The fashion is being driven by commercial and media pressures that exploit women's insecurities and is fraught with unknowns, including a risk to sexual arousal, the British Medical Journal (BMJ) says.Known as elective genitoplasty, the surgery usually entails shortening or changing the shape of the outer lips, or labia, but may also include reduction in the hood of skin covering the clitoris or shortening the vagina itself.
Anecdotal evidence suggests that the practice is spreading fast in the United States as well as in Britain, but the picture is unclear, the BMJ says.
According to Dr Elna McIntosh these procedures are also quite common in South Africa.
Not only is there a disturbing lack of data about the phenomenon, there has been negligible assessment about surgical after-effects - and almost zero consideration of whether a labial "problem" exists in the first place, the BMJ says angrily.
In 2004-5, 800 "labial reductions" were conducted by Britain's state-run National Health Service (NHS), more than a doubling of the figure of six years earlier. Other operations were carried out by the private sector, although the full figures are unknown.
Why women do it
The authors of the article, London gynaecologist Sarah Creighton and clinical psychologist Lih Mei Liao, conducted their own small-scale probe into why women sought this surgery.
"Our patients sometimes cited restrictions on lifestyle as reasons for their decision," they say.
"These restrictions included inability to wear tight clothing, go to the beach, take communal showers or ride a bicycle comfortably, or avoidance of some sexual practices.
"Men, however, do not usually want the size of their genitals reduced for such reasons. Furthermore, they find alternative solutions for any discomfort arising from rubbing or chaffing of the genitals." Patients who sought genitoplasty "uniformly" wanted their vulvas to be flat and with no protrusion, similar to the prepubescent look of girls in Western fashion ads, they found.
"Not unlike presenting for a haircut at a salon, women often brought along images to illustrate the desired appearance," say Creighton and Liao. "The illustrations, usually from advertisements or pornography, are always selective and possibly digitally altered."
Surgery is risky
Plastic surgery to the labia carries risks, for this zone carries nerve fibres that are highly sensitive and are a key pathway of sexual arousal, the article warns sternly.
"Incision to any part of the genitalia could compromise sensitivity," it says.
The BMJ piece suggests genitoplasty is a classic example of where commercial, media and social pressures artificially create a problem, fuel concern over it and then put forward a solution for it.
"There is nothing unusual about protrusion of the labia," it says.
"It is the negative meaning that makes it into a problem -- meanings that can give rise to physical, emotional and behavioural reactions, such as discomfort, self-disgust, perhaps avoidance of some activities and a desire for a surgical fix." – (Sapa-AFP)