Women with normal sized labia minora still seek labial reduction surgery for cosmetic reasons finds new research published in BJOG: An International Journal of Obstetrics and Gynaecology.

Female cosmetic genital surgery is increasingly popular and the number of labial reduction procedures in the National Health Service has increased five fold in the past 10 years.

This is the first study looking specifically at the labial dimensions of women seeking cosmetic surgery. It looked at 33 women who had requested labial reduction surgery and who had been referred by their general practitioner. The average age of the group was 23.

All of the women were examined by a gynaecologist and the width and length of the labia minora were measured and compared with published normal values.

The study found that all women seeking surgery had normal sized labia minora, with an average width of 26.9 mm (right), and 24.8 mm (left).

Three women out of the total number were offered surgery to address a significant asymmetry. Of the women who were refused surgery, 12 (40%) of the women still remained keen to pursue surgery by another route, 11 women accepted a referral for psychology and one participant was referred to mental health services.

The women were asked what they would like to achieve with surgery and 20 women (60%) wished to make the labia smaller to improve appearance. Other reasons included reducing discomfort, improving confidence and wanting to improve sexual intercourse.

The study also looked at how old the women were when they first became dissatisfied with the labia minora. Twenty-seven women (81%) were able to pinpoint this. Of these, 5 women (15%) reported this to be under the age of 10, 10(30%) between the ages of 11 and 15, 5 (15%) between 16 and 20, 4 (12%) in their twenties, and 3 (9%) in their thirties.

Reasons for this dissatisfaction included an increasing self awareness of the genital area, physical discomfort, comments from a partner and watching TV programmes on cosmetic genital surgery.

Sarah Creighton, UCL Elizabeth Garrett Anderson Institute of Women's Health and lead author said: "It is surprising that all of the study participants had normal sized labia minora and despite this nearly half were still keen to pursue surgery as an option.

"A particular concern is the age of some of the referred patients, one as young as 11 years old. Development of the external genitalia continues throughout adolescence and in particular the labia minora may develop asymmetrically initially and become more symmetrical in time."

BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added: "Many women who are worried may have normal sized labia minora. Clear guidance is needed for clinicians on how best to care for women seeking surgery."