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ORIGINAL RESEARCH—WOMEN’S SEXUAL HEALTH
“What Motivates Her”: Motivations for Considering Labial
Reduction Surgery as Recounted on Women’s Online
Communities and Surgeons’ Websites
Sandra Zwier, PhD
Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam,
The Netherlands
DOI: 10.1002/sm2.20
ABSTRACT
Introduction. Increasing numbers of women are seeking labial reduction surgery. We studied the motivations
for considering labial reduction surgery as recounted on women’s online communities and surgery provider’s
websites.
Aims. The study analyzed motivations for considering labial reduction surgery expressed by women on online
communities, looked at the role of the women’s age and nationality, compared findings with motivations indicated
on the websites of an international sample of surgery providers, and identified similarities to and differences from
what is known from extant studies.
Methods. Quantitative content analysis of the posts of 78 American, British, and Dutch women on online commu-
nities, and 40 international surgery providers’ websites about labial reduction surgery was conducted.
Main Outcome Measures. Main outcome measures concerned the incidence and prominence of different motiva-
tional categories (functional/emotional and discomfort/enhancement related). Differences in motivations as a
function of age, national background, and women’s vs. surgeons’ stated motivations were tested.
Results. Emotional discomfort regarding self-appearance and social and sexual relationships was found to be the
most frequent and most prominent motivation for considering labial reduction surgery on women’s online com-
munities, regardless of age and national background. Functional discomfort and desired emotional enhancement
ranked second. Very few age or national differences were found. The surgeons’ websites recognized functional
discomfort more and elaborated upon emotional issues in sexual relationships less than members of the online
communities.
Conclusions. Feelings of emotional and psychosexual distress in addition to functional distress are a highly prevalent
motivation among women considering labial reduction surgery. Emotional distress appears to be greater and more
freely emphasized when women communicate on online communities, while functional issues appear to receive
greater notice on surgery provider’s websites. Zwier S. “What motivates her”: Motivations for considering labial
reduction surgery as recounted on women’s online communities and surgeons’ websites. Sex Med
2014;2:16–23.
Key Words. Labiaplasty; Female Genital Cosmetic Surgery; Online Communities; Surgeons Websites
Sex Med 2014;2:16–23 © 2014 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License,
which permits use, distribution and reproduction in any medium, provided the original work is properly cited and
is not used for commercial purposes.
Introduction
“I hate mine, hate, hate HATE it! It’s like a tongue
sticking out for heavens sake!” “What if they told every-
one in school ‘yeah, she’s pretty but there’s something
wrong down there.’ ” “I’d like to cut them off.”
1
This article is about women’s motivations for con-
sidering a surgical reduction of their labia, or
labiaplasty (labioplasty). The focus will be on a
reduction of the labia minora through surgical pro-
cedures rather than on other forms of female
genital cosmetic surgery, such as surgery of the
labia majora or clitoral hood.
2
There is broad con-
sensus that female genital surgery for a reduction in
the size of the labia minora has risen sharply in
recent years [1,2], and sociocultural explanations
and implications are broadly discussed [3–8]. Our
study aim was to provide further empirical evidence
on the question about what motivates individual
women to consider this very intimate form of
surgery. The study is based on two original data
sources. The first is a quantitative content analysis
of motivations for considering labial reduction
surgery as shared by 78 American, British, and
Dutch members of women’s online communities in
recent years. The motivations for considering labial
reduction surgery that the women gave in this
anonymous, nonclinical context were systemati-
cally coded and analyzed to identify recurrent pat-
terns. The second data source is a content analysis
of motivations for considering labial reduction
surgery given on 40 surgery providers’ websites,
allowing comparisons between women’s online
communities and surgery providers’ websites.
The extant knowledge of individual women’s
motivations for considering labial reduction
surgery is based almost exclusively on reviews of
the medical records or surveys of surgery provid-
ers’ patients (for reviews: [9–11]). A critically con-
founding factor of the findings obtained in this
clinical context however is that women may not
reveal all of their motivations in this context [9,12].
There are at least two reasons for this. First,
because surgery providers function as gatekeepers
in women’s admission to labial reduction surgery,
and a woman may not be accepted for the surgery
if the doctor believes she is psychologically
unstable or under third-party influence [13]. In
addition, women in most Western countries are
denied insurance coverage unless the doctor can
confirm that the procedure is for purely functional
reasons [14]. In fact, every community we analyzed
for the present research included women seeking
advice from other women about the right prompt-
ers to say to the doctor to warrant surgery and
coverage. Second, issues related to the genitals are
an extremely sensitive topic that the majority of
women would find awkward talking about, includ-
ing during the medical encounter [15–17]. Indeed,
many members of the women’s online communi-
ties expressed intense fears of having to talk about
and undergo a medical examination of their labia
with a doctor. Both these factors may seriously
complicate the interpretation of motivations for
labial surgery as recounted in patient–provider
communication.
One study that reported interviews with women
about their motivations for considering labial
reduction surgery that were conducted outside a
direct clinical context [12] identified feelings of
“imperfection” and issues in sexual relationships as
the primary motivations. With six interviewees,
however, the study was exploratory in nature.
Aims
The present study extends upon the extant
research by: (i) analyzing motivations for consid-
ering labial reduction surgery expressed by a larger
international group of women in an anonymous,
nonclinical context; (ii) studying the role of
women’s age and national background; (iii) analyz-
ing motivations for considering labial reduction
surgery indicated on an international sample of
surgery providers’ websites; (iv) comparing the
motivations of members of women’s online com-
munities with the motivations presented on
surgery providers’ websites; and (v) identifying
similarities to and differences from what is known
from clinical research about why women choose to
undergo this controversial surgical procedure.
The study was primarily guided by the following
hypotheses:
H1: Women’s online communities will express
more emotional than functional discomfort moti-
vations for considering labial reduction surgery.
H2: Women’s online communities will reflect
more emotional and less functional motivations
1
These are literal quotes from contributions to online com-
munities about labia reduction surgery (first quote from:
http://www.cosmopolitan.co.uk/community/forums/
thread/1406999, second quote from http://www
.experienceproject.com/group_stories.php?g=106234,
third quote [translated from Dutch] from: http://www
.medischforum.nl/onderwerp/9915/0/).
2
Surgical procedures are reviewed in many of the cited
articles [10,11,21–26].
Labial Reduction Surgery 17
Sex Med 2014;2:16–23© 2014 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.
for considering labial reduction surgery than
surgery providers’ websites.
Method
This study was based on the posts of 78 members
of online communities about labial reduction
surgery and on 40 websites of providers of such
surgery. Both the online communities and the
websites were sampled via a Google search using
the search terms “labia reduction,” “labia correc-
tion,” “labiaplasty,” and their literal Dutch trans-
lations. Four online communities that contained
recent threads about labia reduction surgery (one
from the Netherlands, two from the United States,
and one from the United Kingdom)
3
were
selected. Details about these online communities
are presented in Table 1. Only female community
members who referred to a reduction of the labia
minora (as opposed to other genital surgeries) and
shared their personal motivations (as opposed to
members giving a moral opinion or only asking
other women questions) were sampled. The final
sample consisted of 78 women: 28 from the Dutch,
25 from the American, and 25 from the British
online communities. Not all women mentioned
their age, but of those who did, the youngest
member indicated that her age was 12 years and
the oldest was 61 years; the mean was 21.5 years
(standard deviation [SD] = 9.6).
4
The sample of surgery providers’ websites con-
sisted of 40 English or Dutch language websites
from Australia, Canada, Ireland, the Netherlands,
New Zealand, South Africa, the United Kingdom,
and the United States. Only providers offering
clients an actual surgical reduction of the labia
minora were sampled (as opposed to online plat-
forms, sites that provided only information, or sites
for health care professionals). Nearly all providers
also offered a range of other cosmetic surgeries,
such as mammoplasty (breast augmentation) or
blepharoplasty (eyelid surgery), and sometimes also
other forms of cosmetic genital surgery, such as
vaginoplasty (vagina tightening) or clitoral hood
reduction. Eleven websites (28%) also showed
“before and after” labiaplasty pictures. Twenty-
three websites (57.5%) gave price indications for
labial reduction surgery, varying from €795 (£703/
US$825) to €3,500 (£2,983/US$4,579), with an
average of €1,581 (£1,348/US$2,068).
The unit of analysis for the online communities
was the individual member, and for surgery pro-
viders, it was the web page(s) on labial reduction
surgery.
5
Each motivation for considering labial
reduction surgery mentioned in the member’s
posts or on the provider’s website was coded as
belonging to categories of emotional vs. functional
discomfort and discomfort vs. enhancement-
related motivations. Functional (or “medical”) vs.
emotional (sometimes also “aesthetic” or “psycho-
logical”) motivations are commonly used denomi-
nators in categorizing motivations for female
genital surgery and for cosmetic surgery in general
[9–11]. The discomfort vs. enhancement (or
“treatment/enhancement”) distinction refers to
motivations grounded in the cure of a perceived
disease or disability vs. those that are grounded in
the improvement of a regular condition [18]. An
overview of the categories, including examples, is
presented in Tables 2 and 3.
3
Two online communities from the United States were
sampled in order to have comparable numbers of members
across nationalities.
4
The sample’s average age is probably somewhat higher
because the age of younger girls often played a role in their
considerations (parents’ reactions, clinical admission, etc.),
so that age was presumably mentioned more often by
younger than by older members.
5
The content analysis concerned those pages that discussed
the surgical reduction of the labia minora, thereby omitting
surgical procedures involving other parts of the female
genital area.
Table 1 Details of online communities in the sample
Forum name Thread topic name Nationality Oldest/latest post n sample
Medisch Forum* “Schaamlip correctie” Dutch May 2007–March 2013 28
Cosmopolitan
†
“Labia reduction?” British May 2008–Feb. 2013 25
The Fabulous Vagina
‡
“Labia reduction surgery experience” American July 2005–Feb. 2012 10
Experience Project
§
“I had labiaplasty” American Feb. 2009–March 2013 15
*http://www.medischforum.nl/onderwerp/9915/0/
†
http://www.cosmopolitan.co.uk/community/forums/thread/1406999
‡
http://www.network54.com/Forum/287637/thread/1120209987/last-1329620198/Labia+reduction+surgery+experience
§
http://www.experienceproject.com/group_stories.php?g=106234
18 Zwier
Sex Med 2014;2:16–23 © 2014 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.
Main Outcome Measures
Two indices were calculated on the basis of the
content analysis coding, namely “incidence” and
“prominence” of motivation categories. “Inci-
dence” reflects whether a motivation category
occurred at all in the individual online community
member’s posts/on the provider’s website (coded 0
for “no” and 1 for “yes”). “Prominence” reflects
the extent to which motivations from other cat-
egories were also mentioned by the same member/
website. It was calculated by the incidence measure
of the motivation, divided by the sum of all moti-
vation categories mentioned by the same member/
website. This measure could vary between 0 (the
motivation category was not mentioned) and 1 (the
motivation was the only one mentioned by
the member or on the website).
Statistical Analysis
Employing IBM SPSS Statistics 22 software (IBM
Corporation, Armonk, NY, USA), paired sample
t-tests verified whether prominence and incidence
of the motivations differed within online commu-
nities and within surgery providers’ websites. Dif-
ferences across online communities and surgery
providers’ websites on the prominence and inci-
dence of motivations were tested with analyses of
variance (anovas).
6
6
Because one of the measures (“incidence”) is a dichoto-
mous variable, violating some assumptions for the conduct
of anova, we also estimated the effects with logistic regres-
sions and Fisher’s exact tests and this yielded the same
substantive results. We present the anova results in order
to enhance comparability across analyses.
Table 2 Incidence and prominence of motivations for labial reduction surgery on online communities*
Motivations
Incidence Prominence
% [CI] M (SD)
Emotional discomfort 71.0 [61.0–81.0] 52.0 (40.5)
Self (feeling “freakish,” self-loathing) 48.8 [37.6–59.9]
a
18.3 (25.8)
a
Social (shame, fear of ridicule) 38.8 [27.8–49.7]
ab
15.0 (23.8)
ab
Sexual relations (fear negative partner reaction) 37.5 [26.7–48.3]
ab
15.8 (26.4)
ab
Emotional enhancement 32.5 [22.0–43.0] 14.4 (25.2)
Private area (normal, likable appearance) 28.8 [18.6–38.9]
b
11.6 (23.3)
abc
Sexual relations (more enjoyment) 11.3 [4.2–18.3]
cd
2.8 (9.7)
d
Functional discomfort 52.5 [41.3–63.7] 31.1 (36.8)
Private area (tight clothing, hygiene) 27.5 [17.5–37.5]
b
10.7 (21.0)
abc
Sexual relations (pain during intercourse) 21.3 [12.1–30.4]
bc
8.1 (20.0)
bc
Exercise (soreness when cycling, dancing) 21.3 [12.1–30.4]
bc
7.2 (17.0)
c
Functional enhancement (no rubbing, better hygiene) 7.5 [1.6–13.4]
d
2.5 (12.3)
d
*Different superscripts within the column “Incidence” mark significant differences at the P < 0.05 level between the incidences of the different motivations on the
online communities. Different superscripts in the column “Prominence” similarly mark significant differences at the P < 0.05 level between the different motivations,
but now in the motivations’ prominence on the online communities. Bold numbers are the main categories of motivations.
CI = confidence interval; M = mean; SD = standard deviation
Table 3 Incidence and prominence of motivations for labial reduction surgery on online communities vs. surgeons’
websites
†
Motivations
Incidence Prominence
Online
communities
Surgeons’
websites
Online
communities
Surgeons’
websites
% [CI] % [CI] M (SD) M (SD)
Emotional discomfort 71.0 [61.0–81.0] 98.0 [92.0–100]*** 52.0 (40.5) 38.6 (23.8)*
Self 48.8 [37.6–59.9] 65.0 [49.6–80.5] 18.3 (25.8) 12.8 (16.9)
Social 38.8 [27.8–49.7] 72.5 [58.0–87.0]*** 15.0 (23.8) 21.5 (22.5)
Sexual relations 37.5 [26.7–48.3] 15.0 [3.4–26.6]* 15.8 (26.4) 2.0 (5.1)***
Emotional enhancement 32.5 [22.0–43.0] 37.5 [21.8–53.2] 14.4 (25.2) 11.0 (17.4)
Private area 28.8 [18.6–38.9] 35.0 [19.6–50.5] 11.6 (23.3) 8.3 (13.6)
Sexual relations 11.3 [4.2–18.3] 17.5 [5.2–29.8] 2.8 (9.7) 2.7 (6.5)
Functional discomfort 52.5 [41.3–63.7] 90.0 [80.3–99.7]*** 31.1 (36.8) 47.1 (24.8)*
Private area 27.5 [17.5–37.5] 82.5 [70.2–94.8]*** 10.7 (21.0) 20.5 (13.1)**
Sexual relations 21.3 [12.1–30.4] 15.0 [3.4–26.6] 8.1 (20.0) 2.1 (5.4)
Exercise 21.3 [12.1–30.4] 65.0 [49.6–80.5]*** 7.2 (17.0) 13.4 (11.4)*
Functional enhancement 7.5 [1.6–13.4] 20.0 [7.0–33.0]* 2.5 (12.3) 3.3 (7.1)
†
Asterisks mark significant differences between the online communities vs. surgeon’s websites concerning the incidence and occurrence of motivations, whereby
***P < 0.001, **P < 0.01, and *P < 0.05.
CI = confidence interval; M = mean; SD = standard deviation
Labial Reduction Surgery 19
Sex Med 2014;2:16–23© 2014 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.
Results
Women’s Online Communities
Of the international group of women in the
anonymous context of the online communities,
42.5% mentioned only emotional motivations for
considering labial reduction surgery, 41.2% men-
tioned a combination of emotional and functional
issues, and 16.3% mentioned only functional
motivations.
The average incidence and prominence of
motivations for considering labial reduction
surgery on the online communities is given in
Table 2. As can be seen, the motivation mentioned
most often and most prominently by the online
community members concerned feelings of emo-
tional discomfort regarding the appearance of
their labia. This motivation was mentioned by
more than 70% of the online community members
and accounted for an average of more than half of
the different motivations mentioned by individual
members. Within this category of emotional dis-
comfort, issues that focus primarily on the self
(such as self-loathing and feeling “freakish”) were
mentioned by nearly half of the members and con-
cerned nearly one in five of all the different moti-
vations mentioned.
We conducted paired sample t-tests to verify if
the prominence or incidence of the different
motivations were statistically different from one
another. The superscripts in Table 2 signal sig-
nificant differences at the P < 0.05 level. As indi-
cated by the superscript “a” that is jointly carried
by all three categories of emotional discomfort,
emotional discomfort was mentioned significantly
more often and prominently than any of the
other motivations, including functional motiva-
tions. This is in alignment with Hypothesis 1.
Further, within the category of emotional dis-
comfort, issues that were self-focused were men-
tioned equally often and prominently as
emotional issues with a more social focus (e.g.,
embarrassment, fear of ridicule) or sexual focus
(e.g., fear of rejection by the sexual partner). The
joint superscript “b” in Table 2 further shows that
the second largest and most prominent group of
motivations, significantly lower than emotional
discomfort, consisted of a combination of issues,
namely functional discomfort and the real or
anticipated emotional self-enhancement brought
about by the surgery. A third group of motiva-
tions, carrying superscript “c,” concerned the
functional discomfort experienced particularly in
sexual relationships and during exercise. A final
group of motivations, carrying superscript “d,”
involved the reduced functional discomfort that
could be achieved through the surgery. As can be
seen in Table 2, however, the incidence and par-
ticularly the prominence of this latter group of
motivations among the other motivations men-
tioned by a member were minor.
The Role of Age and Nationality
We divided the 46 online community members
who had mentioned their age into three age
groups: younger than 16 years of age (n = 11),
16–23 years of age (n = 25), and 24 years of age or
older (n = 10). Differences in motivations for con-
sidering labial reduction surgery between age
groups were examined, employing anovas with
incidence and prominence of motivations, respec-
tively, as the dependent variable and age group
(younger than 16 years vs. 16–23 years vs. 24 years
or older) as independent variable.
7
No significant
differences in the motivations between age groups
were found, with the exception of functional dis-
comfort in sexual relationships, F(2,43) = 4.23,
P < 0.05, η
2
= 0.16. Post hoc Scheffe tests showed
that this motivation was more prevalent among
women 24 years of age or older (X = 50.0%,
SD = 52.7) than among the 16–23 years age group
(X = 12%, SD = 33.2) or girls younger than 16
years of age (X = 9.1%, SD = 30.2). No other sig-
nificant differences between age groups were
found on issues of functional or emotional discom-
fort.
8
Further, anovas with the online community’s
national origin (American vs. British vs. Dutch) as
independent variable, and incidence and promi-
nence of the motivations as dependent variables
showed no significant differences in motivations
between the American, British, and Dutch
members of women’s online communities.
Women’s Online Communities vs. Providers’ Websites
Table 3 presents the similarities to and differences
from the motivations for considering labial reduc-
tion surgery mentioned by members of the
women’s online communities vs. those given on
7
See Footnote 6.
8
Because group sizes were small, anovas with two age
groups based on a median split (younger vs. older than 22
years of age) were also conducted. These generated iden-
tical results: No significant differences between age groups
occurred, except functional discomfort in sexual relation-
ships. This motivation was mentioned more often by
the group older than 22 years of age (X = 35.0, SD = 48.9)
than by the younger age group (X = 7.7, SD = 27.2),
F(1,44) = 5.80, P < 0.05.
20 Zwier
Sex Med 2014;2:16–23 © 2014 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.
the surgery providers’ websites. Differences were
again identified on the basis of anovas with inci-
dence and prominence of motivations as the
respective dependent variables and online source
(online community vs. surgery provider’s website)
as the independent variable.
9
Contrary to Hypoth-
eses 2, it was found that although feelings of emo-
tional discomfort were the most frequently
mentioned motivation among the members of the
online communities across nationalities and age
groups, this motivation was mentioned even more
often on the surgery providers’ websites
(F(1,118) = 12.49, P < 0. 001, η
2
= 0.10). In align-
ment with Hypothesis 2, however, this motivation
accounted for a marginally significantly larger
share of the different motivations mentioned on
the online communities than it did on the surgery
providers’ websites (F(1,118) = 3.69 P < 0.06,
η
2
= 0.03). Thus, although the surgery providers’
websites mentioned emotional discomfort issues
more often than online community members did,
the latter tended to talk about this motivation
somewhat more prominently. Further, within the
category of emotional discomfort motivations,
issues with sexual relationships were mentioned
more often (F(1,118) = 6.70, P < 0. 05, η
2
= 0.05)
and more prominent (F(1,116) = 10.65, P < 0.001,
η
2
= 0.08) on the online communities than on the
surgeons’ websites. Emotional issues with a social
focus were recognized significantly more often on
the surgeons’ websites than by the members of the
online communities (F(1,118) = 13.29, P < 0.001,
η
2
= 0.10).
A second group of differences between online
communities and surgeons’ websites concerns
motivations for considering labial reduction
surgery that are related to functional discomfort.
Except for the functional discomfort in sexual rela-
tionships, which showed no differences, this moti-
vation was mentioned significantly more often on
the surgeons’ websites than on the online commu-
nities (F(1,118) = 18.79, P < 0.001, η
2
= 0.14). It
also accounted for a larger share of all motivations
mentioned on the surgeons’ websites than it did on
the online communities (F(1,16) = 6.16, P < 0.05,
η
2
= 0.05). Finally, the surgeons’ websites men-
tioned the functional enhancement that could
be achieved through the surgery significantly
more often than community members did
(F(1,18) = 4.11, P < 0.05, η
2
= 0.04).
Conclusions
The present research findings shed new light on
why women consider undergoing labia reduction
surgery. Extant research so far was almost exclu-
sively conducted in a clinical context, where women
aim to be accepted for the surgery and may feel
awkward talking about sensitive emotional issues.
Motivations recounted in the anonymous, unsolic-
ited context of online communities are less con-
fined by these restrictions. This is not to suggest,
however, that motivations recounted on online
communities are necessarily more “real.” First, this
is because we cannot automatically assume that the
accounts of women who participate in online com-
munities about labial reduction surgery are repre-
sentative of all women considering labial reduction
surgery. Second, just as the clinical context shapes
the accounts given by women, online accounts can
also be assumed to be shaped by the opportunities
and constraints provided by the immediate online
context [19,20]. Within these constraints, our find-
ings lead to a number of conclusions that will be
addressed below.
First, emotional discomfort with the appear-
ance of the labia, such as feeling “freakish” and
ashamed, was highly prevalent on the online com-
munities, with 42.5% of members mentioning
only this motivation for considering labia reduc-
tion surgery. The intensity of the emotion was also
often very high, as illustrated by the quotes from
the online communities given earlier. We know of
two clinical studies that have also divided patients
into those who indicated emotional/aesthetic con-
cerns alone, those who indicated functional con-
cerns alone, and those who indicated both. The
first of these, Alter [21], reports that 13.3 of
patients indicated aesthetic concerns alone, while
Miklos and Moore [22] report 37%. This suggests
that mentioning emotional reasons as the single
motivation is more prevalent on online communi-
ties than in clinical encounters. Further, emotional
discomfort was mentioned as one of the motiva-
tions by 70% of community members, regardless
of age and nationality. Some clinical studies, such
as Goodman et al. [23], have reported lower per-
centages of around 55% of women indicating
emotional/aesthetic concerns as at least one of
their motivations. Other clinical studies, however,
have reported higher percentages of up to 100%
[24–26]. This would suggest that when women can
indicate additional reasons in the clinical encoun-
ter, emotional reasons are actually mentioned at
least as often as on online communities.
9
See Footnote 6.
Labial Reduction Surgery 21
Sex Med 2014;2:16–23© 2014 The Author. Sexual Medicine published by Wiley Periodicals, Inc.
on behalf of International Society for Sexual Medicine.
Some functional complaints were mentioned by
more than half of the members of the online com-
munities. Interestingly, however, these were men-
tioned by 75–100% of clients in clinical contexts
[21–26]. Particularly, functional interference with
exercise, sexual intercourse, and tight-fitting
clothes was reported by more than half of the
women in a series of clinical studies [21–26], while
each of these issues was mentioned by less than
30% of the members of the women’s online
communities.
A second way in which our findings shed new
light on the research to date concerns the role of
age and nationality. Functional discomfort in
sexual relationships was a more prevalent motiva-
tion among the older age group, which can prob-
ably be explained by age- and parity-related
changes in female physiology of the genitals
[27]. Apart from that, motivations for consider-
ing labial reduction surgery were remarkably
similar across nationalities and age. We thereby
hasten to emphasize that the women in our
sample came from Western countries, as female
genital surgery can obviously have a very differ-
ent meaning across cultural and religious contexts
[28,29].
The media in general, and surgery providers’
websites in particular, have been fiercely criticized
for inciting negative associations with larger labia
and encouraging women to seek labia reduction
surgery [3,7,30,31]. The third way in which our
findings shed new light on the extant knowledge is
that provider’s websites recounted an on average
equal share of emotional and functional motiva-
tions. Furthermore, the less controversial motiva-
tion of functional discomfort was mentioned on
providers’ websites more regularly and more
prominently than by the members of the online
communities. Providers’ websites also seemed on
average to be more reserved in emphasizing emo-
tional issues and particularly sexual relationships as
motivations for considering labial reduction
surgery than the members of the women’s online
communities. It should be emphasized that our
study obviously cannot disprove or confirm claims
that surgeons’ websites can impact upon the per-
ceptions and actions of women with larger labia,
and to our knowledge, such effect studies do not
exist in this area. Extant media effects research,
however, rarely supports direct, one-to-one rela-
tionships between media content exposure and
audience reactions [32,33]. All in all, our findings
suggest that the content of surgery providers’ web-
sites likely cannot fully explain the high prevalence
of emotional discomfort among women consider-
ing labial reduction surgery.
Critical scholars on female genital cosmetic
surgery have coined the term “pudendal disgust” to
label strong negative associations with the female
genitals [2,7,28,29]. Reluctance to talk about this
sensitive emotional issue, as well as fear to not be
accepted for the surgery and the desire to obtain
health insurance coverage, may drive women to
emphasize the functional aspects in the clinical
encounter more. Our research, however, has pro-
vided new, quantitative evidence across nationali-
ties and age groups that such feelings of “pudendal
self-loathing” are a highly prevalent force among
women considering labial reduction surgery.
The Internet without a doubt is a very impor-
tant, if not the most important, site where the lay
public finds and exchanges information about cos-
metic surgery [34,35]. The present study has ana-
lyzed the online contents available to women
seeking labial reduction. Awareness of significant
patterns in these materials, scrutinized by so many
clients before ever setting foot into a practitioner’s
office, could potentially assist surgery providers in
client communication.
Corresponding Author: Sandra Zwier, PhD, ASCoR,
University of Amsterdam, Kloveniersburgwal 48,
Amsterdam 1012 CX, The Netherlands. Tel: +31-20-
525-5094; Fax: +31-20-525-3681; E-mail: s.m.zwier@
uva.nl
Conflict of Interest: The author reports no conflict of
interest.
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