Labioplasty involves cutting excess tissue that protrudes from the vagina Women are undergoing surgery to create perfect genitalia amid a "shocking" lack of information on the potential risks of the procedure, a report says. Research published in the British Journal of Obstetrics and Gynaecology also questions the very notion of aesthetically pleasing genitals. Operations to improve the appearance of the sex organs for both psychological and physical reasons are on the rise. But surgeons said the report overplayed the risks of an established procedure. Researchers from University College London reviewed all the existing studies on cosmetic labial surgery - which generally involves reducing the amount of tissue that protrudes from the lips which cover the vagina. They found there had been little work to document any longer-term side effects. Labioplasty, as it is known, costs about £3,000 privately and is offered for a variety of reasons: some women complain that wearing tight clothes or riding a bike is uncomfortable, while others say they are embarrassed in front of a sexual partner. This is a procedure which we have been doing since the 1970s - any operation performed poorly carries risks, but when it's done properly there are very few issues at all

Angelica Kavouni

Plastic surgeon But consultant gynaecologist Sarah Creighton and psychologist Lih-Mei Liao challenged the ethics of offering women surgery to address such insecurities, suggesting it was adverts for a "homogenised, pre-pubescent genital appearance" which created these anxieties in the first place. They also suggested that any pain apparently caused by protrusion may well have a psychological root - noting that male genitalia protrude far further without causing major discomfort. Counselling and support could therefore be a preferable alternative to surgery, they argue. Female circumcision The number of women undergoing labioplasty nationwide is unknown as the majority of the operations are performed privately, but last year procedures on the NHS increased by 70% on the previous year to 1,118. In studies dating back to 1950, examined by the researchers, dissatisfaction with the way the vagina looked was the primary reason for surgery, with patients also speaking of low self-esteem and sexual difficulties. Advertisements promote labial surgery as easy answers to women's insecurities about their genital appearances - insecurities that are fuelled by the very advertisements that prescribe a homogenised, pre-pubescent genital appearance standard for all women

Lih-Mei Liao

Report author But rather than curing sexual problems, Dr Creighton suggested surgery might exacerbate them by damaging the nerve supply to the area, impairing sexual sensitivity and satisfaction. She also suggests that women who undergo this procedure might experience similar problems in childbirth as those who have experienced female genital mutilation, in which parts of the vagina are ritualistically removed. It is now well documented that women who have undergone such circumcision are more likely to experience significant tearing and bleeding after labour and even the death of their babies, problems which are overcome by Caesarean delivery. "Labial surgery needs to be rigorously evaluated in future, and for longer term," said Dr Creighton. "Furthermore, quality research is needed to improve our understanding of the psychological drivers behind women's decision to sacrifice sexually sensitive tissue that contributes to erotic experiences, for a certain genital appearance that used to be an obligation only for some glamour models." 'Terrorising' patients Douglas McGeorge, past president of the the British Association of Aesthetic Plastic Surgeons, rejected the comparison with female circumcision, arguing it was a relatively minor operation with few possible complications. "They've gone a bit over the top. Essentially this is just about removing a bit of loose flesh, leaving behind an elegant-looking labia with minimum scarring. The procedure won't interfere with sexual function. "Women want this for a number of reasons - some find it uncomfortable to ride a bike for instance, but for the majority it is aesthetic, that's true. "Lads' mags are looked at by girlfriends, and make them think more about the way they look. We live in times where we are much more open about our bodies - and changing them - and labioplasty is simply a part of this." Angelica Kavouni, a cosmetic surgeon who carries out labioplasty, said it was wrong to "terrorise patients" with suggestions of long-term consequences. "This is a procedure which we have been doing since the 1970s. Any operation performed poorly carries risks, but when it's done properly there are very few issues at all. "I have seen women who I have sent away because I don't think they have a problem, but for women with serious hypertrophy - when the tissue is dark and hangs down - there is a simple way to deal with it. The feedback I receive is very positive indeed." BJOG editor Professor Philip Steer said the study "underlines the need for multidisciplinary research to investigate the range of factors that affect women's sexual function and wellbeing. "Reliable information on the risks and benefits of labial surgery, as well as alternative approaches, is vital to ensuring informed choice for women."



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