Article

The Size of Labia Minora and Perception of Genital Appearance: A Cross-Sectional Study

Abstract and Figures

Objectives: The aims of the study were to describe and to assess the size of labia minora in normal women, including the women's perception of their genitals to offer better counseling to the women seeking for labiaplasty. Materials and methods: This cross-sectional study was undertaken in the outpatient clinic at the Department of Obstetrics and Gynaecology at Kolding Medical Center between May 2012 and October 2013, when study participants were recruited in connection with their routine visits. Main outcomes of interest were visibility and width of the patients' labia minora. In addition, women were asked whether they perceived their genitals as being normal. Information about age, body mass index, and parity was also collected. We used descriptive statistics and paired t test to compare the clinical measurements. Results: In total, 244 women were included in the study. The median width of labia was 15 mm, and 90% of labia were less than 26.5 mm. Fifty-six percent of the women had visible labia minora. Regarding perception, 86.5% considered their labia as being normal. Within the group of women who perceived their genitals to be abnormal, 73.3% had visible labia minora. Among women with the largest labia (>26.5 mm), two thirds considered themselves normal. There was no statistically significant association between the measurements of labia minora and age, body mass index, or parity. Conclusions: One of 10 women had a measurement of labia minora of at least 26.5 mm in width. It is just as common to have visible labia minora as hidden labia minora. Women who considered their genitals to be abnormal more often had visible labia minora than women who considered their genitals to be normal.
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The Size of Labia Minora and Perception of Genital
Appearance: A Cross-Sectional Study
Annemette Wildfang Lykkebo, MD,
1
Henrik Christian Drue, MD,
1
Janni Uyen Hoa Lam, MHSC,
2,3
and Rikke Guldberg, MD, PhD
3,4
Objectives: The aims of the study were to describe and to assess the size
of labia minora in normal women, including the women's perception of their
genitals to offer better counseling to the women seeking for labiaplasty.
Materials and Methods: This cross-sectional study was undertaken in
the outpatient clinic at the Department of Obstetrics and Gynaecology at
Kolding Medical Center between May 2012 and October 2013, when study
participants were recruited in connection with their routine visits. Main out-
comes of interest were visibility and width of the patients' labia minora. In addi-
tion, women were asked whether they perceived their genitals as being normal.
Information about age, body mass index, and parity was also collected. We used
descriptive statistics and paired ttest to compare the clinical measurements.
Results: In total, 244 women were included in the study. The median
widthoflabiawas15mm,and90%oflabiawerelessthan26.5mm.
Fifty-six percent of the women had visible labia minora. Regarding percep-
tion, 86.5% considered their labia as being normal. Within the group of
women who perceived their genitals to be abnormal, 73.3% had visible labia
minora. Among women with the largest labia (>26.5 mm), two thirds consid-
ered themselves normal. There was no statistically significant association be-
tween the measurements of labia minora and age, body mass index, or parity.
Conclusions: One of 10 women had a measurement of labia minora of at
least 26.5 mm in width. Itis just ascommon to havevisible labia minora as
hidden labia minora. Women who considered their genitals to be abnormal
more oftenhad visible labiaminorathan women who considered their gen-
itals to be normal.
Key Words: labia minora, genital appearance, size, perception,
normal female genital anatomy
(J Low Genit Tract Dis 2017;21: 0000)
An increasing number of women are seeking medical attention
to alter the appearance of their external genitalia, and the num-
ber of labiaplasty operations performed worldwide is booming.
13
Women may seek labia reduction for physical, emotional, or aes-
thetic reasons. Mostly, they find their genital appearance impor-
tant,
4
and the increased demand for labiaplasty is typically due
to a misperception of what is normal, believing that surgery will
improve emotional discomfort, relationship with others, and
sexuality.
1,2,58
Concerns regarding the appearance of the labia
minora can result in considerable psychological and emotional
distress, with young girls in puberty being a particularly vulnera-
ble group.
9,10
During the recent years, the attention and visibility
of the vulva and labia have increased, primarily because of the
increased popularity of removing pubic hair.
11,12
Furthermore,
pornography and labia images, often selective or digitally edited,
are widely available through the media and the Internet, leading
to misguided assumptions of what is normal and desirable.
8,13
Consequently, many women perceive nonprotruding and symmet-
rical labia minora as normal
8,14
and hence desire a prepubescent
appearance.
15
In contrast, labia hypertrophy secondary to body
modification techniques in parts of Africa
16
emphasizes that per-
ception of normalis sociocultural. Few studies have described
the morphology of the female genitalia.
1720
Although different
classification of labia minora hypertrophy exists,
2123
there is no
international consensus among clinicians on how to classify or
confirm the diagnosis. Recently, Motakef et al.
24
produced a clas-
sification system of labia minora hypertrophy on the basis of the
distance of the lateral edge of the labia minora from that of the
labia majora. Because of the lack of guidelines for physicians and
variability in practice, indications for operation have primarily re-
mained individual.
25
Multiple surgical techniques exist to trim the
labia minora, and labiaplasty is found to be safe and carries a high
satisfaction rate,
22,24,26,27
but prospective clinical studies regard-
ing safety and efficacy are lacking. Comparative studies between
surgery and nonsurgical interventions (e.g., psychoeducational
programs) do not exist, because labiaplasty is primarily requested
for aesthetic rather than physical reasons.
1,2,6,7
To counsel women
seeking labiaplasty, knowledge of vulva morphology is essential.
We sought to describe the labial dimensions to define a normal
range and describe women's perception of their own genitals.
Our aim was to provide a possible advisory tool for clinicians
for women feeling abnormal and/or seeking labiaplasty.
MATERIALS AND METHODS
The study participants were recruited in connection with
visits at the outpatient clinic at the Department of Obstetrics and
Gynaecology at Kolding Medical Center between May 2012 and
October 2013. The women were all white, Danish speaking, be-
tween the ages of 18 and 50 years, premenopausal, and visited
the clinic for different reasons.
A small pilot study wasperformed before the initiation of the
primary study to standardize the measurement methods. In thispi-
lot study, each of the 4 female senior gynecologists who subsequently
performed the examinations in the primary study examined all of
the 18 volunteering women to minimize the interobserver vari-
ability. The consultants examined and measured 5 women to-
gether and agreed on the procedure. The remaining 13 women
were first measured by the 2 consultants, where after the other 2
consultants entered the room and measured the same women.
The measurements were compared, and if the difference was
greater than 3 mm, all 4 consultants entered the room and mea-
sured the woman together and an agreement on the method of
measurement was obtained. Regarding measurement of the labia
minora, we found that the outside measurement was the most re-
producible (see Figures 1, 2).
Women with a history of surgery of the external genitalia and
vulva skin disease were excluded. Women were then asked to
1
Department of Obstetrics and Gynaecology, Lillebaelt Hospital, Kolding,
Denmark;
2
Center for Clinical Epidemiology, Odense University Hospital,
Odense, Denmark;
3
Research Unit of Clinical Epidemiology, Institute of Clinical
Research, University of Southern Denmark, Odense, Denmark; and
4
Department
of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
Correspondence to: Annemette Lykkebo, MD, Department of Obstetrics and
Gynaecology, Lillebaelt Hospital, Sygehusvej 24, 6000 Kolding, Denmark.
E-mail: Annemette.Wildfang.Lykkebo@rsyd.dk
The authors have declared they have no conflicts of interest.
All authors contributed equally to the manuscript.
The study was approved by the Danish Data Protection Agency with
notification number 2012-41-0346. Ethical approval by The Regional
Scientific Ethical Committees for Southern Denmark was not required for
this study.
© 2017, American Society for Colposcopy and Cervical Pathology
DOI: 10.1097/LGT.0000000000000308
ORIGINAL RESEARCH ARTICLES:VAGINA AND VULVA
Journal of Lower Genital Tract Disease Volume 21, Number 3, July 2017 1
Copyright © 2017 American Society for Colposcopy and Cervical Pathology. Unauthorized reproduction of this article is prohibited.
answer a questionnaire regarding age (years), parity (number of
births), weight (kilogram), height (centimeter), and whether they
considered their genitals to be normal or abnormal (yes/no). The
definition of normal and abnormal was completely subjective
and under no influence of the health care persons. Completion
of the questionnaire was performed before examination and re-
quired a maximum of 5 minutes. Further information about phys-
ical and mental health was not collected. Body mass index (BMI)
was calculated from height and weight (kilogram per square me-
ter) and categorized in the following 4 groups according to World
Health Organization classification: underweight (<18.5), normal
range (18.524.99), overweight (2529.99), and obese (>30).
Observations and measurements were made in the lithotomy
position using a disposable tape measure. Firstly, we registered
whether the labia minora were visible or covered by the labia
majora, and then the measurements were made. The anatomical
measurements were defined as follows:
Labia minora width: the measurement of the outside of the labia
minora from the sulcus infralabialis (sulcus nymphohymenalis)
to the margin of the labium minus. The labia were not stretched
while being measured.
Labia minora length: from clitoris to the lower margin of the labia.
Perineum: the distance from the posterior fourchette/commissura
posterior to the anterior anal margin.
Analysis of data was performed using Stata Release v. 12.0,
with descriptive statistics and paired ttest with a Pvalue of less
than 0.05 as significant.
Ethical Approvals
The women were given oral and written information and gave
written consent to participate, and in addition, consent for publica-
tion of human image (see Figures 1, 2) was obtained. The study
was approved by the Danish Data Protection Agency (number
2012-41-0346), and further ethical approvals were not required
as confirmed by the Regional Scientific Ethical Committees for
Southern Denmark.
RESULTS
In total, 267 women were invited to participate in this study.
Ten women declined to participate. If a woman had more than 1
visit, we only included data from her first visit. Finally, 244 women
(91%) were included in the analysis. Baseline characteristics are
shown in Table 1.
Fifty-four percent of the women had labia minora that were
visible without (lateral) manipulation of the labia majora. Among
these women, 17.3% considered their labia to be abnormal, whereas
only 7.3% of the women with nonvisible labia minora considered
this to be abnormal (Table 2). There were no age differences in
these perceptions.
The mean labia minora outside width was 15.5 mm (range,
140) on the left side and15.9 mm (range, 145) on the right side.
Paired ttest showed no statistical significant differences between
the size on the left labia versus the right labia (P= 0.9), and mea-
surements of each side were performed by the same clinician.
Thus, to report the distribution of the sizes for guidance use, we
FIGURE 1. Technique of measuring the width of the labia minora from the interlabial sulcus to the edge of the labia minora.
FIGURE 2. Technique of measuring the width of the labia minora from the interlabial sulcus to the edge of the labia minora.
Lykkebo et al. Journal of Lower Genital Tract Disease Volume 21, Number 3, July 2017
2© 2017, American Society for Colposcopy and Cervical Pathology
Copyright © 2017 American Society for Colposcopy and Cervical Pathology. Unauthorized reproduction of this article is prohibited.
used the average of the left and the right labia for each woman
(see Figure 3).
Ninety percent of the measurements of the labia minora
width were less than 26.5 mm.
There was no statistically significant association between the
measurements of labia minora and age or parity. For BMI, we
found a tendency for smaller labia minora in women with high
BMI, although this was not statistically significant.
Regarding perception, the women who considered their gen-
itals to be abnormal compared with women who considered their
genitals to be normal (1) more often had visible labia minora, (2) had
a tendency tolarger labia size (not significant), and (3) were youn-
ger. Furthermore, most former group had given birth. For further
information, see Table 2.
DISCUSSION
In our study, most women (54%) had visible labia minora. A
recent study,
28
based on estimated labia minora protuberance from
253 images from the following 3 sources: online pornography,
TABLE 1. Description of Study Population Recruited from May 2012 to October 2013 (N=244)
1830 y 3140 y 4150 y All Ages
Age Group n=97(40%) n=73(30%) n=74(30%) N= 244 (100%)
Self-reported data
BMI, kg/m
2a
Mean 23.1 23.8 25.2 24.0
95% CI 22.324.0 22.724.8 24.126.3 23.424.5
Range 17.539.9 17.345.3 17.839.7 17.345.3
Parity
Mean 0.4 2.1 2.0 1.4
95% CI 0.30.6 1.82.4 1.82.2 1.21.6
Range 03050405
Perception,
b
n(%)
Normal 79 (32.9%) 66 (27.5%) 65 (27.1%) 210 (87.5%)
Abnormal 17 (7.1%) 5 (2.1%) 8 (3.3%) 30 (12.5%)
Visibility,
c
n(%)
Visible 49 (20%) 39 (16%) 41 (17%) 129 (54%)
Not visible 48 (20%) 32 (13%) 32 (13%) 112 (46%)
Clinical measurements
Labia minora length, mm
d
Mean 40.6 44.6 43.7 42.8
95% CI 38.043.4 41.647.4 41.246.4 41.244.4
Range 582 680 1575 582
Perineum, mm
d
Mean 23.7 24.9 24.6 24.3
95% CI 22.724.7 23.626.1 23.425.8 23.625.0
Range 1342 1540 1440 1342
Left labia minora width, mm
d
Mean 14.1 15.7 17.1 15.5
95% CI 12.415.7 14.017.5 15.119.2 14.416.5
Range 140 245 240 140
Right labia minora width, mm
d
Mean 15.0 15.6 17.4 15.9
95% CI 13.116.9 13.817.5 15.619.3 14.817.0
Range 142 245 138 145
Mean width left and right, mm
d
Mean 14.5 15.6 17.3 15.7
95% CI 12.816.3 13.817.4 15.419.1 14.616.8
Range 140 242.5 1.539 142.5
90th percentile 26 24.5 27 26.5
95th percentile 28.5 29.5 31 29.5
a
Five missing values, n= 239.
b
Four missing values, n= 240.
c
Three missing values, n=241.
d
One missing value, n= 243.
CI indicates confidence interval.
Journal of Lower Genital Tract Disease Volume 21, Number 3, July 2017 Size of Labia Minora and Perception
© 2017, American Society for Colposcopy and Cervical Pathology 3
Copyright © 2017 American Society for Colposcopy and Cervical Pathology. Unauthorized reproduction of this article is prohibited.
anatomy textbooks, and feminist publications, found the labia minora
to be significantly less protuberant in anatomy textbooks and on-
line pornography than in female publications. Our finding stresses
that the perception of normalityand society's idealsmust in-
clude both nonprotruding and visible labia minora and thatthis in-
formation should be stressed in formal medical teaching. We
found that 1 in 10 women had labia minora width measurements
greater than 26.5 mm and that among these women, two thirds
considered their genitals to be normal. This result correlates with
the findings of previous studies
4,14
where most women perceived
their vulva as normal. Among women who perceive their genitals
to be abnormal, most had visible labia minora, indicating that
nonprotruding labia minora has been considered more normal and
desireable.
8
Nevertheless, one fourth had hidden labia minora. In
correlation with other studies, we found a large variation in the sizes
of labia minora. Two frequently cited studies by Lloyd et al.
17
and
Basaran et al.
18
found labia minora width between 7 and 50 mm
(mean [SD] = 21.8 [9.4]) and between 11 and 30 mm (mean [SD] =
17.9 [4.1]), respectively. As with the study by Lloyd et al.
17
,we
found that neither age, BMI, nor parity influenced labia size.
Recent studies describing the wide variations invulva dimen-
sions have been based on small samples.
1,7,18
This study has included
FIGURE 3. Mean size frequency distribution of labia minora.
TABLE 2. Perception of Genitalia and the Visibility of Labia Minora in Women Referred to a Gynecological Department for Various
Gynecological Diseases
Perception
a
Abnormal % Normal % Total %
Age group, y
1830 17 17.7 79 82.3 96 100.0
3140 5 7.0 66 93.0 71 100.0
4150 8 11.0 65 89.0 73 100.0
Total 30 12.5 210 87.5 240 100.0
Visibility
b
Yes 22 17.3 105 82.7 127 100.0
No 8 7.3 102 92.7 110 100.0
Total 30 12.7 207 87.3 237 100.0
Mean size of labia, mm
<5 2 7.7 24 92.3 26 100.0
69 5 11.6 38 88.4 43 100.0
1015 3 5.7 50 94.3 53 100.0
1620 2 3.6 54 96.4 56 100.0
2125 8 25.0 24 75.0 32 100.0
>25 10 33.3 20 66.7 30 100.0
Total 30 12.5 210 87.5 240 100.0
Parity
Nulliparous 10 11.8 75 88.2 85 100.0
Parous 20 12.9 135 87.1 155 100.0
Total 30 12.5 210 87.5 240 100.0
a
Four women did not report their perception.
b
The visibility of labia minora was not reported in another 3 women, leaving us with 243.
Lykkebo et al. Journal of Lower Genital Tract Disease Volume 21, Number 3, July 2017
4© 2017, American Society for Colposcopy and Cervical Pathology
Copyright © 2017 American Society for Colposcopy and Cervical Pathology. Unauthorized reproduction of this article is prohibited.
the largest number of participants. It was based on a systematic re-
cruitment of women in a routine setup and had a very high acceptance
rate of 91%. Thus, we do believe that our findings can be applied to
the general Danish female population visiting gynecological clinics.
However, the results particularly regarding perception may be
limited somewhat, because of the homogeneous population
studied, and may be confounded and not representative of the
global population.
Regarding the measuring method, there is of course some
variation because the tissue is flexible and can be stretched. It is
important to emphasize that the results can only be applied if the
same method of measuring is usedsimply folding the labia to
the side (no stretching).
Previous research
2,5,8
has shown that many women have a
misperception of what is normal and hence express concern with
the appearance of their labia minora. Our results limit the current
scientific gap regarding the normal vulva appearance and show
that visible labia minora are just as, and even more, common than
nonprotruding labia minora. Female genital cosmetic surgery, i.e.,
labia reduction, is increasing in popularity with more women
seeking to beautifytheir genital appearance. Research has dem-
onstrated both a sex and specialty difference in the performance of
labial reduction surgery, with the male cosmetic surgeons the most
likely toapprove the procedure.
25
It can be surmised that decisions
regarding reconstruction needed are entirely subjective. Our re-
sults can help clinicians confidently educate women on the large
variation in vulva morphology and thus better advise healthy
women who are seeking surgery to alter their vulva morphology.
These women need to have access to greater education and knowl-
edge of the diversity in the normal genital appearance. This could
be conducted by presenting the normative data (see Figure 3), ex-
posure to images demonstrating the normal variation, and an
awareness of the use of airbrushing to modulate pictures in the
media. It is alsovital that practitioners and gynecologists are aware
of the normal genital appearance and diversity to counsel women
who have these concerns better.
We recommend the following clinical guidance for women
having concerns about the normality of their genitalia: obtain a
sufficient medical history and an examination of the genitals with
measurement as explained in this study. Consider if the subjective
concerns correlate with the measurements. Inform about the vari-
ety of normal female genital appearance, show them the normal
distribution of size (width) (see Figure 3), and show pictures
representing the variety of sizes of labia. Describe the surgery
and the potential risks including disruption of nerves and blood
vessels, which may impair sensation to the genital area and affect
future capacity for sexual pleasure.
22,23,29
Surgery should, in our opinion, only be undertaken with a
clear understanding of the variation in normal appearance and in
cases, which differ markedly from the normal.
To ensure awoman that her labia are normal might help her ac-
cept the appearance and make her choose not to undergo surgery.
It must be made explicit to the woman that, to our knowl-
edge, currently, there is no evidence that labiaplasty enhances psy-
chological or relationship well-being.
Clinicians must be aware that in some patients, the labia
minora can be of normal size and still the woman can experience
considerable discomfort, which can be caused by small labia
majora. If the labia majora are small, the labia minora have no pro-
tection or cushion. Surgery does not remedy this condition.
CONCLUSIONS
It is just as common to have visible labia minora as hidden
labia minora. Women who consider their genitals to be abnormal
more often have visible labia minora compared with women who
consider their genitals to be normal. One in 10 women has a mea-
surement of labia minora of greater than 26.5 mm in width. There
is no statistically significant association between the measurements
of labia minora and age, BMI, or parity. Women seeking labiaplasty
might have a misperception of what is normal and hence express
concerns about the appearance of their labia minora. These women
need to have access to adequate education and knowledge of the di-
versity in the normal genital appearance. This could be conducted
by presenting the normative data (see Figure 3). Reassurance of nor-
mality of labial appearance is paramount and the need for surgery is
controversial. There is no evidence that labiaplasty enhances psy-
chological or relationship well-being. To ensure the woman that her
labia are normal might help her accept the appearance and make
her choose not to undergo surgery.
ACKNOWLEDGMENTS
The authors thank the volunteers, participants, nurse Lone
Schmidt, Kirsten Lund Sorensen, MD, Trine Kjølby, MD, and Kirsten
Hervert Petersen, MD.
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6© 2017, American Society for Colposcopy and Cervical Pathology
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... Why do people become dissatisfied with the appearance of their genitals? There is evidence showing that men with severe genital dissatisfaction may have smaller penises than controls (Veale, Miles, Read, Troglia, Carmona, et al., 2015), but most of the evidence suggests that both men and women may be dissatisfied despite having perfectly normal genitals (Davis et al., 2013;Gaither et al., 2017;Johnston et al., 2014;Lykkebo et al., 2017;Mondaini et al., 2002;Söylemez et al., 2012). One commonly suggested hypothesis is that increased consumption of pornography, or sexually explicit material (SEM), is associated with an increased genital dissatisfaction (Cranney, 2015). ...
... Our results suggest that people's genital self-image in fact does seem to be affected by actual genital size, as having a larger penis or less protruding labia minora were associated with a more positive genital self-image. These results are in line with the few earlier studies on the topic (Lykkebo et al., 2017;, however, any dissatisfaction occurring because of one's actual genital size is likely mediated by other factors and should still be seen in a cultural context. For perspective, several cultures in Southern and Western Africa practice labia elongation, where women and girls stretch their labia minora with the goal of enhancing beauty, sexual pleasure and sexual functioning (Martínez Pérez et al., 2015;Martínez Pérez & Namulondo, 2011;Vera Cruz & Mullet, 2013). ...
Preprint
This cross-sectional study investigated the distribution and characteristics of genial self-image in a large sample of males and females, and whether factors such as actual genial size (length of penis or protrusion of labia minora), consumption of sexually explicit material (SEM) or avoidance and safety seeking behaviors were associated with genital self-image. Overall, 3.6% of females and 5.5% of males suffered from a severely low genital self-image and 33.8% of all individuals reported dissatisfaction with the appearance of their genitalia, with 13.7% of females and 11.3% of males being positive towards undergoing cosmetic genital surgery. Mean protrusion of labia minora and stretched flaccid penis length in the population was estimated to 0.76 cm (95% CI 0.63-0.89 cm) and 12.5 cm (95% CI 12.33-12.76 cm), respectively. A better genital self-image was associated with having a larger penis or less protruding labia minora, but not associated with the degree of SEM consumption, although 93.6% of males and 57.5% of females had consumed SEM in the past three months. Avoidance and safety seeking behaviors were strongly correlated with a negative genital self-image. Considering this relationship, more research is warranted in the development of potential psychological interventions in order to alleviate genital dissatisfaction in individuals.
... In de afgelopen decennia is er een groeiende ontevredenheid over het eigen genitaal ontstaan en hierbij ook een toenemende vraag naar cosmetische chirurgie (Lykkebo, Drue, Lam, & Guldberg, 2017). Pornografie en andere media schetsen een vertekend beeld van 'normaal' . ...
Article
Samenvatting Onder (jong-)volwassenen neemt de vraag naar cosmetische genitale chirurgie toe en gemakkelijk beschikbare por-nografie schetst een onrealistisch ideaalbeeld van het genitale uiterlijk. Omdat er veel onduidelijkheid is over het 'normale' genitale uiterlijk onderzochten wij de perceptie van verschillende veelvoorkomende variaties van het uitwen-dige genitaal en de tevredenheid daarmee. In dit cross-sectionele onderzoek vulden festivalbezoekers een anonieme vragenlijst in. Deze vragenlijst bestond uit drie onderdelen: 1) vragen over demografie en seksualiteit, 2) vragen over het uiterlijk van het eigen genitaal en de tevredenheid hierover aan de hand van voorbeeldafbeeldingen en 3) de-zelfde vragen over het geslachtsdeel van de laatste sekspartner. Via beschrijvende statistiek is de variatie in uiterlijk beschreven en met een multivariate analyse zijn voorspellende factoren voor (on)tevredenheid geïdentificeerd. In totaal zijn 1472 deelnemers geïncludeerd waarvan 91% onder de 41 jaar en 61% vrouw. Het merendeel was tevreden over het uitwendige genitaal (73% van de vrouwen vs. 72% van de mannen). Tevredenheid over het geslachtsdeel van de partner was hoger: 91% van de mensen met een mannelijke partner was tevreden vs. 89% van de mensen met een vrouwelijke partner. Mannen zijn het minst tevreden over de lengte van hun penis (55%) en vrouwen over de grootte van hun binnenste schaamlippen (63%). Mannelijk gender, 20+ sekspartners en een hogere waardering van het seksleven zijn positief voorspellend voor tevredenheid over het eigen geslachtsdeel. Ondanks de grote vari-abiliteit in het genitale uiterlijk zijn de meeste deelnemers tevreden over het eigen uitwendige genitaal en nog meer over dat van hun partners.
Article
Background Dissatisfaction with the appearance and size of one's genitalia is a common issue, and the use of cosmetic genital surgery is increasing among people with normal genitalia. Aim This cross-sectional study aimed to investigate the distribution of genital self-image in a large sample of males and females, and whether selected factors could predict genital self-image. Methods Three thousand five hundred three anonymous participants completed online questionnaires. Multiple linear regressions were used to identify the association between genital self-image and genital size (length of penis or protrusion of labia minora), consumption of sexually explicit material (SEM), sexual activity, avoidance and safety seeking behaviors, openness toward genital cosmetic surgery and age. Outcomes Total scores on the Female and Male Genital Self Image Scale were used as the main outcome measures. Results Overall, 3.6% of females and 5.5% of males had a severely low genital self-image (defined as 2 SD below the mean) and 33.8% of all individuals reported dissatisfaction with the appearance of their genitalia, with 13.7% of females and 11.3% of males considering undergoing cosmetic genital surgery. Mean protrusion of labia minora and stretched flaccid penis length in the population was estimated to 0.76 cm (95% CI 0.63–0.89 cm) and 12.5 cm (95% CI 12.33–12.76 cm), respectively. A higher genital self-image score was predicted by having a larger penis or less protruding labia minora, but not by the degree of SEM consumption, although 93.6% of males and 57.5% of females had consumed SEM in the past three months. The degree of avoidance and safety seeking behaviors, sexual activity, and openness toward genital cosmetic surgery predicted a low genital self-image. Being older was associated with a better genital self-image in females. Clinical Implications The results show that a psychological intervention may be needed as an alternative to cosmetic genital surgery for people who are dissatisfied with the appearance of their genitals. Strengths and Limitations This is one of few available studies investigating the association between actual genital size and genital dissatisfaction. The vast sample size and high response rate are also strengths. Limitations include the cross-sectional design, and possible bias in the study sample due to self-selection. Conclusion Overall, a low genital self-image and dissatisfaction with one's genitalia is relatively common and is influenced not only by genital size, but also behaviors performed to alleviate worry about one's genitals. Hustad IB, Malmqvist K, Ivanova E, et al. Does Size Matter? Genital Self-Image, Genital Size, Pornography Use and Openness Toward Cosmetic Genital Surgery in 3503 Swedish Men and Women. J Sex Med 2022;XX:XXX–XXX.
Article
There has been an increase in genital cosmentic surgeries over the past decade, with the most common procedure being labiaplasty. This trend has many origins, but a significant motivator is genital self image, which has been shown to be very culturally influenced. Furthermore genital self modification, by way of grooming also is felt to play a role in the desire to surgically alter one's genital appearance. Given the cultural aspect of these practices, sexual health proivders should be aware of the role of self image and self modification in the drive towards persuing surgical changes to the genitals. Schmidt CN, Rowen TS. Female Genital Self-Image and Modification. J Sex Med 2021;XX:XXX–XXX.
Article
Objective: To measure the anatomical dimensions of the vulva in adult Indian women. To analyze their correlations with age, body mass index (BMI), parity, and mode of delivery. Methods: This cross-sectional study was conducted in a tertiary care university hospital in India, among 400 women 18 years of age and above. Various vulval measurements were taken, and Pearson's correction was applied to variables like age, BMI, parity, and mode of delivery. Results: The mean length of glans of clitoris was 5.2 ± 1.43 mm, the labia minora width was 2.6 ± 0.74 cm, length of introitus was 1.3 ± 0.59 cm, and perineal body length was 2.3 ± 0.60 cm. The range of various measurements was versatile like labia minora width in our study ranged from 0.7 to 4.9 cm. The normal percentile curves were constructed for vulval measurements according to age groups. The statistically significant positive correlation of age, BMI, and obstetrics history were seen with labia minora width (r=.165, p=0.001; r=.284, p=<0.001; r=.246, p=<0.001 respectively). Conclusion: The percentile curves can be used as a reference for the Indian population of different ages. These can be used for counseling women coming for female genital cosmetic surgery.
Article
Background Despite existing anthropometric data in the literature regarding the variation of female external genital anatomy, the ideal aesthetic characteristics have yet to be defined. Objectives Authors used crowdsourcing in order to better evaluate preferred anatomic characteristics of external female genitalia. Methods Fifty-six total images were digitally created by altering the proportions of the labia minora, labia majora, and clitoral hood. Images with differing ratios were presented in pairs to Amazon Mechanical Turk (Seattle, WA, USA) raters. Three different experiments were performed with each varying two of the three image characteristics to permit two factor modeling. The Bradley-Terry-Luce model was applied to the pairwise comparisons ratings to create a rank order for each image. Preferences for each anatomic variable were compared using chi-squared tests. Results A total of 5000 raters participated. Experiment 1 compared differing widths of the labia majora and labia minora and determined a significant preference for larger labia majora width and mid-range labia minora width (p=0.007). Experiment 2 compared labia minora width versus clitoral hood length and showed a statistically significant preference for wider majoras (p<.001), but no significant preference in clitoral hood length (p=0.54). Experiment 3 compared clitoral hood length versus labia minora width and showed a statistically significant preference for mid-range labia minora widths (p<.001) but no significant preference in clitoral hood length (p=0.78). Conclusions Raters preferred a labia majora to labia minora width ratio of 3:1 with minimal preference in clitoral hood length.
Article
Modern women feel compelled to meet near-impossible standards of beauty. For many, this pursuit ultimately culminates in cosmetic surgery - a radical form of beautification that is rapidly becoming popular worldwide. Paradoxically, while prevalent, artificial beauty remains widely unaccepted in contemporary society. This narrative review synthesizes feminist dialogue, recent research, and real-world case studies to argue that female beauty standards account for both the growing popularity of cosmetic surgery and its lack of mainstream acceptance. First, we implicate unrealistic beauty standards and the medicalization of appearance in popularizing cosmetic surgery. Second, we analyze how negative attitudes toward cosmetic surgery are also motivated by unrealistic beauty standards. Finally, we generate a synthesized model of the processes outlined in this review and provide testable predictions for future studies based on this model. Our review is the first to integrate theoretical and empirical evidence into a cohesive narrative that explains the cosmetic surgery paradox; that is, how cosmetic surgery remains secretive, stigmatized, and moralized despite its surging popularity.
Article
Objective: The aim of the study was to investigate the knowledge of vulvar anatomy and vulvar self-examination (VSE) in a sample of Italian women attending a gynecology clinic. Methods: For this original research from May to July 2019, 512 women attending the Lower Genital Tract Clinic at the Department of Surgical Sciences of the University of Torino were invited to participate in a 29-question survey about vulvar anatomy, VSE, and sociodemographic details. Data were analyzed using descriptive statistics. Results: Of 512 patients, 500 completed the questionnaire (98% response rate). The mean age of respondents was 41 years (range = 17-77 years). Education level was evenly distributed between elementary, high school, and university graduates. Only 15% of interviewed women were able correctly sketching vulvar anatomy. Seventy-six percent of the women had not heard about VSE, and 61% of the women approach their genitalia with feelings of shame and embarrassment. Only 23% of the women would seek medical advice after identification of possible abnormalities during VSE. A majority (69%) of the women would like to have more information about VSE and vulvar health through educational videos and social media. Conclusions: Education about VSE may lead to earlier diagnosis of vulvar cancers and other pathologies. Further efforts are needed to disperse information about normal external female genital anatomy and VSE to achieve self-confidence among women.
Article
Background: Despite increasing numbers of labiaplasties being performed, there is little quantitative information on normal labial diversity to guide medical education, patient education and surgical treatment. Aim: This scoping review will determine what is known in the published literature about the anatomical basis of normal for labia and female genital cosmetic surgery (FCGS). Materials and methods: The scoping review identified ten population-based studies that recorded labial dimensions by searching three electronic databases utilising a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search strategy. Strict inclusion and exclusion criteria were applied and then reference lists were scrutinised until no further articles that met the criteria were located. Results: These studies showed significant variation in labial length (range 5-100 mm) and width (range 1-60 mm). Labia minora were wider in pre-menopausal women than in post-menopausal women, protruding labia minora were more common than not, and asymmetry between right and left labia was common. Variation in recruitment, inclusion and exclusion criteria, and measurement did not allow for summation of the data sets. Conclusion: This information could usefully be added to medical textbooks and teaching to ensure that medical graduates are sufficiently informed about normal variation in female genital anatomy to assess and advise women seeking FGCS.
Article
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Objective: To evaluate the patient satisfaction after voluntary labiaplasty surgery including aesthetic appearance, patient satisfaction with the procedure, sexual function, lifestyle changes, sexual confidence, physical appearance, improvement in discomfort, body perception, and post operative expectations. We also compared results in patients with a history of previous cosmetic surgery versus those with none. Materials and Methods: This was a prospective study utilizing a cosmetic surgery satisfaction questionnaire a minimum of 3 months post-operatively of all patients who underwent a labiaplasty surgery over a one year time frame. Data was analyzed by using chi-square test for categorical data. The measure of effect was determined by logistic regression analysis. Results: Eighty-nine women were included in the study with average age 41.24±11.19 years old (range 20-69). Forty-three (48.3%) of patients had a history of previous cosmetic surgery. Ninety-two percent reported excellent/ good overall satisfaction for the procedure. 81 of the 89 (91%) responded that they would recommend this surgery to others. In the overall population, 89.88% improved body perception, 82.02% increased self-esteem, 47.19% increased ability to exercise, 75.28% more comfortable in clothes, 60.67% improved appearance in clothes. In regards to sexual function, 85.88% reported increased sexual confidence, 74.70% overall improved sexual life, 52.38% decreased sexual discomfort, 41.86% enhanced ability to orgasm, and 88.37% had better whole life after labiaplasty. 93% reported better than or as expected cosmetic appearance, and 75% reported better or as expected post-op pain levels. There was no significant difference in any category of scores between patients that had previous cosmetic surgery versus those that did not except those who had no prior cosmetic surgery were 4.56 times more likely to report better in ability to exercise compared to those who had prior cosmetic surgery (63.04% vs. 26.83%, OR 4.56, 95% CI 1.85, 11.79). Conclusion: Labiaplasty provides an overall very high patient satisfaction. The study results demonstrate that labia hypertrophy may have a significant impact on a womens self-esteem as well as impact their daily life and sexual life. Following labiaplasty women report an improvement in body perception, sexual confidence, overall sex life, decrease discomfort with sex and labiaplasty does not seem to affect orgasm in a negative way. Comparatively, women with previous cosmetic surgery had similar results versus those that did not.
Article
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IntroductionIncreasing 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. AimsThe 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 communities, and 40 international surgery providers' websites about labial reduction surgery was conducted. Main Outcome MeasuresMain outcome measures concerned the incidence and prominence of different motivational 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. ResultsEmotional 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 communities, 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 **;**:**–**.
Article
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When a healthy woman expresses concerns about her vulva, the doctor's response should be informed by clinical knowledge. For many doctors, accumulation of such knowledge would have begun with undergraduate teaching and medical textbooks. The aim of this study is to examine the information on female genital morphology in medical textbooks. A total of 59 gynaecology and anatomy textbooks were searched for information on the dimensions of vulval constitutent parts. No textbook gave measurements for all vulval structures. Vaginal length was reported in 21/59 textbooks, clitoral size in 15/59 and labia minora in 1/59. Where measurements appear, they suggest narrower ranges than recent reports. Information of vulval morphology is scanty and inaccurate in medical textbooks. The general lack of professional resources means that doctors may consciously or non-consciously rely upon personal experiences and popular culture to form their opinions, as do their patients.
Article
Labia minora reduction has gained more prominence in the recent decade and more women are seeking professional opinions. Unfortunately only a few studies have researched the long-term specificity and functional assessment endpoints. This study was a retrospective questionnaire study where we asked about complications, symptoms, labia sensitivity, influence on sex-life and patient satisfaction. Even though the general patient satisfaction was high, complications such as pain (23%), hematoma (11%) infection (9%) and healing problems (6%) were common. 36% experienced a change in sensitivity; less feeling/ numbness as the main complaint. Sex-life was reported to be better in 59%, while 39% experienced no change. It is important to know about possible complications and changes in sensitivity after reduction of labia minora. It is the responsibility of the consultant to inform women seeking operation in order to facilitate a well-informed decision.
Article
Background: Vaginal labiaplasty has been described for the management of functional and aesthetic problems associated with protrusion of the labia minora. Despite increasing numbers of procedures performed, there is a paucity of data to guide treatment paradigms. This systematic review aims to establish a simple, unifying classification scheme for labial protrusion and summarize current labiaplasty techniques and practices. Methods: A systematic literature review was performed using the PubMed database. Additional articles were selected after reviewing references of identified articles. Results: The search returned 247 articles. After applying inclusion criteria to identify prospective and retrospective studies evaluating different techniques, outcomes, complications, and patient satisfaction, 19 articles were selected. Labiaplasty of the labia minora was described in 1949 patients. Seven different surgical techniques were used for labiaplasty, including deepithelialization, direct excision, W-shaped resection, wedge resection, composite reduction, Z-plasty, and laser excision. Patient satisfaction rates for each technique ranged from 94 to 100 percent. The most common postoperative complication for all techniques was wound dehiscence (4.7 percent). Key areas for perioperative patient management were defined. Conclusions: Labiaplasty is safe and carries a high satisfaction rate. However, current practices remain exceedingly diverse. The authors propose a simplified classification system based on the distance of the lateral edge of the labia minora from that of the labia majora, rather than from the introitus. Key areas for perioperative patient management include patient anesthesia, resection technique used, wound closure, and postoperative care. Further randomized studies using a standardized classification system are required to better compare different techniques and establish best practices.
Article
Introduction: Pubic hair grooming and removal are common behaviors among men and women. However, little is known about the reasons for grooming, preferred pubic hairstyle of sexual partners, and symptoms associated with regular grooming. Aims: This study aims to assess pubic hair removal/grooming practices, pubic hairstyle preferences, and genital outcomes associated with pubic hair removal among men and women in a college sample. Methods: Data were gathered from 1,110 participants (671 women and 439 men) at a large public Midwestern university and a small Southern public university. Main outcome measures: Items assessed demographics, pubic hair grooming and removal practices in the past 4 weeks, reasons for pubic hair status, preference for pubic hairstyle of sexual partners, and symptoms associated with removal and grooming. Results: Most (95%) participants had removed their pubic hair on at least one occasion in the past 4 weeks with shaving being the most commonly reported hair removal technique by women (82%) and men (49%). Women were significantly more likely to report their typical status as hair-free (50% vs. 19%; χ(2) = 165.528, P < 0.001) and men were significantly more likely to prefer a hair-free sexual partner (60% vs. 24%; χ(2) = 211.712, P < 0.001). Genital itching was experienced on at least one occasion by 80.3% of pubic hair groomers and was the most commonly reported side effect. Conclusion: Genital grooming and pubic hair removal are common practices among both men and women of college-age. Women are likely to report stronger associations with feelings of cleanliness, comfort, sex appeal, social norms of their peer group, and affordability as reasons for their chosen pubic hair style. Women also report more experiences with genital side effects of pubic hair removal, an expected result as women are removing pubic hair more frequently and more completely than their male counterparts.
Article
Examine women's perceptions of what is 'normal' and 'desirable' in female genital appearance. Experiment with random allocation across three conditions. Community. A total of 97 women aged 18-30 years. Women were randomly assigned to view a series of images of (1) surgically modified vulvas or (2) nonmodified vulvas, or (3) no images. They then viewed and rated ten target images of surgically modified vulvas and ten of unmodified vulvas. Women used a four-point Likert scale ('strongly agree' to 'strongly disagree'), to rate each target image for 'looks normal' and 'represents society's ideal'. For each woman, we created two summary scores that represented the extent to which she rated the unmodified vulvas as more 'normal' and more 'society's ideal' than the modified vulvas. For ratings of 'normality,' there was a significant effect for condition (F2,94 = 2.75 P = 0.007, radj2 = 0.082): women who had first viewed the modified images rated the modified target vulvas as more normal than the nonmodified vulvas, significantly different from the control group, who rated them as less normal. For ratings of 'society's ideal', there was again a significant effect for condition (F2,92 = 7.72, P < 0.001, radj2 = 0.125); all three groups rated modified target vulvas as more like society's ideal than the nonmodified target vulvas, with the effect significantly strongest for the women who had viewed the modified images. Exposure to images of modified vulvas may change women's perceptions of what is normal and desirable. This may explain why some healthy women seek labiaplasty.
Article
Puxa-puxa is the elongation of the labia minora of the genital organs. It is one of the most widespread genital practices among women in Mozambique, and the practice seems to be specific to this country. The motives underlying this practice and its abandonment were examined in a theory-driven way. A total of 616 women currently living in the provinces of Maputo, Zambezia, and Nampula, aged 18 to 62, were presented with one of two questionnaires that contained items about possible motives for practicing puxa-puxa or possible motives for not practicing it. Seven separable motives for practicing puxa-puxa were found, and the most highly rated were "Having a satisfying sexual life"; "Satisfying my sexual partner"; and "Gaining self-control." Five separable motives for not practicing puxa-puxa were found, and the most highly rated were "Disliking a painful practice"; "Affirming one's value as a person"; and "Avoiding contamination." The main findings of the study are that the practice of puxa-puxa is associated with deep psychological motives common to most women in most cultures, namely having a satisfying sexual life with a reliable partner, creating the conditions for having children, and being able to care for them. The abandonment of this practice is largely the result of personal decisions, which are not taken under constraint and which are not exclusively taken from fear of illness.