Labiaplasty - all you need to know

Studies indicate a significant rise in the number of women seeking labiaplasty procedures both within the NHS and in the private sector. According to the International Society of Aesthetic Plastic Surgery (ISAPS), 194,086 labiaplasty procedures were performed worldwide in 2022, reflecting a continuing global increase in demand. In the UK, labiaplasty remains one of the top cosmetic surgeries for women, with the British Association of Aesthetic Plastic Surgeons (BAAPS) reporting 907 procedures in 2022.

Labiaplasty typically involves reducing the size of the labia minora to minimize or eliminate protrusion beyond the labia majora, and it may also address asymmetry.

While the procedure remains a topic of debate for some, we aim to discuss the main considerations surrounding labiaplasty.

Research shows that cosmetic concerns are the primary motivation for women pursuing labiaplasty, followed by physical issues that can affect both sexual and non-sexual activities. For example, a study of 163 labiaplasty patients in 2000 found that dissatisfaction with labial appearance (87%), discomfort in clothing (64%), sports-related discomfort (26%), and painful intercourse (43%) were key reasons for surgery. A more recent study of 35 women indicated that 71% cited appearance concerns, 69% noted physical (non-sexual) discomfort, 60% mentioned sexual function, and 45% reported psychological factors, including self-esteem.

Labiaplasty is sometimes referred to as “designer vagina” surgery; however, this term is misleading. The labia minora, which are reshaped in labiaplasty, are part of the vulva, not the vagina itself. Anatomically, the labia form part of the external genitalia, so “designer vagina” is not an accurate description for this procedure.

The World Health Organization (WHO) defines female genital mutilation (FGM) as procedures that intentionally alter or injure female genital organs for non-medical reasons. Some commentators have controversially suggested that labiaplasty for consenting adults falls under this definition.

However, the WHO’s definitions primarily cover procedures involving partial or total removal of the clitoris or narrowing of the vaginal opening, usually performed on unconsenting children. Labiaplasty, by contrast, is a procedure chosen by consenting adults for specific personal reasons and does not fit within this category.

The WHO also includes a fourth category: “all other harmful procedures to the female genitalia for non-medical purposes.” The critical term here is “harmful.” Labiaplasty, performed by qualified surgeons, has one of the highest satisfaction rates among cosmetic procedures. While all surgeries carry some risk, these are carefully communicated to patients. Equating labiaplasty with harmful practices ignores the important distinctions and motivations behind this elective procedure.

Much debate and speculation has been about the reasons behind the growing demand for labiaplasty. Some, like an article in The Observer from 2011, attributed this increase to the influence of pornography and its portrayal of idealized female genitalia. While such portrayals may have influenced perceptions, it’s essential to consider the evidence.

A study published in the Aesthetic Surgery Journal examined factors influencing the decision to undergo labiaplasty. In the study, Sharp et al. (2006) compared 35 women seeking labiaplasty with a control group of 30 women who were not. They found no significant difference in exposure to pornography or television images of female genitals between the two groups. However, the labiaplasty group reported more exposure to images of female genitals via the internet and cosmetic surgery advertising. The authors noted that media exposure to a limited range of labial appearances could influence women who are already self-conscious, leading them to believe their anatomy is “abnormal” and that surgery could make them “normal.”

Increased public awareness of cosmetic surgery, partly driven by reality TV shows like Embarrassing Bodies, has also contributed to the normalization of procedures like labiaplasty. While pornography may have some influence, evidence suggests it is only one of several factors shaping women’s perceptions and decisions. Overall, the increased demand for labiaplasty is likely due to a combination of media exposure, societal openness to cosmetic procedures, and personal motivations.

The “labial pride” movement is a feminist initiative aimed at promoting awareness of the natural diversity in vulval appearance and challenging the growing trend of cosmetic surgery on female genitalia. This movement seeks to counteract societal pressures and beauty standards that can influence women’s perceptions of their bodies.

One prominent event in the movement was organised by the London-based feminist group UK Feminista. In December 2011, they held the “Muff March” on Harley Street, a hub for private medical providers. Over 320 women joined, carrying slogans such as “Keep your mitts off our bits!”, “There’s nothing finer than my vagina!” and “Harley Street puts my chuff in a huff.” The event aimed to protest the commercialisation of female genital surgery and encourage acceptance of natural variations.

Various online campaigns have also emerged, encouraging women to share anonymous photos of their vulvas to showcase the natural diversity in labial appearance. One notable example is the “Labia Library,” which offers women a realistic view of anatomical diversity to normalise variations and counteract narrow beauty ideals. However, some critics argue that these campaigns risk suggesting that more prominent labia are the norm while implying that smaller labia conform to beauty standards. They caution against creating new standards that inadvertently exclude or shame certain body types.

As Jessica Sager noted in 2013, “In an effort to make ‘real women’ feel better about themselves, some labia-proud advocates take shots at those whose labia resemble the so-called ‘Barbie’ ideal. But labia, like all body parts, come in all shapes, sizes, colours, and textures. Shaming one to uplift another is counterproductive.” Her perspective reminds us that body positivity should embrace all forms of diversity rather than creating new standards.

We inform all prospective patients that there is no definition of “normal” regarding the labia minora. Labia naturally vary in shape, size, and colour, and this diversity is entirely normal.

Artist Jamie McCartney addresses the anxieties surrounding female genital appearance in his work The Great Wall of Vagina, a collection of 400 plaster casts of women’s genitals displayed across ten panels. This powerful piece confronts viewers with the natural diversity of female genitalia, challenging any notion of a singularly “perfect” aesthetic and prompting society to reconsider its perception of the vulva.

For women considering labial surgery, it’s worth reflecting on McCartney’s words:

“Vulvas and labia are as different as faces, and many people, particularly women, don’t seem to know that. McCartney hopes this sculpture will help combat the rise in cosmetic labial surgeries, a trend that risks setting unrealistic standards for future generations of women.”

While cosmetic surgery is often defined as “the intentional alteration of physical features to enhance appearance,” certain procedures also provide functional benefits, such as relief from physical symptoms—a need many labiaplasty patients express. Arguments that labiaplasty removes or “destroys” normal tissue overlook that other common procedures, like breast and facial surgeries, similarly alter normal tissue yet face far less scrutiny.

Dr Alinsod, a gynaecologist based in California, developed the “Barbie” labiaplasty, a technique involving a more extensive reduction of the labia minora, often resulting in their near-complete removal. According to his website, this is the most popular technique Dr. Alinsod performs and is in high demand on the West Coast.

This approach, achieved through the “trim” method of labiaplasty, essentially removes most, if not all, of the labia minora. While labia minora vary widely in size and shape, it is entirely normal to have visible labial tissue, and a complete excision may not suit every individual.

At our practice, we prioritise preserving natural tissue. We use the “wedge” method, which removes only the excess labial tissue, leaving most of the labia minora intact. This technique also minimises the risk of over-resection, as it would not allow for proper wound closure if too much tissue were removed.

Numerous studies, with contributions from plastic surgeons, gynaecologists, and psychologists, have reported high satisfaction rates among women who have undergone labiaplasty.

A 2016 study by Goodman and colleagues found that women who underwent labiaplasty experienced significant improvements in body image and sexual satisfaction over time, with their satisfaction levels eventually matching or surpassing those of a control group. (Oxford Academic)

Additionally, a multicenter study involving 258 women who underwent female genital cosmetic surgery reported a 91.6% satisfaction rate after a follow-up period of 6 to 42 months. Participants noted significant enhancements in sexual function, and the complications observed were minimal and not of significant consequence. (Oxford Academic)

These findings suggest that labiaplasty can lead to high levels of patient satisfaction and improvements in sexual function, with low complication rates.

Recent trends in pubic hair removal, such as shaving or waxing, may have led to increased awareness of the labia minora, which can be more visible without the natural covering of hair. This visibility has, in turn, contributed to some women feeling more self-conscious about the appearance of their genital area. Grooming practices that expose the labia can also heighten sensitivity to natural variations in size, shape, and colour, prompting some to consider cosmetic procedures for personal comfort or aesthetic reasons.

Likewise, the popularity of tight-fitting clothing, particularly styles like skinny jeans and activewear, can sometimes cause discomfort or irritation in women with more prominent labial tissue. Tight clothing can place pressure on the labia, leading to chafing or sensitivity, especially during extended wear or physical activities. For some, these factors contribute to considering labiaplasty as a means to increase comfort and alleviate self-consciousness.