A new complaint

More and more women are said to be troubled by the shape, size, or proportions of their vulvas, so that elective genitoplasty is apparently a “booming business.”1 Advertisements for cosmetic genitoplasty are common, often including before and after images and life changing narratives.2 Google produced around 490 000 results when we entered “labial reduction”. Forty seven of the first 50 results were advertisements from clinics in the United Kingdom and United States offering cosmetic genital surgery. Television programmes and articles in women's magazines on “designer vaginas” may also fuel desire for surgery, especially with the rising popularity of cosmetic surgery in general. The latest survey by the British Association of Aesthetic Plastic Surgeons reported a staggering 31% increase in uptake of cosmetic surgery in the UK3; women accounted for 92% of this uptake.

Decisions about surgically altering the genitalia may be based on misguided assumptions about normal dimensions. Recently, we reported dimensions of female genitals based on 50 premenopausal women.4 Labial and clitoral size and shape, vaginal length, urethral position, colour, rugosity, and symmetry varied greatly. These findings bring into question assumptions about “normal” genital appearances.

NHS stakeholders are unlikely to encourage demand for cosmetic genitoplasty, but availability in the private sector could …