genital appearance as part of a pilot study investigating the increase in young girls seeking cosmetic surgery.


Ms Barnard said the fact that Medicare no longer covers such surgeries unless a surgeon provides evidence that it is clinically indicated means there is less scope for a discount associated with a lipoplasty performed for cosmetic reasons.


However, those who want cosmetic genital surgery can have it done privately after having a referral.


Figures from the Royal Children’s Hospital show that the median age of 41 girls and young women referred to hospital between 2000-12 with concerns about the appearance of their labia was 14.5 years. In nearly a quarter of cases, it was the mother who was concerned.


Medicare claims for labiaplasty and vulvoplasty more than doubled from 707 in 2002–03 to 1584 in 2013–14, with the number of claims among 15–24-year-olds similar to women aged 25–44.


“What the Medicare figures show is that during this period the numbers were systematically increasing,” he said.


“But these figures are likely to be underestimates because they don’t count anything that wasn’t getting a Medicare rebate.”


Female genital cosmetic surgery usually involves “labiaplasty” to cut the edges of the labia minora so that it does not extend beyond the outer folds of skin, the labia majora. It can also be extended to procedures such as colpoplasty to tighten the vagina or vulvar lipoplasty to remove fat around the vulva.


According to Ms Barnard, many of the participants in her study said that as girls they had only seen vaginas in stylized or perfumed images in textbooks, magazines, social media or online. Fashions for Brazilian waxing, tight clothing and G-strings were also influential, but, perhaps surprisingly, pornography did not seem to play a major role.


Dr Magdalena Simonis, author of the RACGP guidelines on aesthetic surgery of the female genital organshe said newsGP The internet plays a big role in shaping women’s perception of what is ‘normal’.


“What we do know is that there is no such thing as a normal vulva,” said Dr. Simonis.


“A lot of young women say there’s a certain normal look, and normal is also what equates to desirable.”

Dr Magdalena Simonis, author of the RACGP guidelines on female genital cosmetic surgery, says it is important for GPs to always take the time to listen to their young patients’ concerns.

Dr. Simonis said there is no research related to the long-term effects of removing genital tissue from young women on sexual function.


“Their bodies haven’t reached full maturity yet,” Dr. Simonis said.


“And by making the decision to remove a genital tissue that actually serves as a sex organ that is normal and sexually responsive before they even have sexual experiences … they are exposed to potential harm.”


In 2016 the Medical Council of Australia recommended that anyone aged 18 or under seeking any major cosmetic surgery, including liposuction, must undergo a mandatory psychological assessment conducted either by a doctor unrelated to the surgeon performing the procedure , psychologist. or a psychiatrist.


There is also a mandatory cooling-off period of three months before undertaking such an operation once requested.


Should a patient approach them about cosmetic genital surgery, Dr Simonis recommends GPs listen to the young woman’s concerns and investigate any underlying issues.


“What she might be coming up with is a concern about her genital appearance, but where it’s actually coming from might be misinformation she’s received from a website, bullying from friends at school who have been seeing each other naked in the … locker room. ‘ he said.


“The role of GPs is to listen … and then really offer her the opportunity to see the range of images either online using something like lip library [featuring a photo gallery of unaltered images of women’s labia].’


Dr Simonis said GPs should ask about the patient’s mental health and how this particular issue is affecting them, in order to explore whether they may be dealing with body dysmorphic disorder, an obsession with a particular body part or any eating disorders. Any sexual abuse and family attitudes towards sexuality and sex also play an important role.


After establishing trust, Dr. Simonis believes the GP should offer to examine the patient but have an escort, especially in the case of a male doctor.


“I would really give the young person a mirror to show me what it is that they don’t like about themselves,” she said.


“If they say ‘no’ or refuse to touch themselves, it’s usually a sign of deeper anxiety around their genitalia. Self-loathing, loathing is usually an indicator of something that is a bigger problem.’


Dr Simonis said doctors should refer to another doctor if they feel uncomfortable examining a young woman. He also believes that any decisions about surgery should be made between all the people involved.


“It’s a team decision, between the doctor, the adolescent, the parent or guardian who cares, the psychologist or psychiatrist and the gynecologist or surgeon,” he said.



RACGP resource

Cosmetic Female Genital Surgery: A Resource for General Practitioners and Other Health Professionals provides information on surgery, factors driving demand and a set of practical recommendations on how to manage women who seek referral for surgery or express concerns about their genitalia.

* Not her real name.

cosmetic surgery of female genitalia labiaplasty colpoplasty vulvar lipoplasty