By Yasmine Noone.

What is it that drives women to have costly and potentially risky surgery to change the appearance of their vulva?

Every year thousands of women undergo labiaplasties – a relatively new surgical procedure that alters the folds of skin surrounding a woman’s vagina: the labia minora (inner labia) and the labia majora (outer labia).

Derogatory comments about the appearance of their genitals, as well as physical discomfort during certain activities have been identified as key reasons for why women have the surgery.

Research from Flinders University in Adelaide explored the intimate experiences of women who underwent a labiaplasty.

It found unrealistic images of female genitalia on the internet, including pornography, influenced what women thought of as a “normal” labial appearance.

The small study, published in Aesthetic Surgery Journal earlier this year, suggests women often elected to have the surgery after receiving negative comments about the way they looked in a swimsuit or jeans, which caused them long-term psychological and emotional angst.

“The dislike of their genital appearance was so ingrained that their current partner’s reassurance didn’t do anything to change their mind,” study lead and Flinders University clinical psychology PhD candidate, Gemma Sharp, said.

“It’s like telling someone their breasts are normal but they still want a breast augmentation because they just want bigger breasts.”

The research, featuring interviews with 14 women aged 23 to 59, found that women also underwent labiaplasty because of physical discomfort when playing sports, wearing tight underwear or having sexual intercourse.

“There was also a fear of judgement from others, both before undergoing surgery and after. So these women generally told very few people they were having it done,” Ms Sharp said.

Some patients ‘will never be happy’

Although many of the women interviewed had negative experiences prior to their operation, the study revealed most women were very satisfied with their surgical results.

The majority of participants reported significant improvements in their sexual wellbeing after surgery, although some said their emotional discomfort around sexual intercourse did not change.

According to Medicare, around 1,129 women underwent labiaplasty in 2014.

However, Ms Sharp said that figure underrepresented the true number of women who had the surgery, due to Medicare rebate changes and the fact most operations were performed in private practices.

In America, labiaplasty rates increased 16 per cent in 2015 alone.

Sydney gynecologist Dr Rebecca Deans, currently performs labiaplasty for patients she deems to be valid cases.

She said most women were pleased with the results of the surgery, if they went to the right surgeon and were in a good state of mind when they went under the knife.

“But there are also a group of women, with body dysmorphic disorder, who will never be happy, who we worry about having unrealistic expectations about the results of labiaplasty,” Dr Deans said.

“The other concern is that a lot of people don’t have a sense of what ‘normal’ is, as there’s quite a big range of normal within the community.”

Dr Deans said there was a broad range of medically normal labial appearances.

Long-term impact of labiaplasty on childbirth unclear

Dr Deans said for women hoping to have children after a labiaplasty, there were potential issues to be considered.

“We also don’t know the long-term consequences of labiaplasty, from a delivery point of view, as surgery introduces scar tissue into an area that is supposed to stretch during childbirth,” she said.

For this reason, Dr Deans said she maintained reservations about performing the procedure on women who have not yet had children and on those whose vaginal anatomy is within the medical range of normal.

“I perform the surgery and do my due diligence,” she said,

“My feeling is that half are happy and [for] the other half, surgery didn’t change their life either way. If they did or didn’t undergo labiaplasty, they would have been as happy no matter what they did.”

The study did however, show that just over half the survey participants interviewed expected more tissue to be removed during surgery, to create a smooth flat genital surface similar to images circulating online.

Labia needed to protect the vagina

Specialist plastic surgeon Dr Laith Barnouti, said women often requested a vaginal appearance with a flat surface.

“I see that in my practice,” Dr Barnouti said.

“But it all comes down to the consultation. This is where we educate our patients that the function of the labia is to protect the entrance to the vagina.

“If you cut the tissue flush, you could have ulceration at the beginning of the vagina, so we don’t cut it flush.

“But the key point of the surgery is not to produce a scar on the leading edge.”

The cost of a labiaplasty varies from surgeon to surgeon but can reach $5,000 for patients covered by private health insurance, or around $7,500 if they are not.

The risks posed by labiaplasty are small, but include bleeding, wound separation, and infection – although some surgeries provide patients with a preventative antibiotic.

However Dr Barnouti warned no matter how small the risk, things could go wrong if surgery was conducted by an inexperienced doctor. He also accepted claims that some surgeons had mutilated women in the course of conducting a labiaplasty.

For this reason, he recommended women do their research and consult the expertise of a trusted plastic surgeon with a good reputation, before going ahead with labiaplasty

“It’s just like anything else in life. If you do it properly, you do it well and people will be satisfied,” he said.

This post originally appeared on ABC News.