Thirty years ago, when I first started working as an obstetrician and gynaecologist in the NHS, I hardly ever saw a patient who was worried about the size and shape of her labia. If I did get a referral, it would be a genuine case where the woman had abnormal labia.
Today, I see girls as young as 13 and 14 who are desperately upset about what they see as enlarged external genitalia. They may come into the clinic alone or with their mother, who can be even more upset, asking to be given labia reduction surgery as soon as possible. They are rarely over the age of 20.
It can’t be that labia have actually changed over the years. It must be women’s perception of them. Every time I see one of these patients, I know what I am going to find. In 99.9 per cent of cases, their labia prove to be perfectly normal.
But I’m also very likely to find that the girls have removed most or all of their pubic hair. The fashion for this has become almost universal among young girls over the last few years, and I am in a good position to know. In my opinion, it is driven by peer pressure and a wrong-headed sense that no pubic hair makes them more attractive to the opposite sex. But whatever the reason, it has had another unwanted side effect – to expose their labia to personal scrutiny. When I was young, we didn’t spend hours every week grooming our private parts and angsting about what we found. These girls do, and they aren’t happy with what they see. Labia, which include the labia majora (the outer lips) and the labia minora (the thinner inner lips) are remnants of pigmented tissue that would have changed into the scrotum and male genitalia in the womb had a foetus been male. They are not always neat and tucked away. They enlarge during sexual arousal and can be a range of colours. There is no hard and fast rule about what they have to look like.
Shaving also leads to skin irritation and chafing. The labia are not protected by a cushioning blanket of pubic hairs and the girls feel discomfort and itching.
The banishment of pubic hair is not the only reason there is an epidemic of girls wanting labia reduction procedures. Another massive change over the last decade is the kind of underwear that girls tend to wear. Many of the girls who come into my clinic with this problem are wearing knickers that aren’t really knickers. The tiny thongs that they prefer offer no support to the undercarriage. If they would wear knickers that actually existed beyond a string, they may find that their problem vanishes overnight.
The third thing that I think has made a huge difference is the rise of reality TV doctoring programmes, including Embarrassing Bodies made by Maverick for Channel 4. In this programme, women regularly talk about their overlarge labia and allow themselves to be intimately examined in front of the camera. This has caused a surge in self-criticism and self-analysis among young women who compare themselves to the women they see on TV.
I know that some people think that sexting on social media and the ease of accessing pornography has also caused girls to become hyper-aware of their bodies.
The number of girls requesting surgery to ‘correct’ normal labia has led to the GP commissioning bodies deciding not to fund any more of these procedures. I still get referrals but I cannot recommend girls for free surgery, even if I thought it was necessary. This does mean that some girls go home and accept the situation (hopefully improving matters by changing their underwear and allowing themselves to grow normal adult pubic hair) but a proportion scrape the money together to get plastic surgery done privately. In my experience, this doesn’t tend to make them feel any happier, and indeed I see women who have been referred because they are distressed by the surgical results. Reducing the labia is a technically difficult operation because the skin is very loose and scars can form which are rigid and hard. I find it a real shame that women, who are normal, put themselves through this kind of procedure simply because they won’t buy knickers with a proper gusset.
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- Why 13 year old girls are out of love with their labia - 29th May 2016