Lois Rogers

The Sunday Times Published: 09 October 2011. Lois Rogers.

Genital remodelling has hit the mainstream. But what´s behind the demand for this private perfection?

Whether or not women should wear a bra was a subject for debate in the early days of feminism. More than 40 years later, the argument has moved down to knickers – and whether or not you should surgically interfere with what´s inside them in order to present an idealised version of femininity to a man.

Last month a study by female doctors revealed that more than 2,000 women a year are receiving labial reduction or reshaping operations on the NHS, with thousands more performed in the private sector.

The procedure, virtually unknown in the 1980s and 1990s, has become one of the fastest growing areas of cosmetic surgery. It is, we are told, a spin-off from the pornography industry and explicit reality TV shows where all female performers have perfectly symmetrical – and hair-free – body parts.

The consequence of this pubic beautifying is that everyone in the changing rooms can see if what´s underneath measures up to porn-movie standards of symmetry and neatness.

According to experts, most people, in their natural state, do not. For very many women the inner lips are flappy or uneven. Thanks to the new age of internet voyeurism, this is now seen as unfeminine, unacceptable and a source of shame.

Lih-Mei Liao is a clinical psychologist at University College Hospital, London, and one of the authors of the new study published in the Journal of the Royal College of Obstetrics and Gynaecologists. She has spent several years investigating the growing phenomenon of genitoplasty and says increasing numbers of women are anxious to create a flat vulva with no protrusion beyond the outer labia, even though it is totally normal for the labia minora, the inner folds of the vulva, to be visible between the outer lips.

The normal labial reduction operation involves trimming the outer edges of the labia minora and stitching over the raw edges like a thin piece of fabric.

The procedure, done under local anaesthetic, takes minutes, but healing takes up to a week and patients are advised to avoid sex for up to eight weeks.

Liao´s study reviewed 33 women, with an average age of 23, who were referred to the hospital for NHS labial reduction surgery between 2007 and 2010. All were convinced their genitals were in some way ugly, but were subsequently deemed normal by gynaecologists and turned away. When questioned afterwards, a number said they would seek private operations.

Like Ambrose, Liao is vehemently opposed to such surgery. “It has become a social phenomenon,” she says. “It is nothing to do with a recognisable disease or condition. There is something cultural going on about what women think about the way their genitals appear to themselves or their partners.”

There are no guidelines for surgeons about whether someone needs surgery – it is purely down to the individual clinician to decide whether or not a prospective patient´s genitals could be visually improved. Liao and her team are collaborating in a 10-minute documentary called Centrefold, to be shown at film festivals next spring, with the aim of generating debate about the ethics of what they view as a form of female genital mutilation.

They also want to see more research to establish whether women get hooked on cosmetic genital enhancement, in the same way that some become nip-and-tuck regulars for facial surgery.

Meanwhile, Angela Whitworth, 53, from Sussex, freely admits that conforming to a more idealised image of femininity was her principal motive when summoning up the courage to have the operation earlier this year. She has two adult children from her first marriage and has been married to her second husband, a successful company director, for 20 years. Before the operation they had not had sex for 11 years. “I was talking to a friend about plastic surgery, and she suddenly told me she had had her labia reduced. I went to see the surgeon she recommended and he behaved as though it was the most natural thing in the world.” Angela didn´t tell her husband she was having it done. “I had always felt self-conscious about having a bulge there. I don´t think it made much difference to my husband, but the fact I now feel so much sexier and better about myself has absolutely delighted him. I can honestly say it has changed my whole life.”

Katrina Blears, 39, from Guildford, who has two children aged three and five, says her self-image changed as a result of child-bearing. “I felt as though I had been shredded after the birth of my second child. It took a long time to heal, and, to put it delicately, everything was left a bit lopsided and flappy. I felt about as feminine as a Soviet shot-putter. I don´t think it would have made much difference to my husband either way, because the muscles were all okay, but the fact I feel sexier and better about myself has made a huge difference to both of us.”

Sheela Purkayastha, a private specialist in vaginal tightening and “rejuvenation” in London´s West End, concedes that most of her fellow senior gynaecologists take a dim view of labiaplasty. Undaunted, she is now getting requests for up to two operations a week, and has even been to California to learn how to perform the procedure using a special laser that burns away the excess skin and avoids the need for stitching. “I would never do this on someone with normal labia, but I see plenty of women with abnormal ones,” she says. “Only the other day I had a patient in her fifties who had a difficult birth 18 years ago. She had suffered discomfort and embarrassment from an extended labia ever since, and now her life has been transformed.”

Others are at pains to point out that the operation is not being sought by nymphomaniacs or exhibitionists. Paul Banwell, a spokesman for the British Association of Aesthetic Plastic Surgeons, who does labiaplasty on the NHS as well as privately, says: “My patients are not people in the glamour industry – pole dancers and porn stars – these are middle-aged mothers, professionals and businesswomen who experience functional discomfort cycling or working out in a gym, often as a result of elongation of the labia during childbirth. It is about self-esteem, self-worth and quality of life. These are women in their forties, fifties and sixties who have been concerned about it for very many years before they seek help.” Like the other specialists, however, Banwell recognises that “normal” is a subjective notion, and one affected by fashion.

Media images of labial perfection are more likely to dictate trends than feminist blandishments. Labial sculpting, then, along with Botox , boob jobs and highlights, looks as if it´s here to stay.