Medical research: No (wo)man is an island and subjective perceptions of genital normality

The Journal of Sexual Medicine has published, in 2011, significant research on the subjective nature of “normal” female genitals. The study, by Reitsma, Mourits, Koning, Pascal and van der Lei, is entitled “No (wo)man is an island – the influence of physicians’ personal predisposition to labia minora appearance on their clinical decision making: a cross-sectional survey“.

Reitsma et al conducted a multi-centre study of 210 physicians in the Netherlands in 2009; this scale is significantly larger than any study of intersex patients. It examined the dispositions of general practitioners, gynaecologists and plastic surgeons to refer or perform a surgical labia minora reduction. 164 physicians completed the survey, carried out with a “five-point Likert scale appraisal of four pictures showing a vulva, each displaying different sizes of labia minora”.

Questions were posed concerning physicians’ personal predisposition to the vulvas, with regard to naturalness, attractiveness (i.e., the extent of appealing), the physician’s private ideal (i.e., the overall preference), and what the physician believed to be society’s ideal. Skin color, pubic hair growth, potential irregularities, and asymmetries were comparable among the pictures, thereby eliminating potential biases…

Almost all of the participating plastic surgeons (90.7%; 39/43) and the majority of the gynecologists (58.5%; 24/41) had performed a labia minora reduction procedure in their clinical practice.

The survey results indicated:

  • Ninety percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents society’s ideal (2-5 on the Likert scale).
  • More plastic surgeons regarded the picture with the largest labia minora as distasteful and unnatural, compared with general practitioners and gynecologists.
  • Irrespective of the woman’s labia minora size and the absence of physical complaints, plastic surgeons were significantly more open to performing a labia minora reduction procedure than gynecologists.
  • Male physicians were more inclined to opt for a surgical reduction procedure than their female colleagues.

The study found that:

the opinions of general practitioners and gynecologists, on the one hand, and those of plastic surgeons, on the other hand, diverge when considering what constitutes a natural-looking and attractive vulva. Moreover, this survey clearly reveals that gender of the physician is a significant influence: male physicians in all specialties are more inclined to perform the surgical procedure, compared with their female colleagues.

The study team felt it possible that surgical trends are informed by trends in the pornography industry and media, including use of image manipulation.

In the view of OII Australia, the study reveals both a gendered bias, and the absence of standard objective measures for cosmetic perceptions of “normal” female genitals.

More information

W Reitsma, MJ Mourits, M Koning, A Pascal, B van der Lei, 2011, No (wo)man is an island – the influence of physicians’ personal predisposition to labia minora appearance on their clinical decision making: a cross-sectional survey, in The Journal of Sexual Medicine, 2011 8(8):2377-2385, doi: 10.1111/j.1743-6109.2011.02321.x,