The incredibly worrying new plastic surgery trend in girls as young as nine-years-old.

Younger and younger girls are feeling unhappy with the look of their labia, and doctors are worried by the trend.

It can start with girls as young as nine. They’re so distressed by the appearance of their vulva that they want surgery.

In the UK, in 2015/16, more than 150 girls under the age of 15 had labiaplasty on the National Health Service. It’s an operation that involves shortening or reshaping the lips of the vagina.

Adolescent gynaecologist Dr Naomi Crouch has told the BBC that she’s yet to see a girl that actually needs labiaplasty for medical reasons.

“Girls will sometimes come out with comments like, ‘I just hate it, I just want it removed,’ and for a girl to feel that way about any part of her body – especially a part that’s intimate – is very upsetting,” she says.

Meanwhile, Dr Paquita de Zulueta has been a GP in the UK for 30 years and has only recently started seeing girls unhappy with their labia. She says she’s seeing 11-, 12- and 13-year-olds expressing “almost disgust”.

“Their perception is that the inner lips should be invisible, almost like a Barbie, but the reality is that there is a huge variation,” she says. “It’s very normal for the lips to protrude.”

Perhaps it’s not surprising that young girls are becoming unhappy with the appearance of their genitals. Many of them are unhappy with the appearance of their bodies generally from a young age.

A new Australian non-profit called The Pretty Foundation quotes research showing that 38 per cent of four-year-old girls want a different body size.

In Australia, plastic surgeons are also concerned with the number of girls who come in asking for their labia to be shortened. Professor Mark Ashton, who is the president of the Australian Society of Plastic Surgeons, says they tend to start coming in around the age of 16, after they’ve become sexually active.

“A number of the girls I’ve seen have said, ‘Oh, I need to do this because my boyfriend’s giving me grief – he says I look weird,’” Professor Ashton told Mamamia.

“More often than not, what they perceive to be significantly enlarged labia is actually not. It’s well within the spectrum of normal.”

He says sometimes girls come in, having had stories go around about the size of their labia.

“As you know, boys amongst their peers can be very cruel. A girl can then be labelled as having particularly large labia amongst the boys in the school, even though the labia are in normal limits.”

LISTEN: Mamamis Out Loud discusses how our girls are being influenced by our unattainable standards of beauty (post continues after audio...)

Professor Ashton thinks girls and their boyfriends are getting unrealistic impressions of what vulvas look like from pornography. One of the reasons for this is that in Australia, photos of naked women in magazines are often Photoshopped so that no labia minora is protruding.

Magazine publishers do that to get approval from the Office of Film and Literature Classification to be able to sell their magazines “unrestricted” – that is, not in sealed plastic bags.

“It’s the girls but also more importantly it’s the boyfriends of the girls that are looking at this pornographic material. They have the perception that a normal vulva is one in which the labia minora do not protrude past the labia majora.”

Professor Ashton will not perform labiaplasty on girls under the age of 18 because of the “vulnerability and impulsiveness” of that age group.

“Under the age of 18 we would just simply say, ‘Look, this is an operation that you should not be considering. What we want you to do is have a think about it. We want you to talk to your mum, to your dad, to your close friends, and get some perspective about things.’”

The youngest girl Professor Ashton has seen about the possibility of labiaplasty was 11. She was brought in by her mum.

“She had, it would be fair to say, gigantism of her labia minora,” he remembers. “Her labia were like 6, 7cm long.”

However, even though he could see the girl had a medical reason for the surgery, he told her mother that she would have to wait until her daughter was 18.

Despite this strong stance by Professor Ashton and other plastic surgeons, labiaplasty is being carried out on young girls in Australia. It’s often done under local anaesthetic and not in a hospital. Professor Ashton knows, because he’s seen “a lot of people” after their surgery has gone wrong.

“I’ve seen three or four people who’ve come in and one labia has completely died, so then we’ve spent four or months reconstructing a labia to match the other side,” he reports.

Professor Ashton thinks education is the key. He thinks girls and boys need to see the variety of vaginas that are all completely normal. The Great Wall Of Vagina artwork installed at the Museum of Old and New Art in Hobart, which features plaster casts of hundreds of vaginas, gets his approval. So does a similar wall of vaginas in the UK, which was toured around schools.

“It’s about education, so the kid looks and says, ‘Jeez, I’m not as bad as that.’ That’s what you want. You want them saying, ‘Okay, I’ve got some perspective now.’”