tag:theconversation.com,2011:/uk/topics/genital-appearance-19257/articlesGenital appearance – The Conversation2020-10-06T19:20:16Ztag:theconversation.com,2011:article/1474382020-10-06T19:20:16Z2020-10-06T19:20:16ZIs my vulva normal? Not all genitalia look the same, and we’re trying to teach teenagers that<figure><img src="https://images.theconversation.com/files/361764/original/file-20201006-20-vgenr6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/cf1BbWH6qyc">Sharon McCutcheon/Unsplash</a></span></figcaption></figure><p>Cosmetic genital procedures are becoming increasingly popular in women. The <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2011.03088.x">most common</a> is labiaplasty, which involves the surgical reduction of the inner lips of the vulva — the <em>labia minora</em>. </p>
<p>Most women who undergo labiaplasty in Australia do so through the private sector, which does not require reporting of statistics. But in the United States <a href="https://www.surgery.org/sites/default/files/Aesthetic-Society_Stats2019Book_FINAL.pdf">procedure numbers have increased 30%</a> in the past five years alone. </p>
<p>Of the labiaplasty procedures performed in 2018 in the United States, <a href="https://www.surgery.org/sites/default/files/ASAPS-Stats2018_0.pdf">4% were on girls aged under 18</a>. At this age, genital development is not yet complete and there is <a href="https://journals.lww.com/clinicalobgyn/Abstract/2020/09000/The_Adolescent_and_Genital_Dissatisfaction.8.aspx">significant risk of harm</a> such as scarring, loss of sensation and painful sexual intercourse. </p>
<p>We showed teenage girls an educational video on genital self-image. After the video, girls felt better about their genital appearance and could more accurately name anatomical structures than before.</p>
<h2>Genital concerns start early</h2>
<p>To have a chance of making a positive impact on how adult women feel about their genital appearance, we have to reach them as adolescents.</p>
<p>Like appearance concerns focused on other parts of the body, <a href="https://academic.oup.com/asj/article/36/4/469/2613943?searchresult=1">our research</a> suggests genital appearance concerns in girls start at a young age, particularly around 13. Most women undergo cosmetic genital surgeries in their 20s and 30s as they have the finances to do so by this age, but they have often struggled with their concerns for a number of years. </p>
<p>During puberty, the <em>labia minora</em> become more prominent after having been more hidden behind the <em>labia majora</em> (the outer genital lips) in childhood. One side of the <em>labia minora</em> may grow faster than the other, producing an “uneven” appearance. </p>
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<p>
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Read more:
<a href="https://theconversation.com/women-dont-always-get-what-they-want-from-labiaplasty-68431">Women don't always get what they want from labiaplasty</a>
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<p><em>Labia minora</em> are typically <a href="https://www.tandfonline.com/doi/full/10.1080/13691058.2013.780639">airbrushed out of sexualised media images</a> so girls may think their protruding or uneven <em>labia minora</em> are unsightly. This is particularly the case if they <a href="https://journals.sagepub.com/doi/10.1177/0959353516680233">remove their pubic hair</a>, which many teenage girls do. </p>
<p>This is also a time when girls may think about becoming sexually active, which means they may be showing their genitals to a sexual partner for the first time. If this sexual partner has a <a href="https://academic.oup.com/asj/article/36/8/920/2613944?searchresult=1">negative reaction</a> to their genitals, it can lead to genital concerns and pursuing surgery. </p>
<h2>How to educate teenage girls about their genitals</h2>
<p>To educate teenage girls on such a sensitive topic as genital self-image, we designed a two-minute animated video. The video was age-appropriate as it did not include any explicit images. It discussed genital anatomical features and their function, as well as the diversity of genital appearance, and challenged the airbrushed “ideal” for genital appearance. </p>
<p>The video also showed examples of the different types of genitalia through artistic representations and medical illustrations.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/361770/original/file-20201006-24-1v7msn0.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A screenshot of the educational video, that shows what is commonly referred to as " src="https://images.theconversation.com/files/361770/original/file-20201006-24-1v7msn0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361770/original/file-20201006-24-1v7msn0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361770/original/file-20201006-24-1v7msn0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361770/original/file-20201006-24-1v7msn0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361770/original/file-20201006-24-1v7msn0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361770/original/file-20201006-24-1v7msn0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361770/original/file-20201006-24-1v7msn0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The video challenged girls’ conceptions about the ‘ideal’ genital appearance.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1740144520303843">Our study</a> involved 343 girls, aged 16-18, living in Australia via social media. It was published recently in the journal <a href="https://www.journals.elsevier.com/body-image">Body Image</a>.</p>
<p>We conducted the study through an online survey. All girls completed short questionnaires about how satisfied they were with their genital appearance, how likely they were to undergo labiaplasty in the future, as well as their ability to match up genital anatomy terms (such as vulva, clitoris and <em>labia minora</em>) with the correct anatomical structure on a diagram. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-normal-anyway-gps-should-discourage-women-from-unnecessary-genital-surgery-45650">What's normal, anyway? GPs should discourage women from unnecessary genital surgery</a>
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<p>We then showed half the girls our video and the other half a control video. The girls then completed the same questionnaires on genital appearance satisfaction, consideration of labiaplasty and genital anatomy knowledge so we could compare their pre- and post-video answers. </p>
<h2>What we found</h2>
<p>The video improved girls’ genital anatomy knowledge from around 75% to almost 100% correct on average.</p>
<p>Compared to previous research in <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144515001382?via%3Dihub">adult women</a>, the teenage girls were considerably more concerned about their genital appearance and likely to undergo labiaplasty prior to watching the video. </p>
<p>However, the girls were about 7% more satisfied with their genital appearance and 8% less likely to undergo labiaplasty in the future after watching the video. These improvements were on the smaller side, but impressive given the video was only two minutes long. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/361769/original/file-20201006-16-wteybj.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An anatomically correct, and labelled, drawing of a female genital area." src="https://images.theconversation.com/files/361769/original/file-20201006-16-wteybj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361769/original/file-20201006-16-wteybj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=471&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361769/original/file-20201006-16-wteybj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=471&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361769/original/file-20201006-16-wteybj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=471&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361769/original/file-20201006-16-wteybj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=592&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361769/original/file-20201006-16-wteybj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=592&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361769/original/file-20201006-16-wteybj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=592&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Most girls were able to match the correct names to their anatomy.</span>
<span class="attribution"><a class="source" href="https://www.youtube.com/watch?v=OOhgwjEnfAA">Screenshot/TedX</a></span>
</figcaption>
</figure>
<p>We also asked girls for recommendations for teaching other young people about genital self-image. Along with the common recommendation to show our video, the girls talked about reaching people at a young age, and teaching it to all genders.</p>
<p>One girl told us:</p>
<blockquote>
<p>Get in as early as possible. Girls begin to worry and be confused about the changes in their bodies long before sex education is usually taught at schools. It would also help to normalise talking about female genitalia at a younger age because there is such a shame and stigma attached to it.</p>
</blockquote>
<p>Another girl said:</p>
<blockquote>
<p>Showing young people images of all types of female genitals to show them that what is seen in popular culture and in particular porn is not how all female genitals look. Explaining to females that they should not be concerned with their genital appearance and educating boys and girls not to comment on women’s genitals.</p>
</blockquote>
<p>We need to start talking with people as young as possible in an accurate way, including information about the diversity in genital appearances. </p>
<p>Part of this discussion involves the need to challenge the messages young people are receiving in wider media by improving their <a href="https://www.tandfonline.com/doi/full/10.1080/00224499.2018.1556238">critical media-engagement skills</a>. This has the capacity to change people’s perspectives about what bodies are considered normal and desirable, increasing their body confidence and sexual self-esteem.</p><img src="https://counter.theconversation.com/content/147438/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Sharp receives funding from an NHMRC Early Career Research Fellowship (Health Professional Category). She is working in collaboration as part of the Active* Consent program, to develop an online sexual media literacy intervention which challenges genital appearance norms and aims to increase body confidence among adolescents of all genders.</span></em></p><p class="fine-print"><em><span>Kate Dawson receives funding from Lifes2Good Foundation. Kate is a team member of the Active* Consent program, and is working to develop an online sexual media literacy intervention which challenges genital appearance norms and aims to increase body confidence among adolescents of all genders.</span></em></p>To have a chance of making a positive impact on how adult women feel about their genital appearance, we have to reach them as adolescents.Gemma Sharp, NHMRC Early Career Senior Research Fellow, Monash UniversityKate Dawson, Postdoctoral Research Fellow, University of GalwayLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1251352019-12-09T01:11:07Z2019-12-09T01:11:07Z‘How do I clean my penis?’<figure><img src="https://images.theconversation.com/files/305101/original/file-20191204-70167-1dlj45h.png?ixlib=rb-1.1.0&rect=538%2C0%2C2958%2C2000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wes Mountain/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><blockquote>
<p>Growing up, no one ever gave me the rundown on how or what I should do to keep my penis clean […] I’ve never read any reliable answer beyond washing it with water. Do I use soap? Any soap? How normal is smegma? If my penis gets itchy from smegma should I go see a doctor? If so, my GP or a urologist? — Anonymous</p>
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<h2>Key points</h2>
<ul>
<li>clean under the foreskin, using soap, but not too much</li>
<li>smegma is normal</li>
<li>if you have any concerns, see your GP.</li>
</ul>
<p><a href="https://theconversation.com/au/topics/i-need-to-know-66587"><img src="https://images.theconversation.com/files/290837/original/file-20190904-175686-polw3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" width="100%"></a></p>
<p>It’s a shame some people think talking about cleaning and caring for our genitals is embarrassing or taboo. We probably know more about hair care than penis care.</p>
<p>The penis is simply another part of our anatomy, so cleaning should be relatively straight forward.</p>
<p>If you’ve been circumcised, where your foreskin was removed soon after birth, your penis will look something like the one in the diagram (below, right), with the head (or glans) always exposed.</p>
<p>But if you have a foreskin (below left and centre), there are some extra things to think about when washing, which we’ll get to soon.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Foreskin facts</h2>
<p>But first, some foreskin facts. From around the time you turn five, your foreskin <a href="http://www.cirp.org/library/hygiene/camille1/">separates</a> from the head of your penis, bit by bit. This allows you to pull back your foreskin (retract it). In some boys, the foreskin can stay partially stuck to the head of the penis until puberty.</p>
<p>You should <a href="https://www.berghahnjournals.com/view/journals/boyhood-studies/1/2/bhs010206.xml">never forcibly pull back</a> your foreskin. That’ll be painful, you could bleed, you could scar, or have other complications.</p>
<h2>OK, now for the washing part</h2>
<p><a href="http://www.cirp.org/library/hygiene/camille1/">Once your foreskin separates easily from the glans</a>, gently retract and clean underneath the foreskin with each bath or shower. Then, after washing, pull the foreskin forward to its normal position.</p>
<p>When it’s time to dry off, retract the foreskin again so you can dry the head of the penis with a towel. Then, you guessed it, pull the foreskin forward to its normal position.</p>
<p>It’s OK to clean with soap whether you have a foreskin or not. But generally, too much soap is worse than none at all. Excessive cleaning removes essential body oils that would normally keep our skin moist and reduce friction. If you have sensitive skin, you can use a soap-free wash from the chemist.</p>
<h2>What about smegma?</h2>
<p><a href="https://www.healthline.com/health/smegma">Smegma</a> is a thick, whitish discharge consisting of a build-up of dead skin cells, oil and other fluids under the foreskin. And it’s very useful. It protects and lubricates the penis. </p>
<p>Some people have oilier skin than others and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1464-410x.1999.0830s1034.x">tend to have more smegma</a>.
So some smegma is normal, but if you have too much or it becomes smelly, you may need to clean more.</p>
<h2>Things to watch out for (and when to see your GP)</h2>
<p>If the head of your penis becomes painful, red, itchy and has a discharge, you may have a treatable condition called <a href="https://www.mshc.org.au/SexualHealthInformation/SexualHealthFactSheets/BALANITIS/tabid/134/Default.aspx#.XcJiPfZuKUk">balanitis</a>.</p>
<p>It’s more common if you have a foreskin. And the bacteria and fungus that cause it like the warm and moist conditions under there.</p>
<p>Skin disorders, infection, poor hygiene, friction from sexual activity, and using too much soap all <a href="https://www.dermnetnz.org/topics/balanitis/">cause the condition</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-make-your-next-sexual-health-check-less-erm-awkward-72498">How to make your next sexual health check less, erm ... awkward</a>
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</em>
</p>
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<p>You can clear a mild case with good hygiene and simple treatments, such as an antiseptic or antifungal cream. You can buy these from any pharmacy. In addition to the medication, the cream itself helps protect and moisturise the inflammed skin. </p>
<p>If you have balanitis you may need to be more careful than usual to avoid urine irritating your inflamed skin. Retract your foreskin when you urinate. Dry the head of the penis gently after you finish.</p>
<p>If your penis is still inflamed after a week of these simple measures it’s <a href="https://www.aafp.org/afp/2018/0115/p102.html">best to see your GP</a>. They can then investigate other causes, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK537143/">psoriasis or an allergy</a>.</p><img src="https://counter.theconversation.com/content/125135/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s a surprisingly common question. Here’s what you need to know.David King, Senior Lecturer in General Practice, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/684312016-11-29T19:16:55Z2016-11-29T19:16:55ZWomen don’t always get what they want from labiaplasty<figure><img src="https://images.theconversation.com/files/147837/original/image-20161129-22735-r2g0ne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australian rates of labiaplasty – sometimes called 'the Barbie surgery' – have doubled since 2001. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/173260?src=9IWgmfitBEkTCfLlyjaiuw-1-68&id=173260&size=huge_jpg">Shutterstock/Uber Images</a></span></figcaption></figure><p>Labiaplasty is the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03088.x/full">most common</a> form of female genital cosmetic surgery and involves surgical reduction of the <em>labia minora</em> or the inner lips of the vulva. </p>
<p>However we still don’t really know what impact the procedure has on the lives of women who choose to have it. This is not that surprising given female genitals are still considered <a href="http://www.tandfonline.com/doi/abs/10.1080/02646830020032374">taboo</a>. The words “vulva” and “vagina” are difficult to say for most people, never mind an entire discussion on the topic!</p>
<p>But these questions can be addressed through research. Our <a href="http://journals.lww.com/plasreconsurg/Abstract/2016/12000/Psychological_Outcomes_of_Labiaplasty___A.11.aspx">latest study</a> shows although women are pleased with how their genitals look after labiaplasty, their self-esteem and general sexual confidence do not improve. This sort of information is vital to help women weigh up whether labial surgery is the right option for them.</p>
<h2>Rising rates of labiaplasty</h2>
<p>Labiaplasty has become increasingly popular over the last 10-15 years in Western countries, including in Australia. From 2001 to 2013, the number of these procedures <a href="http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp">more than doubled from 640 to 1,605</a> in public patients across Australia. These numbers do not include women undergoing procedures in the private sector, for whom we have no national data.</p>
<p>In <a href="https://www.mja.com.au/journal/2016/205/8/vulvoplasty-new-south-wales-2001-2013-population-based-record-linkage-study#1">NSW</a> specifically, numbers in both public and private hospitals rose from 256 in 2001 to 421 in 2013, representing a total increase of 64%.</p>
<p>Although there is a common misconception teenagers are the age group most interested in labiaplasty, women are most often aged between <a href="https://www.mja.com.au/journal/2016/205/8/vulvoplasty-new-south-wales-2001-2013-population-based-record-linkage-study#1">25 and 34</a> when they undergo surgery.</p>
<h2>Why do women have ‘the Barbie surgery’?</h2>
<p>Although there are physical or functional reasons for having labiaplasty (discomfort participating in sports like <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03088.x/full">cycling</a> or <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/psychological-characteristics-and-motivation-of-women-seeking-labiaplasty/350027B1EBCB5050A0CEFA57FAF2C38F">during sexual intercourse</a>), most women do it due to reported unhappiness with their <a href="http://asj.oxfordjournals.org/content/36/4/469">genital appearance</a>. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=790&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=790&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=790&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=993&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=993&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=993&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Labiaplasty involves cosmetic reduction of the labia minora that surround the vagina.</span>
<span class="attribution"><a class="source" href="http://www.labialibrary.org.au/">The Labia Library/Women's Health Victoria</a></span>
</figcaption>
</figure>
<p>Women desire a smooth genital surface, with <em>labia minora</em> (the inner lips) that do not protrude beyond the <em>labia majora</em> (the outer lips). As a result, this surgery is sometimes nicknamed the “<a href="http://link.springer.com/article/10.1007/s00192-013-2117-8">Barbie surgery</a>” as these dolls have no obvious genital features.</p>
<p>The way women’s genitals are portrayed in the media – particularly in pornography and on the internet – may be promoting this “<a href="http://pwq.sagepub.com/content/39/2/182">ideal</a>”. And men appear to be picking up on this too, prompting some to <a href="http://asj.oxfordjournals.org/content/36/8/920">criticise</a> their partner’s genitals. As a result, an increasing number of women are becoming concerned their genitals are unacceptable and need to be surgically altered.</p>
<p>But what happens to women after undergoing labiaplasty – do they really get what they were hoping for?</p>
<h2>Labiaplasty won’t fix your sex life</h2>
<p>In our most recent research published in <a href="http://journals.lww.com/plasreconsurg/Abstract/2016/12000/Psychological_Outcomes_of_Labiaplasty___A.11.aspx">Plastic and Reconstructive Surgery</a>, we applied a forward-looking study design to examine psychological outcomes of labiaplasty. We found women experienced significant improvements in satisfaction with their genital appearance from pre- to post-surgery. But we found no significant improvements in any other psychological domains, such as self-esteem and sexual confidence.</p>
<p>Labiaplasty is often <a href="http://bmjopen.bmj.com/content/2/6/e001908.full">advertised online</a> as a way for women to restore self-confidence and esteem, and improve their sexual relationships: our results suggest this is not necessarily the case. Instead, it appears although labiaplasty allows women to stop worrying about their genital appearance, it does not radically change how they view themselves and their intimate relationships.</p>
<p>Our <a href="http://journals.lww.com/plasreconsurg/Abstract/2016/12000/Psychological_Outcomes_of_Labiaplasty___A.11.aspx">research</a> was the first to examine preoperative characteristics of women who are likely to be dissatisfied with their surgical outcomes. We found women who were more psychologically distressed – showing depression and anxiety symptoms in particular – or were currently involved in an intimate relationship were more likely to be dissatisfied after labiaplasty. </p>
<p>Although further investigation is required, we reasoned these women may have had unrealistic expectations for how labiaplasty might improve their psychological well-being or their relationship with their partner, and when this did not happen, they were dissatisfied.</p>
<p>It’s important for doctors to be able to identify these women before they undergo labiaplasty so they can be guided into another form of treatment that may be more beneficial, such as psychological therapy.</p>
<h2>Avoiding disappointment after surgery</h2>
<p>It looks like most women are getting what they want out of labiaplasty in terms of becoming more comfortable with their genital appearance. </p>
<p>But when women have unrealistic expectations for improvements in other areas of their lives such as their self-esteem and sexual relationships, they are more likely to be disappointed. For this reason, we recommend doctors thoroughly explore their patients’ motivations and expectations for labiaplasty so women can get treatment that will best address worries about their genital appearance. </p>
<p>Now we’ve started to identify some of the issues related to women’s dissatisfaction with labiaplasty, we hope our findings might assist doctors when they’re considering a patient’s suitability for cosmetic genital surgery.</p><img src="https://counter.theconversation.com/content/68431/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although women like how their genitals look after labial surgery, self esteem and sexual confidence may not improve.Gemma Sharp, PhD candidate (submitted), Flinders UniversityJulie Mattiske, Senior Lecturer , Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/549062016-02-25T19:02:41Z2016-02-25T19:02:41ZWild sex: when sex roles get reversed, some females develop a ‘penis’<figure><img src="https://images.theconversation.com/files/112432/original/image-20160222-25879-6ts8nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"> A male African jacana bird mounts a female, but who takes the lead in caring for the young?.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-139494011/stock-photo-a-male-african-jacana-mounting-a-female.html">Shutterstock/Dave Montreuil</a></span></figcaption></figure><p>In many species, the males develop elaborated sexual traits to attract females and dissuade potential rival males through competition. Some iconic examples are the extraordinary feathers of the peacock or paradise birds, or the menacing antlers of dominant red deer males.</p>
<p>But how is the role of each sex determined in nature? Why do males generally compete for access to females?</p>
<p>Researchers believe the answer lies in what is known as the <a href="http://theconversation.com/male-female-ah-whats-the-difference-12786">Bateman principle</a>, which suggests that sexual selection acts with more intensity in the sex that invest less in the offspring.</p>
<p>Parental investment was <a href="http://roberttrivers.com/Publications_files/Trivers%201972.pdf">proposed in 1972</a> by the American evolutionary biologist <a href="http://roberttrivers.com">Robert Trivers</a> as a key factor determining which sex is under higher sexual selection pressure.</p>
<p>According to Trivers and the Bateman principle, sexual selection is stronger in the sex that allocates fewer resources to parental investment. The costs associated with the production of (minuscule) sperm cells are lower than those associated to the production of (large) eggs.</p>
<p>This implies males can produce a much larger number of <a href="http://www.nature.com/scitable/definition/gamete-gametes-311">gametes</a> – the cells that merge during sex – than females do, which, in turn, entails important consequences for <a href="http://theconversation.com/male-female-ah-whats-the-difference-12786">differences between the sexes</a>.</p>
<p>In general, females keep investing more in the offspring through parental care such as incubation, nourishment and protection. So parental investment is usually far greater in females, and males compete to get access to them.</p>
<h2>Sex-role reversal</h2>
<p>But examples of sex-role reversal – when females compete more intensely than males to obtain mates – are not rare in nature. In some cases, the evolution of this so-called role reversal comes with stunning adaptations.</p>
<p>There are a variety of examples in nature in which males are the caregivers or females compete for access to mates.</p>
<p>Examples include the <a href="http://www.britannica.com/animal/jacana-bird-family">jacana</a> water birds, New Zealand’s <a href="http://www.britannica.com/animal/kiwi-bird">kiwi</a> birds, the <a href="http://www.britannica.com/animal/tinamou">tinamou</a> birds native to Central and South America and some shorebird species. </p>
<p>Then, there are <a href="http://www.britannica.com/animal/sea-horse">sea horses</a>, among whom males get pregnant and carry the offspring during development; amphibians such as some species of frogs of the genus <em>Dendrobates</em> and; mammals such as the African <a href="http://www.britannica.com/animal/topi">topi</a> antelope (<em>Damaliscus lunatus</em>).<br>
A most amazing process in regards to physiological changes associated to sex-role reversal is found in fishes, such as the hermaphrodite gilt-head bream (<a href="http://www.fao.org/fishery/species/2384/en"><em>Sparus aurata</em></a>). All the individuals are males when they hatch but, when they reach a certain age, they can become females, depending on weight, hormones and social factors.</p>
<h2>Nature pushing borders</h2>
<p>Genital morphology is one of the most <a href="https://theconversation.com/seen-one-seen-them-all-more-to-genitalia-than-meets-the-eye-2046">diverse and rapidly evolving</a> features of animals with sexual reproduction.</p>
<p>In species with traditional sex roles, strong selection due to intense sexual competition has generally shaped more complex genitalia in males than in females.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/112052/original/image-20160219-21502-rbsncg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/112052/original/image-20160219-21502-rbsncg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/112052/original/image-20160219-21502-rbsncg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/112052/original/image-20160219-21502-rbsncg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/112052/original/image-20160219-21502-rbsncg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/112052/original/image-20160219-21502-rbsncg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/112052/original/image-20160219-21502-rbsncg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/112052/original/image-20160219-21502-rbsncg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The spines of the male genitalia of the seed beetle <em>Callosobruchus maculatus</em> damage the female reproductive tract during copulation.</span>
<span class="attribution"><span class="source">Eduardo Rodriguez-Exposito</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Males frequently exhibit adaptations in the genitalia or the ejaculates (for instance, regarding seminal fluid proteins) to improve sperm transfer, stimulate a female’s uptake of sperm, or to outcompete rivals. In some species, such as in some damselflies, males even remove the sperm transferred to the female by previous males.</p>
<p>But, as with almost anything in nature, there are exceptions that commonly prove the evolutionary processes underlying general patterns.</p>
<p>Among vertebrates, the females of the spotted hyena (<a href="http://animaldiversity.org/accounts/Crocuta_crocuta/"><em>Crocuta crocuta</em></a>) have developed a pseudo-penis structure. This is the result of an elongation of the clitoris due to a hormonal boost during the final stage of cub development.</p>
<p>This structure, which protrudes several inches from the female’s body and is very narrow, makes it more difficult to achieve successful copulation by males as well as giving birth for females. Although their genitals are female in function, they are male in form.</p>
<p>But another remarkable example, which constitutes a huge step towards understanding the selective pressures acting on the sexes, has been <a href="http://www.nature.com/news/female-insect-uses-spiky-penis-to-take-charge-1.15064">recently observed</a> in cave insects of the genus <em>Neotrogla</em>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/112047/original/image-20160219-12817-1etcvht.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/112047/original/image-20160219-12817-1etcvht.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/112047/original/image-20160219-12817-1etcvht.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/112047/original/image-20160219-12817-1etcvht.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/112047/original/image-20160219-12817-1etcvht.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/112047/original/image-20160219-12817-1etcvht.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/112047/original/image-20160219-12817-1etcvht.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/112047/original/image-20160219-12817-1etcvht.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Two <em>Neotrogla curvata</em> engaged in sex, the female is on top.</span>
<span class="attribution"><span class="source">Current Biology, Yoshizawa et al.</span></span>
</figcaption>
</figure>
<p>In this species, males lack an intromittent, or penis-like, organ and females have developed a penis-like structure (called gynosoma), which is used <a href="http://www.sciencedirect.com/science/article/pii/S0960982214003145">to penetrate the body of the males</a> to collect so-called spermatophores.</p>
<p>Commonly used by many invertebrate species but also by some vertebrates such as newts and salamanders, the spermatophores are sperm-containing capsules. In the extraordinary case of <em>Neotrogla</em>, females are pulling the sperm out of the male body using their innovative and exclusive penis-like organ. This organ has spines that allow females to grasp and hold mates from the inside.</p>
<p>What leads to the development of this structure? The answer is simple: sexual competition and sexual conflict over seminal fluid.</p>
<p><em>Neotrogla</em> inhabit caves where water and food resources are very scarce. In these conditions, competition to obtain seminal fluid is fierce; and females strive to mate. Once a female finds a male, the gynosoma enables prolonged copulation by anchoring her to the male.</p>
<h2>Don’t stereotype</h2>
<p>Nature provides us with a deluge of common mating patterns, but also with exceptions. These exceptions enhance our knowledge of how nature and evolution work.</p>
<p>Sexual stereotypes are not as universal as traditionally thought. Instead, the way each sex behaves depends on several factors such as asymmetries in parental investment, sex-ratio or the availability of mates.</p>
<p>So the next time you see an animal with what seems to be an intromittent sexual organ, don’t take for granted it’s a male.</p><img src="https://counter.theconversation.com/content/54906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paco Garcia-Gonzalez has previously received funding from the Australian Research Council and the Spanish Ministry of Economy</span></em></p><p class="fine-print"><em><span>Eduardo Rodriguez-Exposito does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sex roles in nature don’t always follow the same script. In fact, some females have genitals that resemble a penis. How can this be? Evolution has the answers.Eduardo Rodriguez-Exposito, PhD student. Department of Ethology and Conservation of Biodiversity, Consejo Superior de Investigaciones Científicas (CSIC)Paco Garcia-Gonzalez, Researcher, Consejo Superior de Investigaciones Científicas (CSIC)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/456502015-08-06T04:45:30Z2015-08-06T04:45:30ZWhat’s normal, anyway? GPs should discourage women from unnecessary genital surgery<figure><img src="https://images.theconversation.com/files/90969/original/image-20150806-1969-1c47b0z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women are increasingly feeling embarrassed about their genital appearance.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/sophielovescute/4660990790/in/photolist-6mcyHt-7ZBJTA-6qgCYn-4K7LN3-86SNbb-7um8th-bEdZ6h-7jq1Nu-avokom-9PWDbR-58hvVT-7mq5Ex-fmM8c-nuPunk-nuPJf1-nM9fAm-nARVnZ-bUDgfr-runCRE-o6s6R7-nR1hy7-o8n94E-s9VFUB-bRRzL4-5v6X2B-dcCTRt-7fhPi2-isqYLk-kgdr3T-kgf8py-kgfcAj-avoto1-nuQcUg-nuPJw3-e5DY5p-pSGTox-oagEnp-o8n9i7-o8n913-7ftXHv-aNwLZK-7VZ6CD-rBYWf-7fhPiP-7TdEKU-9P7mwH-sfiWxa-ehTFHM-dsSiTH-6SGnjz">Sophie/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>General practitioners have an important role to play in alleviating women’s anxiety about their genital appearance and can help stop the rise in women going under the knife for cosmetic reasons.</p>
<p><a href="http://whv.org.au/static/files/assets/ca7e9b2f/Women-and-genital-cosmetic-surgery-issues-paper.pdf">Figures show</a> 640 Australian women made Medicare claims for genital cosmetic surgery in 2000. The number grew threefold over the next decade, with 1,565 claiming the same surgeries on Medicare in 2011. There was no accompanying rise in the incidence of congenital or acquired diseases that would need such surgery.</p>
<p>The Medicare statistics reveal surgeries are as common among women between the ages of 15 to 24 as they are among those between 25 to 44. These figures are only the tip of iceberg as most women seek out genital cosmetic surgery through the non-rebatable, private system.</p>
<p>In response, the Royal Australian College of General Practitioners this week <a href="http://www.abc.net.au/news/2015-08-03/world-first-guidelines-for-female-genital-surgery-requests/6669306">introduced</a> world-first guidelines to advise doctors how best to deal with women’s rising interest in having genital cosmetic surgery.</p>
<p>When women ask for surgical modification to their genital tissue, they often don’t know enough to describe what they want removed, nor do many understand the long-term implications. </p>
<h2>What is normal?</h2>
<p>As a GP with more than 20 years’ experience in women’s health, I have seen a marked increase in the number of women embarrassed about their genital appearance. They might hint at their shame during a routine gynaecological procedure, either as an apology for how they look “down there” or as a blatant statement such as: “It’s so ugly, I’m so embarrassed, I want it fixed.” </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/90864/original/image-20150805-22449-14zgnro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90864/original/image-20150805-22449-14zgnro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90864/original/image-20150805-22449-14zgnro.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90864/original/image-20150805-22449-14zgnro.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90864/original/image-20150805-22449-14zgnro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=451&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90864/original/image-20150805-22449-14zgnro.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=451&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90864/original/image-20150805-22449-14zgnro.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=451&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">General practitioners are often the first medical professional to see a woman’s anxiety over her genital appearance.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/cane_rosso/2124744542/in/photolist-4eKSwA-aDDLUg-xNiWs-6wUHts-6wdZBD-bGCLJH-N6K2x-6SyALq-9p25xE-bPzRSZ-712Nbm-N6Kq6-J1G5Q-bndKvQ-8UMM2s-axeTfZ-baTtMe-2TQPPY-3MwcX-4uJwjV-5ES6ez-7aZeQT-5qy5Mo-eLg8N-kN5eGt-9SFC43-4PU8VU-9mtgE4-9mnUG5-7vMD8T-bvU3Se-xpQdo-biJpoZ-9y5ues-8FyXXg-9SCDiT-aCE5xn-5HbsX2-kN6S6g-kN7RFs-kN5Gga-kN5r96-kN7nzN-kN7ajq-kN54Rr-kN72iq-kN4T68-kN6LF9-kN6zsN-kN4r3M">Ludo/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>General practitioners are often the first medical professional to see a woman’s anxiety over her genital appearance. This embarrassment may be based on an idealised benchmark of stylised, hairless and prepubescent genitals, so often depicted and promulgated through media, pornography and fashion. In real life, though, women and men know very little about genital diversity. And little research has been conducted on what constitutes normal genital appearance.</p>
<p>Marketers of female genital cosmetic surgery make a genital tissue “trim” seem like a simple lifestyle choice. But trimming labia is not the same as trimming one’s hair. The labia minora (inner lips) isn’t made of ordinary skin but tissue rich with nerve fibres <a href="http://www.ncbi.nlm.nih.gov/pubmed/18564153">that developed</a> as part of the primordial phallus (what becomes the clitoris during fetal development). </p>
<h2>A lucrative industry</h2>
<p>Female genital cosmetic surgery comprises a suite of relatively new procedures. Labiaplasty – where the labia minora are “trimmed” to not extend beyond the margins of the labia majora (outer lips) – is the most common, accounting for about 50% of all such surgeries. </p>
<p>Genital-related anxiety seems to have increased over the past decade, along with the use of <a href="https://www.themedicalbag.com/bodymodstory/porn-star-surgeryaka-the-barbie">terms</a> such as “Barbie-plasty”, “designer vagina” and “vaginal rejuvenation”. Google these and you see a plethora of consumer websites touting “facts” <a href="http://www.aesthetica.com.au/treatments/labiaplasty/">such as</a>: “more than 30% of women have excess genital tissue”. </p>
<p>These websites reinforce existing social and cultural messages about the vulva and vagina but <a href="http://bmjopen.bmj.com/content/2/6/e001908.full">offer scant information</a> about the diversity of genital appearance. Nor do they talk about the long-term risks of the surgery, which have not yet been researched. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/90863/original/image-20150805-22481-hy1wo.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/90863/original/image-20150805-22481-hy1wo.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/90863/original/image-20150805-22481-hy1wo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=789&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90863/original/image-20150805-22481-hy1wo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=789&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90863/original/image-20150805-22481-hy1wo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=789&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90863/original/image-20150805-22481-hy1wo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=991&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90863/original/image-20150805-22481-hy1wo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=991&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90863/original/image-20150805-22481-hy1wo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=991&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In female genital cosmetic surgery, the labia minora are ‘trimmed’ to not extend beyond the margins of the labia majora.</span>
<span class="attribution"><a class="source" href="http://www.labialibrary.org.au/anatomy/">The Labia Library/Women's Health Victoria</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Such advertisements tap into the dissatisfaction some women feel about not being “normal”. But their existence shows a new and lucrative area. Prices in Australia for labiaplasty vary from A$3,000 to A$9,000 and can be coupled with clitoral hood reduction or mons pubis reduction (the mounded area above the pubic bone) – specialties women are seeking in high numbers. </p>
<p>These surgeries can be performed by anyone with a medical degree. No formal training is required and there are currently no evidence-based guidelines to support the procedures.</p>
<p>Complications often arise. Surgeons may remove too much genital tissue, exposing the woman’s clitoral head to undergarments and causing pain in ordinary clothing. Another common complication is irregularity and scarring along the trimmed labia minora or change in pigmentation of the skin and hypersensitivity. </p>
<p>Worryingly, the complications are so common that one prominent, plastic surgeon in the United States has found a lucrative market for correcting them, dubbing them <a href="http://www.labiaplastyrevisionsurgeon.com/index.html">“botched labiaplasties”</a>.</p>
<h2>Guidelines for GPs</h2>
<p>While few Australian researchers have explored the GPs’ role in cosmetic surgery, UK studies <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020045/">have indicated</a> a need for GPs to educate women who express concern about their genital normality or appearance.</p>
<p>The recently launched doctors’ resource – the <a href="http://www.racgp.org.au/your-practice/guidelines/female-genital-cosmetic-surgery/">RACGP guidelines</a> for female genital cosmetic surgery, which I helped develop – address the lack of balanced information. The guidelines recommend doctors listen to and educate patients about genital normality. Doctors are encouraged to refer women to sites such as the <a href="http://www.labialibrary.org.au">Labia Library</a> to help them understand the diversity of genital appearance.</p>
<p>Guidelines also advise GPs to examine the woman respectfully and explore the reasons for her concern. This is an opportunity to consider the psychological or sexual reasons for her anxiety by discussing personal or relationship issues, past history of sexual abuse or even mental health issues. Anecdotal evidence from GPs and surgeons suggests coercion due to partner criticism is sometimes a factor for women’s genital shame.</p>
<p>GPs should refer a woman for a gynaecological opinion if they feel their advice is not sufficiently reassuring. If the patient is under 18, they should refer her to an expert adolescent gynaecologist. </p>
<p>Hopefully the RACGP guide will prompt GPs and other health professionals to take the time to discuss women’s concerns about their genital appearance and ultimately reduce the rate of unnecessary and potentially harmful surgery.</p><img src="https://counter.theconversation.com/content/45650/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Magdalena Simonis is affiliated with
RACGP National standing Committee Quality Care
Women's Health Victoria, board member .</span></em></p>New guidelines launched by the Royal Australian College of General Practitioners aim to help doctors educate women about the variety of genital appearance and stop them having unnecessary surgery.Magdalena Simonis, Lecturer, General Practice and Primary Health Care Academic Centre, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.