New research aims to examine why more girls seek genital cosmetic surgery

Neelima Choahan

2/07/2018 3:25:34 PM

A pilot study is investigating why increasing numbers of Australian girls as young as 11 are seeking cosmetic surgery on their genitals.

Melbourne University researcher Emma Barnard says girls often compare themselves to stylised photos online or in magazines.
Melbourne University researcher Emma Barnard says girls often compare themselves to stylised photos online or in magazines.

At just 13, Melanie* started worrying about how her vagina looked after noticing textbook drawings that looked different to her body.
Melanie’s worried mother took her to a GP, who referred her to Melbourne Royal Children’s Hospital where she was reassured that she was perfectly normal.
Girls as young as 11 are seeking cosmetic surgery on their genitals, according to University of Melbourne researcher Emma Barnard.
‘Something has changed in the last 10–15 years to make women and girls more aware of the appearance of their genital anatomy,’ Ms Barnard said.
‘In the 10 years up until 2014, there were 12,190 [labiaplasty] procedures billed to Medicare.
‘And just a quarter of that … number was performed on women under the age of 25.’
Ms Barnard is interviewing young women who sought medical advice about their genital appearance as part of a pilot study investigating the increase in young girls seeking cosmetic surgery.
Ms Barnard said the fact Medicare no longer covers such surgery unless a surgeon provides evidence that it is clinically indicated means there is less room for rebate to be associated with a labiaplasty that is performed for aesthetic reasons.
However, those who want genital cosmetic surgery can have it done privately once they have a referral.
Royal Children’s Hospital figures show the median age of the 41 girls and young women referred to the hospital between 2000–12 concerned by how their labia looked was 14.5 years. In nearly a quarter of cases, it was the mother who was concerned.
Medicare claims for labiaplasty and vulvoplasty more than doubled from 707 in 2002–03 to 1584 in 2013–14, with the number of claims among 15–24-year-olds similar to women aged 25–44.
‘What the Medicare data does show is that over that time the numbers were systematically going up,’ she said.
‘But those figures are likely to be an underestimate because they are not counting anything that wasn’t getting a Medicare rebate.’
Female genital cosmetic surgery most commonly involves ‘labiaplasty’ to cut the edges of the labia minora so it does not extend beyond the outer skin folds, the labia majora. It can also extend to procedures like vaginoplasty to tighten the vagina, or vulval lipoplasty to remove fat around the vulva. 
According to Ms Barnard, many of her study’s participants said that as girls they had only seen vaginas in stylised or airbrushed images in textbooks, magazines, social media or on the internet. Fashion for Brazilian waxing, tight-fitting clothing and G-strings were also an influence, but, perhaps surprisingly, pornography appeared not to have played a major role. 
Dr Magdalena Simonis, author the RACGP’s guidelines on female genital cosmetic surgery, told newsGP the internet plays a large part in forming women’s perception about what is ‘normal’.
‘What we do know is that there is no such thing as a normal vulva,’ Dr Simonis said.
‘A lot of young women are being told there is a particular normal appearance and normal is also what is equated with desirable.’

Dr_Magdalena_Simonis-hero-(2).jpgDr Magdalena Simonis, author the RACGP’s guidelines on female genital cosmetic surgery, says it is important for GPs to always take the time to listen to their young patients’ concerns. 

Dr Simonis said there is no research related to the long-term implications of removing young women’s genital tissues in terms of sexual function.
‘Their bodies have not yet reached full maturity,’ Dr Simonis said.
‘And taking the decision to remove a genital tissue that actually serves as sexual organ that is normal and sexually responsive before they even have sexual experiences … they are being exposed to potential harm.’
In 2016 the Medical Board of Australia recommended that anyone 18 or under seeking any major cosmetic surgical procedure, including labiaplasty, must undergo a mandatory psychological assessment conducted either by a GP who is not affiliated with the surgeon who is conducting the surgery, a psychologist, or a psychiatrist.
There is also a mandatory cooling off period of three months before such surgery is undertaken once it has been requested. 
In the event they are approached by a patient about genital cosmetic surgery, Dr Simonis recommends that GPs listen to the concerns of the young woman and investigate for any deeper issues.
‘What she might be coming in with is a concern about her genital appearance, but where that actually stems from might be misinformation that she has received from an internet site, bullying from girlfriends at school who have seen each other naked at … change rooms,’ she said.
‘The role of the GPs is to listen … then to actually offer her the opportunity to see the range of images either online through using something like the labia library [featuring a photo gallery of unaltered images of women’s labia].’
Dr Simonis said GPs should ask about the patient’s mental health and how this particular issue is affecting them in order to investigate if they may be experiencing body dysmorphic disorder, an obsessive fixation on a particular body part, or any eating disorders. Any sexual abuse and family’s attitudes towards sexuality and sex also play an important role.
After establishing trust, Dr Simonis believes GP should offer to examine the patient but have a chaperone present, especially in the case of a male doctor.
‘I would actually give the young person a mirror so that they can show me what it is that they don’t like about themselves,’ she said.
‘If they say “no” or refuse to touch themselves, they are usually hallmarks of deeper anxiety around their genitals. Self-disgust, revulsion is usually a marker of something that is a bigger problem.’
Dr Simonis said GPs should refer to another practitioner if they feel uncomfortable examining a young woman. She also believes any decisions regarding surgery must be made among all relevant people.
‘It is a team decision, between the GP, the adolescent, the parent or the guardian carer, the psychologist or psychiatrist, and the gynaecologist or surgeon,’ she said.
RACGP resource
Female genital cosmetic surgery: A resource for general practitioners and other health professionals provides information on the surgery, the factors driving demand, and a set of practical recommendations on how to manage women requesting referral for surgery or expressing concern regarding their genitalia.

* Not her real name.

female genital cosmetic surgery labiaplasty vaginoplasty vulval lipoplasty

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