More and more women are asking for surgery to 'tidy up' or shorten their labia – an operation known as labiaplasty. This is happening all over the western world, but particularly in Britain and America.

Indeed, in the UK the number of labiaplasty operations on the National Health Service (NHS) has almost trebled in three years. However, the vast majority of operations on the labia in Britain are done privately, since the cash-strapped NHS is finding it more and more difficult to fund non-vital surgery.

In a moment, we'll look at why so many women want their sexual organs reshaped. But first let's make clear what we're talking about, because there's still a great deal of confusion about this particular area of the female anatomy.

Why labiaplasty doesn't mean 'designer vaginas'

A lot of people still think that that the external genitals of a woman are called 'the vagina'. This is wrong. The vagina is the tube or passage inside. You can't really see it from the outside.

What you can see from the outside is the vulva. And it's the vulva that so many people want surgically altered these days.

The main features of the vulva are the four labia or 'lips'. There are two outer labia, and these are called the 'labia majora'. Nestling inside them are the two smaller labia or labia minora. The entry to the vagina lies between the two inner lips. In case you're wondering, the singular of 'labia' is 'labium'.

A lot of women are unhappy with the appearance of their labia. They're particularly likely to complain about the two labia majora, saying that they are 'too long' or 'too irregular' or just 'too ugly'.

Complaints about the inner labia (the labia minora) are less common. But some people have the mistaken idea that these shouldn't be visible at all and that they should never 'poke out' from between the two outer labia.

Until very recently, doctors tended to regard complaints about the appearance of the labia as rather trivial. If you went to see a gynaecologist complaining that your vulva looked abnormal, it's likely you would have been told that you were 'wrong' and your appearance was 'perfectly okay'.

However, in the first decade of the 21st century, medical attitudes began to change. These days, some gynaecological and plastic surgeons are more receptive to the idea that a woman might be unhappy with the look of her labia, in just the same way that she might be unhappy with the look of her nose. And some of them are willing to operate, though probably this will have to be done privately.

Why are so many women unhappy with their vulvas these days?

There are two reasons why so many females have started to ask for surgery on their labia, and they're rather surprising ones!


The influence of porn

During the last decade, huge numbers of women have seen pictures of other females' genitals. This has never happened before in human history, because up until about the end of the 20th century, images of the vulva were considered obscene.

But now, photos and movies of the labia are widely available in most western countries.

These images are found in adult magazines, on the internet and occasionally in women's publications. Although most of them are really intended for male viewing, a lot of females do see them.

Furthermore, some men have a regrettable habit of saying to their partners: 'Sweetheart, I wish you looked like that'.

So in the last few years, large numbers of women have seen these pictures of other people's vulvas.

Unfortunately, these images have one big drawback. Most of them are totally unrealistic.

Why? For these following reasons:
the people who produce those pictures or films (photographers, directors, editors etc) almost invariably select models who have very 'tidy' genitals
photos of female genitalia in adult magazines are heavily 'airbrushed' to make them even neater and tidier
some American publishers of men's magazines have a policy of never allowing the labia minora to be seen at all.

As a result of this explosion of 'neat and tidy' porn, many women have got the idea that they themselves must be abnormal.

For instance, they notice that one outer lip is slightly longer than the other one and think this means that they need an operation. Or they observe that their labia minora are sometimes visible and get the idea that this indicates something is wrong. These assumptions are actually false.


The popularity of shaving and waxing

The other factor that has made women more conscious of their vulvas is the popularity of shaving and waxing.

During the first decade of this century, more and more women have opted in for removing all or part of their pubic hair. Shaving, waxing and laser hair removal have become extremely common.

This current fashion is largely harmless. But what it has done is to make the labia much more visible – not only to women but to their partners. They can see the vulva clearly, whereas they couldn't do so before.

As a result, people are much more likely to get the idea that their labia are 'too long' or 'lop-sided'. The outcome may be that they decide to enquire about surgery.

What should you do if you think your labia are abnormal?

Well, the first thing is to get an expert opinion from a doctor who is used to looking at vulvas.

I suggest that you have a consultation at a family planning clinic because the (largely female) doctors there are used to inspecting dozens of vulvas every week.

They can tell you immediately whether your labia are abnormal or not. The odds are, the family planning doctor will be able to reassure you that you're perfectly normal.

If you are still worried that your labia aren't okay, it's a good idea to look at one of the sites on the internet, which show the great diversity of appearances in the normal human vulva.

For instance, the famous US sex guru Betty Dodson has a website demonstrating that normal women's labia can be of many different shapes and sizes. Go to the Betty Dodson and Carlin Ross sex information online website and navigate to Betty's vulval illustrations.

What should you do if you really want a labiaplasty

Let's assume that you want to go ahead and see a surgeon. What do you do?

Well, you can go to your GP and ask to be referred to a gynaecologist under the NHS. You'll probably be seen by the gynaecologist within a couple of months at a local NHS hospital.

However, please bear in mind that the surgeon may well turn you down for surgery and tell you that your labia are really 'within normal limits'.

Although as we've said above, NHS operations on the labia have nearly trebled in recent years, and they still amount to only about 1,200 per year. So the odds for you being selected for free surgery are not good.

In practice, most women who obtain labiaplasties get the operation done by a private surgeon.

How do you select one? I'd strongly advise you not to go and see anyone who advertise themselves as 'the UK's greatest gynaecologist' or 'the world's top expert on labiaplasty'. In Britain, reputable surgeons just don't do this type of thing.

What you need is a good, highly-experienced, ethical plastic surgeon or gynaecologist. Sensible advice about choosing a surgeon is available from:
British Association of Aesthetic Plastic Surgeons (BAAPS)
Royal College of Obstetricians & Gynaecologists (RCOG).

Always find out the costs before you sign up for anything! Currently, the operation will cost you at least £3,000.

The labiaplasty operation

What does the operation of labiaplasty involve? It's a shortening or reshaping of your vaginal lips. It can be done under local anaesthetic, but many women prefer a general.

What the surgeon generally does is to put a clamp across each labium, to prevent bleeding, and then to cut away the unwanted tissue with a scalpel or a laser. Finally, he or she stitches up the wound.

Make no mistake: this will hurt afterwards. Some women feel pain for a couple of months or more.

Possible problems with labiaplasty

Possible complications of the operation include bleeding, bruising and infection. Scarring can occur. Urinating may be difficult for some days. Sex is definitely not a possibility until the surgeon says it's safe to resume.

It's just possible that surgery on your labia could affect your sexual sensation. Beware of thinking that the operation will cure any sex difficulties you may have. It won't.