The secret risks of labiaplasty that reality TV doesn’t show

Twenty years ago, almost no one had heard of this procedure, including this seasoned women’s health expert. Now a new conversation has erupted about genital surgery and the risks it carries.

The ‘Barbiplasty’ has become the most requested female genital cosmetic surgery procedure, says expert Melbourne GP, Associate Professor Magdalena Simonis

Labiaplasty, also referred to as “Barbiplasty” or “designer vagina”, is the most requested of cosmetic procedures that fall under the umbrella of female genital cosmetic surgery.

Twenty years ago, almost no one had heard of this procedure, including myself, a seasoned women’s health expert.

Labiaplasty, in its simplest form, involves the cutting of the labia minora, which are the inner, most sensitive, moisture-producing lips of the vulva. The aim is to prevent their protrusion from the margins of the labia majora, which are the hair-covered outer flaps. About 50 per cent of women have labia minora that are visible beyond the line of the labia majora, and this appearance was not considered anomalous nor newsworthy, until recently.

Social forces and trends such as a widespread lack of knowledge about the diversity of genital appearance, genital hair removal or the “Brazilian”, online pornography that displays unrealistic, airbrushed images of models with pre-pubescent looking genitals, tight-fitting sportswear that is unkind to generously proportioned women and girls, skimpy women’s fashion including the notoriously uncomfortable G-string, social and media commentary using terms such as “camel toe” and “meat flaps”, among other derogatory descriptors, have led to a swath of anxious women and girls seeking information on how to get their vulva to look a certain way.

Some women feel different following childbirth, and seek a return to a “youthful”, pre-pregnancy body. Each of these influences has given rise to a new condition the medical profession refers to as “genital anxiety”, for which a surgical solution has been promoted by an opportunistic cosmetic surgery industry.

Up until 2011, female genital cosmetic surgery procedures were mostly performed under the Medicare Benefits Scheme in women for extreme genital abnormality, vulval cancer, female genital mutilation repair, the rare congenital condition known as labial gigantism, or for gender reassignment procedures. The inexplicable threefold increase in MBS requests over a decade did not correspond with an increase in medically indicated conditions and instigated a review of these procedures, assisted by concerns raised by several women’s health advocates, of which I am one.

In Australia, women were being advised by surgeons and online blogs to see their GP to get a referral to claim their rebate for “functional impairment” due to chafing when exercising, or for needing to manually part their “lips” upon penetration during sex. Such requests for procedures can no longer be claimed under the MBS as they don’t qualify, and although the taxpayer wins here, cosmetic cowboys flourished, many of whom marketed the “youthful vagina” and offered expensive simple “walk-in-walk-out” procedures, without any training or understanding around the complexity of the genital anatomy themselves.

A still from Hulu's The Secret Lives of Mormon Wives where reality star Jessi Ngatikaura shared her labiaplasty experience

The risks associated with labiaplasty include the loss of sexual sensation postoperatively which might worsen post menopause as genital tissue becomes thinner and shrinks. Few women are ever told that the labia minora are densely innervated with nerve fibres, second only to the clitoris, which means labiaplasty reduces the surface area which produces lubrication and pleasurable sensation during sex. Other risks include infection, painful scar-tissue formation and some undergo clitoral hood reduction to achieve symmetry at the same time, which exposes the clitoris by removing its protective flap and can result in constant pain, as the clitoris rubs on clothes. Even more concerning is the fact that full genital maturity is not complete until around 18 years and yet the largest group requesting labiaplasty falls within the 15 to 35-year age group, which means outcomes can change, with repeat surgery often requested at extra cost.

Online blogs and reports of women proclaiming that they are happy with their new “designer vagina”, or that they have better sex or fewer urinary or genital infections such as thrush, should be taken with a grain of salt. A whole surgical industry has burgeoned under the banner of “botched labiaplasty” and those reconstructive surgeons report that up to 50 per cent of labiaplasty recipients require some corrective surgery down the track.

Similarly, my study findings of 2015 revealed that up to 98 per cent of GPs surveyed had seen women with genital anatomy concerns who wonder, “am I normal down there?”. Most of the surveyed GPs suspected other mental health issues and social influences also, in those requesting female genital cosmetic surgery. Adolescence is also the period when up to 50 per cent of mental health issues such as anxiety, depression, body dysmorphic disorder or eating disorders to name a few, will develop. Intimate partner violence, peer pressure in adolescence can be drivers of requests for labiaplasty which makes it more important to consider the social forces and provide education around genital diversity.

Dr Magdalena Simonis

Overall, society suffers a collective ignorance around women’s health and this knowledge gap is amplified around female genital anatomy. Unlike men, women’s genitals are hidden behind pubic hair which when and if removed, displays an area unfamiliar to them because women don’t share toilet cubicles and there’s stigma surrounding menstruation from early life.

Rarely do women and girls know the correct names of their genital structures and they know even less about their function, let alone the causes of infection. Up to 50 per cent of recurrent genital irritation is caused by G-strings (in those who wear them), yet patients respond to this statement with disbelief. Furthermore, when I offer a mirror to women during a gynaecological examination to talk them through the structures of their own body, they usually refuse. Women’s Health Victoria responded to the lack of understanding around genital anatomy by establishing an online labia library which is free and accessible. The site provides information, non-airbrushed photos and collects data for research.

Things to consider when concerned with your genital appearance are that labiaplasty is irreversible, labia minora are second to the clitoris in sensitivity, women know little about their own anatomy and social forces influence the way women feel about their bodies. Familiarise yourself about genital diversity and have a talk to your GP or a health professional, who will not benefit financially from your choice to proceed with surgery.

Associate Professor Magdalena Simonis AM is the author of Female genital cosmetic surgery: A resource for general practitioners and other health professionals, Royal Australian College of General Practitioners. Dr Simonis is a member of the RACGP Expert Committee for Quality Care and was a board director of Women’s Health Victoria until 2022.

References

Female genital cosmetic surgery: a cross-sectional survey exploring knowledge, attitude and practice of general practitioners M Simonis, R Manocha, J J Ong

Female genital cosmetic surgery A resource for general practitioners and other health professionals

The Labia Library