Body dissatisfaction is to teenage girls what involuntary boners and death-grip masturbation is to teenage boys: an inevitable part of growing up. But for young women growing up today, being unhappy with your physical appearance can even lead to surgical consequences.
More young girls than ever before are seeking cosmetic genital surgery to address perceived problems with the appearance of their vulvas. Such is the scale of the problem, the American College of Obstetricians and Gynecologists recently issued new guidance about what to do when teenage girls ask for cosmetic genital surgery. Amongst the recommendations include screening teenage girls for body dysmorphic disorder, and providing "reassurance" that the changes young girls are experiencing in their bodies are, in fact, totally normal.
While the concept of cosmetic genital surgery is generally associated with older women, who may have experienced changes post-childbirth, the idea of teenage girls having labiaplasty or equivalent surgical treatments causes horror among many medical professionals. The motivating factor seems to be the idea that not all vaginas are created equal. Pretty, pink and tucked away—like the vaginas you see in porn—equals good.
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Although such procedures remain extremely rare, they are on the increase. According to data from the American Society for Aesthetic Plastic Surgery, 4.6 percent of those having labiaplasty are under 18 (400 girls in 2015, compared to 222 the year previously). To find out what's driving young girls to surgery, we spoke to Dr. Amanda Tozer, a consultant gynecologist at the London Clinic.
Dr. Tozer confirms that, for the most part, women are pretty chill with the vaginas they were born with. "I've certainly seen some young girls coming to me wanting labia reduction. But the numbers are really small—I'd say in the last ten years, I've only encountered about three women who've asked for it."
In all three cases, the girls did have what Dr. Tozer refers to as "unusually large labia, to the point that they were really obsessed by it and it was affecting them psychologically. One had asymmetry, meaning that the labia was really large on one side and small on the other. So I could understand why she wanted it matched."
As a medical professional, Dr. Tozer counsels against unnecessary surgical interventions: particularly when the patient is so young. "I'd be reluctant to perform surgery on teenage girls, and certainly not because it's fashionable. I'd need a really good reason—either asymmetry, or a medical problem. Otherwise, personally, I wouldn't do it."
We already know that teenage girls tend to be more anxious about their bodies than teenage boys, and this can manifest in a damaging preoccupation with having the 'perfect' vagina. While education can help teenage girls to recognise that not all vaginas look a certain way, it might not be enough to undo the root causes.
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"Education is difficult when it comes to gynecology, because we need to be getting to heart of why these girls think they look abnormal," Dr. Tozer says. "Is it because they're looking at porn? Have their boyfriends or partners passed comment? Where are they getting their information from in the first place? Trying to educate the population when there's no inherent medical problem is a challenge."
Another challenge doctors face is that cosmetic genital surgery can sometimes veer into dangerous (and illegal) territory. "When doing labia reductions, you need to be really careful that you don't fall into FGM territory. As gynecologists, we have to be extremely cautious with regards to where we tread. So from my point of view, it's important to be performing surgery for medical reasons only."
In many instances, what can seem like a physical problem—misshapen or oversized labia—can have a psychological solution. "If a patient came to me and said they were struggling with their vagina but there was nothing physically wrong with their genitalia, my first thought would be that they need to see a psychologist."
Dr. Tozer's advice to young girls who're struggling to accept how they look down there? "If you're worried there's a medical abnormality, certainly go to your doctor and get it checked out. Maybe there is a congenital problem. But if there's not, at least you can be reassured medically.
"This is what you're born with. This is normal for you."