More women are requesting vulvoplasty, a range of surgical procedures that change the structure and appearance of healthy genitalia, a study of almost 500 general practitioners published in online medical journal BMJ Open has found.
The survey found 97% of GPs had been asked about genital "normality" and more than half had seen patients ranging in age from as young as 10 to 65 years old requesting female genital cosmetic surgery.
More than half the GPs surveyed suspected psychological disturbances in their patients including anxiety, depression, body dysmorphic disorder, eating disorders, relationship difficulties or a history of sexual abuse.
“Most patients I see requesting genital cosmetic surgery are extremely poorly informed about normal anatomy, based on porn," one GP told researchers.
One women's health practitioner with 30 years' experience described a patient who had been "coerced" into having the surgery by her ex-husband who "humiliated her and made her feel she was abnormal and unlovable".
Another said the trend for "full Brazilian hair removal" had "uncovered" vulvas and made them "more visible to women and their partners.
"Many people think that a ‘normal’ vulva is supposed to look somewhat pre-pubertal," the doctor said.
“There are people building a business around labiaplasty, advertising images online of women with prepubertal genitalia, depicting it as the desirable norm and a lifestyle choice,” Dr Magdalena Simonis, who lead the study, said.
The requests for labiaplasty procedures, which involves the removal of folds of tissue around the vulva, performed in Australia increased threefold from 640 in 2001 to more than 1500 in 2013.
“The figures are only the tip of the iceberg – they only capture the procedures surgeons charge to Medicare,” the study's supervisor Dr Jason Ong said.
This month the Medical Board of Australia began advising that girls under 18 who ask for vulvoplasty should receive counselling and a three-month cooling-off period to ensure they are aware of the implications of surgery.