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The L Word More and more women seek a controversial gynecological surgery.

Roses for Velentine

If you ask a room full of women what labiaplasty is, you’re likely to be met with one of two reactions: blank stares or abject horror. Ask for further explanation, and those in the know will probably launch into a stumbling explanation, red-faced and prone to innuendo: You know, when they take your, um, lady lips and, like, cut them to make them smaller…

It may come as a surprise, then, that the surgery is more popular than it’s ever been. To put it plainly, labiaplasty is an operation performed to reduce the size of the labia minora, or the inner lips, of the vulva.

“The surgery itself is very straightforward,” says Dr. Adam Basner of the Plastic Surgery Center of Maryland. “There are two ways to do it: one is direct excision of the excess tissue, which is almost like an amputation, and the other, which most surgeons now use, is the wedge technique.”

The latter, he compared to a pie. “You cut out a large slice, then push the pie—or, in this case, the tissue—back together.”

And yes, many women actually want this surgery. In fact, it’s among the most rapidly growing cosmetic surgeries in the United States, with a 16.1 percent increase from 2014 to 2015, according to the American Society for Aesthetic Plastic Surgery.

So why the sudden interest in a surgery that can cost up to $7,500 out-of-pocket? In short, Brazilians and porn.

“The generation before ours didn’t wax or shave or get laser hair removal,” says Dr. Karen Boyle, a sexual health specialist and surgeon at Chesapeake Urology. “And I think with that, and with the internet, there’s so much more awareness of what our and others’ genitals look like.”

Given those motivations, it’s not shocking that national news reports detail a rise in teenage patients. Neither Dr. Basner nor Dr. Boyle, however, reported a similar demographic shift in their operational history—Basner said he had not yet been approached by anyone in that age group, and Boyle expressed reluctance to operate on younger women who may not be emotionally or physically mature enough. Both said that the majority of their surgeries have been for women in their 20s and 30s.

“It’s very important to pick your patients carefully,” Boyle says. “I’ve seen a number of young patients come in with their moms, and I have to make sure that they’re doing it for the right reasons—not because of a partner or negative sexual experience, or to try to chase some sort of social norm.”

Labiaplasty is largely elective, meaning it is rarely recommended for health or medical reasons.

“I see maybe two or three cases a year of a genuine hypertrophic labia,” said Dr. Tola B. Fashokun, the fellowship program director of Female Pelvic Medicine and Reconstructive Surgery at Johns Hopkins. “A lot of women who come to me say they’re concerned with the size of it, but they’re perfectly normal. I reassure them that there’s no such thing as a perfect labia—and they definitely don’t need to look like a porn star.”

In fact, Dr. Fashokun says, there are only a few reasons to become concerned, namely a noticeable change in size caused by pregnancy or hormone therapy. Otherwise, she says, issues with the labia are likely body image-related, and thus not sufficient cause for surgery. “When someone doesn’t have a legitimate medical problem, the risk outweighs the benefits,” she says. After all, recovery can be painful, and it’s, um, “not an area you can avoid interacting with.”

That’s not to say, however, that the surgery is always considered superfluous; while occasionally sought for purely cosmetic reasons, many patients experience discomfort as a result of long or large labia.

“Many women don’t like how [an enlarged labia] looks, but the thing that brings them in most of the time is that they don’t like how it feels,” says Dr. Boyle. “If the labia are bulky, they can get in the way, get pulled inside the vagina during intercourse, pinch during workouts or be bothersome in a bathing suit or tight clothes.”

For one of Dr. Basner’s labiaplasty recipients (who chose to remain anonymous), a combination of cosmetic and comfort factors influenced the decision to seek surgery.

“I’ve always had long labia, to the point that I would have to tuck it up in order to feel comfortable walking or in clothing,” she says. “It felt so unsanitary—I’d have to touch myself to re-tuck after using a public restroom and touching the dirty doorknobs. I was just sure I was constantly picking up germs down there.”

At the same time, however, she liked the idea of labiaplasty from a sexual standpoint. Though the surgery doesn’t affect sexual pleasure or sensation, she says she had always been embarrassed by the size of her labia—and, after getting separated recently, she was ready for a change. Committing to the operation was a little scary, of course, but she claims the payoff was so worth it.

“When you’re with someone for a long time, they get used to it,” she says. “But I’m reentering the dating pool, and now I’m so much more comfortable being intimate. I didn’t expect it to be so neat and natural-looking!”

As for a final conclusion on this controversial plastic surgery? Well, our lips are sealed.

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