Medical diagrams and in particular line drawings of genitals are partly responsible for young women considering cosmetic labia surgery, according to preliminary research from the University of Melbourne.
"Those sort of images that people do see are all likely to be stylised, airbrushed, or are images of genitals that have had cosmetic surgery," says PhD student Emma Barnard, the lead researcher on the Labiatalk study. "So they're not really a good representation of what we would consider to be normal."
The number of young women and girls seeking female genital cosmetic surgery is on the rise in Australia and the University of Melbourne is trying to figure out what's behind the trend.
Labiatalk is a pilot study designed to try and understand the decision-making processes behind female genital cosmetic surgery, and the influences that lead young women to believe that their genitals are abnormal in the first place.
To do this Barnard is recruiting young women who approached a health professional as a teenager about their genital appearance and considered surgery.
While the project is still in its early stages and only 12 women have been interviewed so far, Barnard told BuzzFeed News she is surprised by the findings.
Barnard has also found that when parents are involved, it may be because their own perception of normal vulvas is limited, and that mothers may also not have a good sense "around what is normal or what constitutes normal".
Over an 11-year period, Medicare claims for female genital cosmetic surgeries including labiaplasty and vulvaplasty (a reconstructive surgery to remove excess skin folds) more than doubled.
In the 2002/03 financial year 707 claims were made for these procedures, and by the 2013/14 financial year that number had risen to 1,584.
Nearly a quarter of those procedures were performed on girls aged five to 25.
While the number of women undergoing the procedure in Australia is now difficult to estimate, as Medicare changed its standards for rebates in 2014, driving these cosmetic surgeries into the private sector) international trends suggest that those numbers may be still rising dramatically.
One 2016 study found that 35% of GPs in Australia had been approached by women aged under 18 requesting genital cosmetic surgery.
However, Barnard noted that the question of whether young women ever need this surgery is contested due to a lack of medical definition of what is normal for measurements of female genitals.
A Swiss study of 650 women published in June of this year attempted to define the medically "normal" appearance of a vulva with limited success.
The authors concluded that their findings support "the assumption that uniform thresholds concerning the size of the vulva for diagnoses of vulvar diseases are inappropriate".
The authors suggested that while vulva measurements might be initially useful for indicating a diagnosis, individualised examinations are always required.
The study also noted that the literature concerning the normal length of the labia minora (the inner fold) varies dramatically. One paper described the width of the labia minora as 20 to 30 millimetres, while another stated that anywhere under 50 millimetres is considered normal.
This lack of a medically-defined "normal" vulva means that women are open to receiving different advice from different practitioners, said Barnard.
"So if you were to go to a specialist gynaecologist who had adolescent training, you might get a very different answer about what is normal than if you were to go to a cosmetic physician of some description," she said. "Which I think is a problem, specifically for young people."
A study from the Royal Children's Hospital Melbourne published earlier this year found that when girls and young women present with these insecurities, surgery is not the only answer.
"With appropriate education and counselling, the majority of girls with concerns regarding labial appearance can be managed without surgery."