Women's perceptions of what is considered normal and desirable female genitalia may be influenced by exposure to modified images, suggests a new study published in BJOG.

Requests for labiaplasty (reducing and making the labia minora symmetrical) has become the most widely performed female genital cosmetic procedure covered by the NHS over the past decade, increasing five-fold between 2001 and 2010.

Researchers, from Australia's University of Queensland School of Psychology, looked at whether exposure to images of modified vulvas influenced women's perceptions of what is considered normal and desirable by society.

The study included 97 women aged 18 to 30 years, who were randomly assigned to three groups to view a series of images in two screenings.

The first screening exposed one group to a series of images of surgically modified vulvas, one group to a series of non-modified vulvas, and the third group viewed no images.

During the second screening, all groups then viewed a series of mixed images of both surgically modified and non-modified vulvas. The women then rated each image according to their perception of 'normality' and 'society's ideal'.

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The study found that women who had initially viewed the modified vulvas identified the modified images in the second screening as more normal than the non-modified vulvas. This was significantly different from the control group, who initially viewed no images, and were 18% less likely to rate the modified vulvas as normal.

Furthermore, when asked to rate the images according to society's ideal of genitalia, women in all three groups rated the modified images as more like society's ideal than the non-modified vulva images. Again, women who initially viewed the modified images were 13% more likely to rate the modified vulvas as more society's ideal than the control group.

Claire Moran, School of Psychology, University of Queensland and lead researcher of the paper, said: "Our results showed that exposure to images of modified vulvas can significantly influence women's perceptions of what is considered a normal and desirable vulval appearance.

"These findings further heighten concerns that unrealistic concepts of what is considered normal may lead to genital dissatisfaction among women, encouraging women to seek unnecessary surgery.

"This research is the first to document the extent to which exposure may impact women's genital dissatisfaction and more needs to be done to promote awareness and education around genital diversity in our society."

Pierre Martin Hirsch, BJOG Deputy Editor-in-Chief, added: "The conclusions of this study may explain the increase in requests for female genital surgery in the NHS and why some women feel the need to seek labiaplasty and other unnecessary gynaecological procedures for aesthetic purposes.

"These findings are concerning for healthcare professionals because genital cosmetic surgery can have short-term risks, including bleeding and wound infection, but there are currently no data on the clinical effectiveness of these procedures or the longer-term physiological and psychological effects on women.

"It is important that healthcare providers counsel women on the normal variations in genital appearance and ensure they are well informed of any associated risks for surgical procedures."