There is mounting concern about a vaginal plastic surgery procedure more and more Australian women are having.
Each year more than 1,200 Australian women undergo surgery on their genitalia in a procedure known as labioplasty.
Doctors and surgeons fear that some women may be having the operation unnecessarily and there are concerns about operations being done by unqualified medical professionals.
In Britain, where the procedure is equally popular, medical experts are warning of a shocking lack of information about the risks and long-term impact.
It is controversial surgery but it is booming nonetheless.
For some, labioplasty is an exercise in Hollywood-style vanity, while for others it is a transformative procedure that trims, sculpts and restores a woman's genitalia.
But there have been no studies to prove its long-term safety and doctors are worried about its ballooning popularity.
Dr Ted Weaver from the Royal Australian College of Gynaecologists says there are concerns.
"We put out about a statement from our college a couple of years ago, highlighting concerns about this designer vagina craze because we felt that often it did prey on fears of women and women's insecurity about their particular genital appearance," he said.
"The surgery's potentially damaging. It could potentially lead to further problems for a woman as a result of surgery and may not fix her insecurity."
Dr Kourosh Tavakoli is a member of the Australian Society of Plastic Surgeons and a fellow of the Australasian College of Surgeons.
He has been performing the labioplasty for seven years and is seeing a 100 per cent increase in that number year on year.
"Let's not kid ourselves. The last survey in my practice was 80 per cent for cosmetic and I would say for psychological reasons - that's what I see as a function," he said.
"There are two reasons [women give for having the surgery] - I can't get comfortable during sex and the number two reason is essentially pure physical, in terms of running or jogging and not being able to wear a leotard or cossie."
Labioplasty can cost between $4,000 and $6,000 and is often covered by Medicare.
Safety fears
Dr Tavakoli says it is a lucrative field, but he fears some practitioners are not up to the task.
"I have seen horrendous results from them. I mean there's three groups doing it - plastic surgeons, gynaecologists and GP surgeons in their offices, without proper lighting or sedation or anything," he said.
"I think the last group is a concern because they can take excess tissue and cause problems."
Research published in the British Journal of Obstetrics and Gynaecology is questioning the value of the labioplasty, with concerns that many women seek the surgery without fully understanding the risks. British medical experts are also questioning the ethics of the surgery.
Dr Weaver says some women are being exploited.
"We think anybody performing these procedures certainly should be well trained, not only in the surgical technique but also have the training in the ability to try to perhaps dissuade a woman from having it done," he said.
"[They should] also be able to counsel the woman that there is a variation in normal appearance and that she doesn't have to confirm to a picture that she might have noticed in a girlie magazine or something equally ridiculous."
He believes there are women in Australia who are having the procedure unnecessarily.
Dr Tavakoli says patients must be psychologically screened and they must have realistic expectations. But either way, he says the procedure is here to stay.
"I believe it's a good operation. I stand by this operation. I've had enough experience to see the mental transformation that this operation can bring and it will become a mainstay operation in cosmetic surgery," he said.
"But again it needs to be very heavily scrutinised and patient selection is imperative. In the right patient, it will have benefits and patient selection is paramount."
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