An increasing number of American teen girls are asking their doctors for cosmetic genital surgery, according to a new paper from the American College of Obstetricians and Gynecologists. Between 2014 and 2015, the number of girls age 18 and under who received labiaplasties—procedures that alter the external appearance of the vulva—almost doubled.
To be fair, that number is still small: The American Society for Aesthetic Plastic Surgery reports that 400 girls got the procedure last year, though there are probably more that obtained labiaplasties from gynecologists, which wouldn’t figure into the data. Julie Strickland, who heads ACOG’s committee on adolescent health care, told the New York Times she was “sort of baffled” by the fast-growing count. Most of these patients are girls who want their labia minora shortened for aesthetic reasons, though some cite discomfort during sports as the impetus for their surgeries.
ACOG’s opinion on teen labiaplasty, released last week, states that young women are particularly vulnerable to body anxieties that may lead to a request for cosmetic surgery:
Adolescents, under the influence of pubertal hormones, undergo rapid transformation and growth of their breasts and genital tissues. This can lead an adolescent to question whether her body is normal and to express occasional dissatisfaction with her body’s appearance, size, symmetry, or function. … This age group may be under particular stress regarding these issues because of societal conceptions of the ideal female body and parental concerns for body perfection.
Labiaplasty may affect sexual sensation and function—a concerning prospect for doctors with patients at the very beginning of their sexual lives. ACOG says doctors should screen teen girls for body dysmorphic disorder before performing any genital modification (since surgery could worsen bodily dissatisfaction spurred by a mental health issue) and suggest counseling and nonsurgical alternatives.
The Times reports that girls age 18 and under receive fewer than 2 percent of all cosmetic surgeries—they’re mostly ear surgeries, nose jobs, and breast reductions—but nearly 5 percent of all labia surgeries. The body insecurities that come along with puberty are nothing new, of course. But adolescent girls didn’t always seek surgical alterations for body parts usually only seen by locker room cohabitants and sexual partners. Most young women don’t see many other girls’ labia in person, so they don’t learn of the wide range of sizes, shapes, and colors of women’s vulvas. Today’s teen girls have grown up with easy access to porn—photos and videos of genitals that are often already surgically modified or chosen for their slight, monochrome appearance.
Even when a girl looks outside the realm of porn for clues about her place on the labial spectrum, she’ll probably find only a narrow selection of vulvas to compare with her own. In 2014, Slate asked Vagina author Naomi Wolf to analyze the Wikipedia entry for vagina. “Why is there only one image?” she wondered. “I’ve never seen a labia like that. Not outside of porn. It’s not showing a true range.” Indeed, the entry’s featured photo is a completely shaven pubic area with a barely there labia minora and a small clitoris—the size and shape preferred by porn films and increasingly desired by teen girls (many of whose labia are well within the normal range) who ask their doctors for genital modification. (The Wikipedia entry for vulva, a lesser-understood term that gets far fewer views than vagina on the site, features a tremendous collage of labial and clitoral configurations.) Meanwhile, the penis entry features an entire paragraph on size range in the header and a dedicated section further down the page.
Teenage boys are notorious propagators of the myth that women’s vaginas change shape—and their labia change size and color—depending on how many men they’ve had sex with. The internet teems with accounts of self-conscious women convinced that their labias look like “roast beef.” Without easily available, medically accurate sex education, girls don’t have the resources to resist these unrealistic ideals. In a climate that prizes a specific kind of vulvar perfection, it’s no wonder teens questioning their changing bodies look to surgery for an answer.