When Your Daughter Wants Plastic Surgery: What Parents Need to Know About Labial Hypertrophy

If you have a tween or teen daughter, then you are all too familiar with the images and ideals of beauty that she is bombarded with every day. As a pediatric gynecologist and surgeon, I can tell you that these ideals are increasingly (and alarmingly) showing up in gynecologists’ offices across the nation, as women of all ages are seeking cosmetic surgery to achieve what has been deemed by societal pressures as a “more attractive” vagina.

If it sounds absurd, that’s because it is – and this is an important message I am hoping that mothers and daughters (sisters, friends and families) will hear; vaginas are as varied as the females who have them – there is no “right” way for genitals to appear.  Before you or your daughter decide on an elective surgery to fix a problem that most likely doesn’t need fixing, I hope you’ll consider the following:

Understand the anatomy. The majority of questions and concerns seem to be around the appearance of the inner lips of the vagina, the labia minora. Girls are worried that their labia minora are the wrong color, protrude too much past the outside lips (labia majora), or that one side is bigger than the other. “Normal” female genitalia come in range of colors, shapes and sizes – especially during adolescence. It’s very common for a girl’s labia minora to develop first, and for the outer lips – which are actually pads of fatty tissue – to grow later in the teen years. On a thin adolescent girl, labia minora can become even more prominent.  When girls don’t know this, they (and sometimes their mothers) assume something is wrong.

Everyone is different ‘down there.’ I’ve had cases where moms who have been teaching their daughters how to use tampons, become concerned at what they see, define it as abnormal, and seek medical attention and/or surgical intervention. However, most of the time, these well-meaning parents have a limited database of how labia minora “should” look. Daughters aren’t going to look exactly like their mothers—in any aspect of their anatomy. Many teens in this generation remove all of their pubic hair – making these body parts visible in a way that some parents may not be accustomed to.

What’s wrong with this picture? Access to pornography has given people of all genders an unrealistic idea of what a vagina is “supposed” to look like. In many cases, the pictures have been airbrushed to either completely remove the labia minora, or alter their appearance and color.

Cosmetic surgery comes with risks. Labiaplasty’s potential complications include bleeding, infection, wound breakdown, repeat surgery, the development of scar tissue, and loss of sensation. The labia minora is thought to play a role in a woman’s sexual arousal and response. There is increasing concern that altering the genitalia may potentially lead to painful intercourse and sexual dysfunction later in life.

However, sometimes surgery is needed. There is an actual condition called labial hypertrophy, where the labia minora are big enough to make physical activity uncomfortable and/or impact function. Most of the surgeries I have done are on girls who are very active in sports. Labial hypertrophy should be diagnosed by a pediatric gynecologist. If surgery is needed, the procedure should be conducted by a gynecologic surgeon who is familiar with genital nerves and anatomy. The surgery should not be performed on a girl who has not moved through adolescence and completed her development as well as have the emotional and developmental maturity to understand the risks and significance of undergoing surgery to alter the appearance of her genitalia.

As more teens are seeking elective labial surgery, the American College of Obstetrics and Gynecology through the Committee on Adolescent Health Care has recently developed guidelines to educate gynecologists about the limited role of surgical interventions for this group of patients. The guidelines emphasize limiting surgery to older teens who have significant functional impairment and avoiding surgery for enhancement alone. The committee, for which I am a member, also sought to encourage gynecologists to educate patients and their families about the broad range of “normal” genital anatomy and promote teen self-acceptance. If you know a girl who is questioning her body, explain that surgery won’t necessarily help her achieve a standard of beauty. You can help these girls navigate their way through this vulnerable time through education, emotional support, and reassurance that they are perfect exactly the way they are – and that diversity is beautiful.

Geri Hewitt, MD
Geri D. Hewitt, MD, is Chief of the Section of Obstetrics and Gynecology at Nationwide Children’s Hospital and an Associate Professor of Clinical Obstetrics in the Departments of Obstetrics and Gynecology and Pediatrics at The Ohio State University College of Medicine. Dr. Hewitt’s primary interests are caring for the gynecologic and reproductive health needs for young girls as well as adolescents. Dr. Hewitt is an examiner for the American Board of Obstetrics and Gynecology. Dr. Hewitt is a Fellow of the American College of Obstetricians and Gynecologists and a co-editor for the Journal of Pediatric and Adolescent Gynecology’s Tips for Clinicians section.

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