A world-first study has found that girls as young as 15 are asking their GPs about genital cosmetic surgery, and are increasingly concerned that their genitals don’t look “normal”.

Lead author of the study, Dr Magdalena Simonis from the University of Melbourne’s department of general practice, said she was compelled to conduct the survey after her own patients began asking about labiaplasty, a surgical procedure that removes tissue from the labia. “I felt underprepared to respond to those requests,” she said.

“When I spoke to colleagues who were also working in areas of women’s health, they also expressed the same sort of experiences with women questioning whether their genitals looked normal. Many of them volunteered that that 20 or 25 years ago, this was never an issue.”

The study was published in BMJ Open and represents the first large survey to explore GP experience of female genital cosmetic surgery.

Simonis said she believes fashion, online pornography, perceptions of beauty, as well as Brazilian waxes were playing a major role in women’s dissatisfaction with and concern about their genitals.

While some women experience medical issues related to their labia and require a labiaplasty, more than 1,500 labiaplasties were performed in Australia in 2013, representing a threefold increase in the procedure over the previous decade despite there being no increase in genital abnormalities.

Over a 10-week period last year, Simonis and her research team conducted interviews with 443 Australian GPs and asked them 31 questions about their patients and requests for female genital cosmetic surgery. Most were GPs who specialised in women’s health.

Of the respondents, 54% had seen female patients requesting genital cosmetic surgery. Overall, 75% of GPs rated their knowledge of the surgery as inadequate and 97% said they had been asked by women of all ages about genital normality.

More than half the GPs suspected psychological disturbances in their patients requesting the surgery such as depression, anxiety, relationship difficulties and body dysmorphic disorder.

Surgery could sometimes lead to complications such as ongoing pain and could also affect sexual response, “because the clitoris is not just a ‘pea’ as described in textbooks, but is a larger organ, most of it not visible to the eye”, Simonis said.

“When we talk about adult women into their 20s of course they are entitled to make their own decisions about their body and surgery, provided they are well informed and have good information and don’t have any mental health disorders that might be affecting their decision,” Simonis said.

“But the really vulnerable here are young women and teens impressed by what they see online and what a lot of the portrayals are like in pornography. I think we need to be carefully looking at those women and ensuring they are supported and better informed.”

Simonis was an author of the Royal Australian College of General Practitioners clinicians’ guide on female genital cosmetic surgery, the first guide for Australian GPs and other health professionals, published last year. She said while this was helping GPs to navigate questions and concerns about female genitals, cosmetic surgeons also had a role to play.

Surgery for mental health issues is not a appropriate therapy Dr Magdalena Simonis

“They are simply building a business around demand,” she said.



“The question is, why is there demand? It behoves them to look more closely at the psychological background of women and girls and make sure they are well screened for mental health issues, because surgery for mental health issues is not a appropriate therapy.”