Education

  • Only one in 10 women think that there is no shame in having discussions about the female genitals
  • Up to 89% of women do not think their genitals are attractive, sexy or beautiful
  • Almost half of women (47%) believe the vagina is the body part they know least about
  • More than half (57%) of women think their genitalia is an improper size
  • Only half of women have ever performed a self-exam of their genitals, and one-quarter (24%) has not looked at her vulva in a year or longer
  • Women perceive their genitals very differently than their spouse/partner perceives their genitals
  • Since 2005, Google has reported a "Breakout" increase (more than 5000%) for numerous search terms and phrases related to female genital cosmetic surgery, including "labia surgery", "labiaplasty", vaginal rejuvenation", "vagina surgery cost", and many more. Note that each search independently increased by more than 5000%.
  • Since 2005, Google has reported a "Breakout" increase for numerous searches related to the notion of a "normal" vulva, including "normal labia minora", "normal labia pictures", "normal labia size", "normal vulva", and many more. Note that each search independently rose by more than 5000%.
  • In 2008 the medical group Surgicare (UK) saw a threefold increase in labiaplasty over the previous year, and inquiries rose seven fold in three years.  Most women asking for the surgery were in their late teens or early 20s, though as young as 10 or 11.  In almost all cases, requests came from women with completely healthy vulvas, but seeking more “attractive” genitals.
  • Women’s genital perceptions are significantly related to their gynecological care perceptions and intentions. (In other words, if a woman has negative perceptions about her genitals she is less likely to seek gynecological care.)
  • While multiple studies have found wide variation in labial length and color, a recent survey of Playboy Magazine found labia minora visible in just 7% of the photographs, and only a single picture (of a total of 185) depicted the inner labia as a color other than pink or light red.
  • Among the top five questions asked to some popular sex educators is “Is my vagina normal?”

Genital Appearance
A cluster of sociocultural factors have led to an increased emphasis on the appearance of a woman’s genitals. Over the past decade, there has been a strong trend among Western women to remove the hair from their pubic region, by shaving, waxing and other means. The removal of hair renders the vulva much more visible, allowing for greater scrutiny and potentially exacerbating any negative perceptions one might have regarding their genitals. Pornography has also been cited as a cause for the increased anxiety regarding the appearance of one’s genitals. With the advent of high-speed internet, online pornography has become readily accessible and is now a leading source of sexual information among young women and men. Mainstream pornography has been accused of misrepresenting reality in terms of sexual behavior as well as genital anatomy of both women and men; women’s vulvas are most often hairless and often devoid of apparent labia minora. However, women may be unaware that the vulvas of many models have been digitally altered, often including completely editing out the labia minora (inner labia), or that the models in pornography are disproportionately likely to have had genital cosmetic surgery. A recent survey of Playboy centerfolds found that labia minora were visible in just 7% of the images, and pubic hair has all but disappeared from the pages of soft and hard-core pornography. This is not an accurate representation of reality, and in fact emphasizes only one extreme end of the natural range of genital diversity.

Cosmetic Genital Surgery
Procedures for cosmetic genital surgeries include labiaplasty, labia majora augmentation, liposuction to the mons pubis and/or labia majora, vaginal tightening, clitoral hood reduction, clitoral repositioning, G-spot amplification, and hymen reconstruction. The most commonly performed female genital cosmetic surgery is reduction labiaplasty, in which the inner labia are reduced and/or made symmetrical. There is genuine concern that female genital cosmetic procedures are not justified on medical grounds and are being performed without adequate evidence of either safety or psycho-social benefit. While reliable data is limited, these surgeries appear to be rapidly rising. In the UK, the private medical group Surgicare saw a threefold increase in labiaplasty procedures and a seven fold increase in inquiries over a three year period. In the public sector, procedures tripled from 2006 to 2008. In almost all cases, the request was a response to the physical appearance of completely normal and healthy labia. 
These surgeries pathologize women’s natural genital diversity and the effects reach far beyond the experiences of those who undergo it; it is not simply “medical” intervention, it is culturally influenced and culture influencing. The practice serves to promote a single aesthetic and any deviation from that aesthetic comes to be perceived as unappealing, legitimizing an individual’s desire for surgical “correction”.  What gets forgotten is the reality that this “ideal” is a socially constructed one, so any social pressures which may have influenced a woman’s desire tend to be minimized, allowing for her request to be viewed as fully informed. This also serves to undermine non-surgical treatments to her distress.
Breast augmentation can be used as an example of the trajectory female genital cosmetic surgery may take. Breast augmentation was legitimized in the 1950’s as a solution to a newly created condition, hypomastia, but has since expanded well beyond the realm of medical “necessity”. Once a relatively rare operation, it is now the most commonly performed cosmetic surgery in the US, with more than 300,000 surgeries performed in 2009.

Society  
Women may be inclined to develop dissatisfaction with certain aspects of their genitals given the socio-cultural representations of the female genitalia as unattractive, dirty, malodorous, and generally unpleasant.  

Much of our language regarding the female genitalia suggests that there is a decreased emphasis and awareness of those parts of the female anatomy which are not crucial for reproduction and heterosexual sex.  The common use of the word “vagina” in reference to the external female genitalia (which is accurately referred to as the vulva) may send a particularly insidious message to women - the labia majora and minora, as well as the clitoris, are inconsequential.  The shame with which so many women view their genitals is also codified in language; The Latin term for the external genitalia, now used most commonly to refer solely to the female anatomy alone, is pudendum, meaning “that of which one should be ashamed”.  Social reality is constructed in large part by language, and there is a dearth of positive symbolism associated with the female genitalia.  There exists no female equivalent of the word phallus, used to describe any item which symbolically resembles a penis, and carrying with it positive implications of  male sexuality and fertility.  Instead, much of the imagery used to denote the female genitalia underscores its unmentionable quality (e.g. “down there”), make it cute or childish (e.g.“kitty”) or are outright derogatory.  Indeed, some of the harshest language in our culture references female genitals. The rise of labiaplasty may reflect a movement in the West to mirror those messages.  

Many sources of information suggest that pudendal disgust is a social reality; advertisments, old and new, for “feminine hygiene” products prey upon phobias about menstruation; and newly marked birth control pills allow women to deal with the inconvenience of menstruation just four times per year.  

References
http://www.radicalpsychology.org/vol8-1/brauntiefer.html
Berer, M. (2010). Labia reduction for non-therapeutic reasons vs. female genital mutilation: contradictions in law and practice in Britain. Reproductive Health Matters, 18(35):106-110.
Braun, V. (2005). In search of (better) female sexual pleasure: Female genital 'cosmetic' surgery. Sexualities, 8(4):407-424.
Braun, V. (2010). Female genital cosmetic surgery: a critical review of current knowledge and contemporary debates. Journal of Women’s Health, 19(7):1393-1407.
Cartwright, R., and Cardozo, L. (2008). Cosmetic vulvovaginal surgery. Obstetrics, Gynaecology and Reproductive Medicine, 18(10):285-286.
Conroy, R. M. (2006). Female genital mutilation: Whose problem, whose solution? Britsh Medical Journal, 333:106-107.

Howarth, H., Sommer, V and Jordan, F. (2010). Visual depictions of female genitalia differ depending on source.  Medical Humanities 36: 74-79.
Liao, L.M., Michala, L., and Creighton, S.M. (2010). Labial surgery for well women: a review of the literature. British Journal of Obstetrics and Gynaecology, 117:20-25.

Lloyd, J., Crouch, N., Minto, C., Liao, L., and Creighton, S. (2005) Female genital appearance: “normality” unfolds. British Journal of Obstetrics and Gynecology 112: 643-646.
Morris, K. (2006). Feature Issues on female genital mutilation/cutting - progress and parallels. The Lancet, 368:S64-S566.

Schick, V., Rima, B., and Calabrese, S. (2010). Evulvaluation: The portrayal of women’s external genitalia and physique across time and the current Barbie Doll ideals.  Journal of Sex Research 47: 1-9.

Schick, Vanessa (2010). Examining the Vulva: The Relationship between Female Genital Aesthetic Perceptions and Gynecological Care.  PhD Dissertation, The George Washington University.
Tiefer, L. (2008). female genital cosmetic surgery: freakish or inevitable? Analysis from medical marketing, bioethics, and feminist theory. Feminism & Psychology, 18(4): 466-479.

Zielinski, Ruth. (2009). Private Places - Private Shame: Women’s Genital Body Image and Sexual Health. PhD Dissertation, The University of Michigan.

Vagina Dialogues, The Association of Reproductive Health Professionals, 2003
http://www.arhp.org/publications-and-resources/studies-and-surveys/vagina-dialogues