What does it take to convince women the appearance of their vulva is normal?

Because many women believe their vaginas are not normal, thousands every year submit to costly and potentially risky labiaplasty - a surgical procedure to remove or reduce the size of the inner labia - in a bid to achieve the neat, "single slit" look promulgated in media images.

Experts have attributed the trend to the popularity among women of Brazilian waxing, which exposes genital tissue previously hidden, and the pornography industry's failure to depict a broad range of variation in labia size - it's often called the "Barbie doll" look: smooth, tucked, discreet.

But a new Australian study has found improving women's understanding of the diversity in genital appearance — and dissuading them from having unnecessary surgery — could be as simple as showing them a free online video.

WARNING: The video below contains nudity, including female genital nudity, and strong scenes of surgical procedures.

For the study, published in Body Image: An International Journal of Research, psychology researchers at Flinders University surveyed 136 female undergraduate students and measured the effectiveness of two online resources — one a video, the other a collection of still photographs — designed to educate people about variations in women's genitals.

The video, a seven-minute documentary produced by the ABC's Hungry Beast program in 2010, looked at the airbrushing out of "excess" labial tissue in soft-core pornography, which is done in accordance with Australian classification guidelines for unrestricted publications.

"Realistic depictions of sexualised nudity should not be high in impact. Realistic depictions may contain discreet genital detail but there should be no genital emphasis," the guidelines state.

After viewing either the video or the images, participants were asked to rate six photographs of different women's genitals on scale of 1 to 5 for "normality".

While the static images had little impact on participants' perception of what a normal vulva should look like, women who viewed the video provided higher normality ratings and demonstrated greater knowledge of the digital alteration of women's genitals in media images.

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Flinders University clinical psychology PhD candidate Gemma Sharp said the findings could help educators design more effective resources for teaching women about their bodies, and potentially reduce the demand for unnecessary cosmetic surgery.

"I'm all about women making informed choices," Ms Sharp told the ABC.

"If they have all the research, women can approach labiaplasty thinking, 'This is what the research says and I still want to have it,' or 'This is what the research says and maybe I won't.'

"It was never our intention to persuade women one way or the other about having a labiaplasty, we simply wanted to find out whether or not they had a realistic idea of what normal actually looked like, and to ensure they made informed decisions."

However, Ms Sharp stressed that educational resources like the Hungry Beast video may not alleviate the concerns of women who were already unhappy with their appearance, and that more research was needed to understand what causes them to feel that way.

"There are going be some women that are aware that their labia are anatomically normal but still want surgery. They want an 'improved' look," she said.

"Frankly, the satisfaction rates for labiaplasty are actually quite high, so [surgery] might be a good option for those women."

Increasing number of Australian women seeking labiaplasty

Data on the number of Australian women who have had labiaplasty is difficult to pin down because many have it done within the private system.

The number of women claiming Medicare rebates for labiaplasty doubled in the decade between 2003 to 2013, with Medicare statistics showing 1,584 claims were made from July 2013 to June 2014.

However, in the 2014-15 financial year, only 1,129 Medicare claims were made for the procedure, a decrease experts have attributed to Medicare's crackdown on medically-unnecessary surgeries.

Australian Society of Plastic Surgeons president Associate Professor Hugh Bartholomeusz said that while the number of taxpayer-funded labiaplasties had decreased, a growing number of women were seeking the surgery via the private system, which is not required to publish data on procedures.

He told the ABC in August last year, "There's been an increase in the number of female genital surgery procedures done.

"It seems to have been driven by the media and by the perception that women have abnormalities within their genitalia.

"These procedures can be performed by other plastic surgeons or gynaecologists. So because the Medicare system isn't involved there's no visibility about who is performing this procedure, where or how."

Censorship laws, culture of shame partly to blame

The Australian Classification Board requires that images of vulvae "must be healed to a single crease". ( freeimages.com: scottsnyde )

Dr Maggie Kirkman, a senior research fellow at the Jean Hailes Research Unit at Monash University, said many factors contributed to women's feelings of dissatisfaction with the appearance of their genitals, including Australia's censorship laws.

Indeed, the Australian Classification Board requires that images of vulvae "must be healed to a single crease" - meaning the inner labia cannot be shown.

"The censorship law is one designed to protect society and I think it has had an unexpected and unanticipated outcome that has distorted what people expect vulvas should look like," Dr Kirkman told the ABC.

"It plays into the expectation of the invisibility of women's genitals, just a neat little crease and nothing else, and limits the kinds of images that most women see."

Dr Kirkman, who is also currently undertaking research to better understand the motivations of women seeking labiaplasty, said addressing the problem was difficult because of the culture of shame that surrounds women's bodies and sexuality.

"Having conversations about and viewing images of women's genitals is awkward because it is one of the not quite forbidden, but complicated topics in human experience … it's quite difficult to talk about without feeling as though we're heading in the direction of pornography."

But it was important, she said, to circulate resources like the Hungry Beast video and Women's Health Victoria's Labia Library initiative to help women understand that a normal vulva is different for everyone.

"Many women have never seen another woman's genitals, so they don't know what they ought to look like," Dr Kirkman said.

"And they look at their own and they don't perhaps match the images they see - the neat 'Barbie' appearance - and they think there's something wrong with them."

Gemma Sharp is currently looking for Australian women aged 18+ who have undergone labiaplasty to share their experiences in an online survey. For more information or to participate, visit her survey page.