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 Fat thighs. Hairy arms. Muffin tops. Breasts that are too big or not big enough. To the long list of body parts that adolescent girls worry about and want to tinker with, the Internet age has added a new one: the vulva. 
 
 So many teenagers are seeking cosmetic surgery to trim or shape the external genitalia that the American College of Obstetricians and Gynecologists issued guidance from its Committee on Adolescent Health Care to doctors last week, urging them to teach and to reassure patients, suggest alternatives to surgery that may alleviate discomfort, and screen them for a psychiatric disorder that causes obsession about perceived physical defects. 
 
 As for why there has been an increase in demand for the surgery among teenagers, physicians are “sort of baffled,” said Dr. Julie Strickland, the chairwoman of A.C.O.G.’s committee on adolescent health care 
 
 For adults, the procedure is marketed as “vaginal rejuvenation,” tightening the inner and outer muscles of the vagina, as well as often shaping the labia; it is geared to older women and women who have given birth. But gynecologists who care for teenage girls say they receive requests every week from patients who want surgery to trim their labia minora, mostly for cosmetic reasons, but occasionally for functional reasons, such as to relieve discomfort. 
 
 The guideline does not rule out surgery on the labia, or labiaplasty for teens, but says it is rarely appropriate. “It should not be entertained until growth and development is complete,” Dr. Strickland said. 
 
 “The big thing I tell patients about labiaplasty is that there are a lot of unknowns,” she said. “The labia have a lot of nerve endings in them, so there could be diminishment of sexual sensation after surgery, or numbness, or pain, or scarring.” 
 
 A 2007 A.C.O.G. committee opinion on cosmetic vaginal procedures for adults, which was reaffirmed in 2014, said the procedures were not medically indicated, had not been proved safe or effective, and could cause serious complications. 
 
 The American Society for Aesthetic Plastic Surgery says that 400 girls 18 and younger had labiaplasty last year, an 80 percent increase from the 222 girls who had cosmetic genital surgery in 2014. While the overall numbers remain small, the data probably understates the trend because it does not include procedures performed by gynecologists. A 2013 British report found the number of labial reductions on girls and women done by the National Health Service had increased fivefold over 10 years. 
 
 Girls 18 and younger account for less than 2 percent of all cosmetic operations, but almost 5 percent of all labiaplasties. (The most popular cosmetic procedures for teenagers are ear surgery, with 11,288 procedures last year; nose surgery with 10,308; and breast reductions with 3,698.) 
 
 What’s driving the trend for labia surgery? Well, for one, doctors say, many young girls shave or wax their pubic hair, exposing the genital area. According to a 2012 study, more than 70 percent of girls and young women ages 12 to 20 said they routinely shaved or waxed the pubic area. 
 
 These girls have come of age at a time when they can go online and look up images of the vulva, doctors say. But the images are often air-brushed and do not portray the range of normal variation in shape, color, size and asymmetry, experts say. 
 
 “I think the most important thing to understand is that there’s huge variety in anatomy,” said Dr. Veronica Gomez-Lobo, the director of Pediatric and Adolescent Ob/Gyn at MedStar Washington Hospital Center and the president of the North American Society for Pediatric and Adolescent Gynecology. She often recommends young women look at unretouched photographs of vulvas, like those in the book “Petals” by Nick Karras. 
 
 The new committee opinion says doctors should screen patients for body dysmorphic disorder, a psychiatric disorder that can be debilitating and involves being obsessed or preoccupied with a physical defect that is being imagined or exaggerated. Dr. Katharine Phillips, the director of the Body Dysmorphic Disorder program at Rhode Island Hospital/Brown University, said cosmetic treatment does not help the condition, and “sometimes, patients get a lot worse.” 
 
 But Dr. Jennifer Walden of Austin, Tex., who has done labia surgery on teenagers, dismissed the idea that girls who wanted the surgery had a psychiatric disorder. “If they’re coming to a cosmetic surgeon, they do not like the cosmetic appearance of it,” said Dr. Walden, who added that she performed the procedure only on patients that she deemed emotionally stable and had their parents’ consent. “But that often goes hand in hand with a functional element in teenagers as well.” 
 
 Doctors agree that not all of the concerns about large or misshapen labia are strictly cosmetic. Adolescent girls who are involved in certain sports may experience discomfort, such as chafing or itching in the labia, Dr. Strickland said. 
 
 For some girls, surgery may be appropriate, Dr. Gomez-Lobo said, like the teenager who stayed home when she had her period because her labia became so painful and swollen that she was incapacitated, and another girl who quit basketball because of painful, irritated labia. “That’s not an aesthetic issue,” Dr. Gomez-Lobo said. 
 
 Related: ||||| It’s shocking but true: One of the hot trends in plastic surgery right now is labiaplasty, a procedure to trim the vulva’s inner lips, aka the labia minora. (Add this to the list of things you shouldn’t do to your vagina.) According to the latest statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), labiaplasty procedures spiked 49 percent between 2013 and 2014 (from 5,070 to 7,535). And the trend seems to be continuing. 
 
 “I am asked about labiaplasty at least once a month,” says ob-gyn Jennifer Gunter, MD, who runs a specialty clinic for vulvar conditions at Kaiser Permanente in San Francisco. “Five years ago, I was probably asked one to two times a year.” 
 
 What’s behind this (crazy?) craze? Here’s a look at the facts. 
 
 RELATED: Everything You Ever Wanted to Know About Your Vagina 
 
 Why the rise? 
 
 Michael Edwards, MD, a former president of ASAPS, told Time that some women with more pronounced labia are “devastated.” Another plastic surgeon, Richard Swift, MD, on Manhattan’s Upper East Side, told the New York Post, that women “whose labia are enlarged” feel uncomfortable in yoga pants. 
 
 But “normal” labia minora come in all shapes and sizes, ranging from 2 to 10 cm in length and 0.7 to 5 cm in width, per a study published in the journal BJOG (images NSFW). And it’s quite common for the labia minora to stick out past the outer lips of the vagina, according to Dr. Gunter, without any discomfort. 
 
 In a blog post about labiaplasty (also NSFW), she noted that smaller labia seem to have become the cultural norm, perhaps because many female performers in the adult film industry have small labia. “Whether this is a self-selecting feature or the result of surgery is hard to know,” Dr. Gunter wrote. But “if you see a lot of images of small labia minora you are more likely to come to view that as … desirable.” 
 
 RELATED: Am I Normal ‘Down There’? 
 
 How pubic hair trends also play a role 
 
 “There is an expression for men, ‘The shorter the bush, the taller the tree,’” and a similar visual effect happens with female genitalia, says Dr. Gunter. “If you remove your pubic hair or trim it significantly, you may start to notice your labia minora.” 
 
 In fact, the rise in labiaplasty has been linked to the popularity of the Brazilian wax. As Barbara Levy, MD, the VP of Health Policy at the American Congress of Obstetricians and Gynecologists, put it to NBC News, the hairless trend made women more aware of their genital appearance, and plastic surgeons saw dollar signs. 
 
 Do larger labia really cause any symptoms? 
 
 The vagina’s smaller, inner folds of skin have an important job: They protect the vaginal opening—called the vestibule—which is made up of delicate mucosa tissue, filled with highly-sensitive nerve endings. 
 
 Some women blame painful sex on the size of their labia. Others suspect their labia are the source of their yeast infections, or other irritation. Even doctors attribute some of these vulvar symptoms to the size of the labia minora. But there is almost always another cause, Dr. Gunter says. If you have vulvar symptoms, talk to your ob-gyn first—not a plastic surgeon. You might even want to see a vulvar specialist, Dr. Gunter advises. 
 
 RELATED: 20 Weird Facts About Sex and Love 
 
 Is labiaplasty safe? 
 
 A 2014 study found that more than 91 percent of women who had the surgery felt more satisfied with their genital appearance afterward. But there are no solid figures on complications, and the long-term implications are TBD. “We don’t know how labiaplasty will affect women as they become menopausal, and their tissues start to change,” Dr. Gunter points out. 
 
 The bottom line 
 
 Dr. Levy summed up the labia-trimming trend like this: “It’s one more body part that we as women are being told to be insecure about.” But that’s not to say that no woman should ever consider the procedure. As with any plastic surgery, the best advice is to make sure you’re interested in the procedure for you, rather than some outside pressure. 
 
 For an awe-inspiring reminder that every woman’s body is different, take a gander at the Great Wall of Vagina. The sculpture, by British artiest Jamie McCartney, features plaster casts of 400 vulvas, each beautifully unique. 
 
 RELATED: 7 Sneaky Reasons Your Vagina Itches ||||| By Amy Norton 
 
 HealthDay Reporter 
 
 FRIDAY, April 22, 2016 (HealthDay News) -- A growing interest among teenaged girls in plastic surgery on their breasts or genitals has prompted a leading ob/gyn group to recommend that doctors first talk to these young women about "normal" sexual development. 
 
 "Our membership has been telling us this is coming up more and more frequently with their adolescent patients," said Dr. Julie Strickland. She is chair of the Adolescent Health Care Committee of the American College of Obstetricians and Gynecologists (ACOG). 
 
 The new recommendations also suggest that physicians screen these patients for body dysmorphic disorder, which is an obsession with an imagined or slight defect in appearance. 
 
 There are already guidelines from the American Society of Plastic Surgeons (ASPS) on breast augmentation and reduction among teenagers. If it's strictly for cosmetic reasons, the society recommends surgery should generally be delayed until age 18. 
 
 But, Strickland said, there's no guidance for cases where teenagers want labiaplasty -- where surgery is used to reduce the inner labia, the folds of skin that surround the vaginal opening. 
 
 Normal labia come in all sizes and shapes, Strickland said, and there's no widely accepted definition of labial "hypertrophy," or enlargement. Nor are there clear guidelines on when surgery might be appropriate for teenagers. 
 
 The new guidelines appear in the May issue of Obstetrics & Gynecology. 
 
 When girls are worried about the appearance of their breasts or genitals, Strickland said, the anxiety can often be "diffused" by letting them know there is a wide variation in "normal" development. 
 
 Even in this day and age, she noted, many girls do not know what their genitals are "supposed" to look like. "Despite all of the anatomy books that have been published over the years, we're lacking in descriptions of normative female genital development," Strickland said. 
 
 Nationwide, about 8,000 13- to 19-year-olds underwent breast augmentation in 2014, according to the ASPS. Statistics on breast reduction are harder to come by, but in 2010 about 4,600 were performed on 13- to 19-year-olds. 
 
 The ASPS does not track labiaplasty figures, and it's not clear how many teenagers have the procedure each year, according to ACOG. 
 
 No one knows exactly why teenagers are voicing more concerns about their labial development, either, Strickland said. 
 
 "One theory is that girls these days are seeing images of 'idealized' bodies," Strickland said. "There have also been cultural changes, with more girls grooming their pubic hair. That may make them more self-conscious about the appearance of their genitals." 
 
 Then there are the yoga pants and other form-fitting clothes that can either make girls scrutinize their appearance, or be physically uncomfortable, she added. 
 
 And it is actually physical discomfort that seems to be the main issue for teenage girls who want labiaplasty, said Dr. David Song, president of the ASPS. Song is also chief of plastic and reconstructive surgery at the University of Chicago. 
 
 "It's pretty rare to have a teenager coming in for cosmetic reasons," Song said. 
 
 When the inner labia protrude from the outer labia, he explained, it can be "very uncomfortable" to wear tighter clothing, or to exercise at all. In those cases, surgery to reduce the inner labia may help a girl feel better physically and emotionally, Song said. 
 
 He agreed that it's important to be sure teenagers are mature enough, and fully informed of the risks, before any plastic surgery. With labiaplasty, ACOG says, the potential risks include infection, scarring, and pain during sex. 
 
 According to Song, board-certified plastic surgeons are also trained to screen for body dysmorphic disorder and other mental health issues, like depression. 
 
 "They understand when they should be referring patients to a mental health professional," Song said. 
 
 That's why it's key, he added, for parents and young women to make sure they're seeing a surgeon who is board-certified. 
 
 When it comes to breast surgery, the ASPS does recommend that it generally be delayed to age 18. But, Song said, the issue is "not black-and-white," and there are cases where earlier may be better. 
 
 An example, he said, would be a younger teen whose breast growth is far out of proportion to the rest of her body -- to the point that it's causing her physical discomfort. 
 
 According to Strickland, the bottom line for parents is this: Listen to your daughter's concerns about her development, and be able to reassure her that she's going through normal changes. If you're not sure of what's "normal," talk to your pediatrician or family doctor, Strickland said. 
 
 "It's typical for teenagers to question whether they're 'normal' or not," she noted. "So we shouldn't be 'horrified' if they come to us with these questions. We need to respond sensitively and honestly." 
 
 More information 
 
 The U.S. National Library of Medicine has more on teens' sexual development. ||||| Recommendations 
 
 The American College of Obstetricians and Gynecologists makes the following recommendations regarding breast and labial surgery in adolescents: 
 
 The obstetrician–gynecologist caring for adolescents should have good working knowledge of nonsurgical alternatives for comfort and appearance as well as knowledge of indications and timing of surgical intervention and referral. 
 
 When adolescents seek medical treatment, the first step is often education and reassurance regarding normal variation in anatomy, growth, and development. 
 
 Appropriate patient counseling and assessment of the adolescent’s physical maturity and emotional readiness are necessary before surgical management or referral. 
 
 Individuals should be screened for body dysmorphic disorder. If an obstetrician–gynecologist suspects an adolescent has body dysmorphic disorder, referral to a mental health professional is appropriate. 
 
 Adolescents, under the influence of pubertal hormones, undergo rapid transformation and growth of their breasts and genital tissues. This can lead an adolescent to question whether her body is normal and to express occasional dissatisfaction with her body’s appearance, size, symmetry, or function. There has been increasing patient interest in surgical modification of breast and genital tissues during the adolescent period. The obstetrician–gynecologist who provides care for adolescents with these concerns should have good working knowledge of nonsurgical alternatives for comfort and appearance as well as knowledge of indications and timing of surgical intervention and referral. 
 
 Adolescents often desire to improve physical conditions that, if left uncorrected, may affect them into adulthood or that they perceive as flawed (1). This age group may be under particular stress regarding these issues because of societal conceptions of the ideal female body and parental concerns for body perfection (2). Although reconstructive procedures aimed at correction of abnormalities (caused by congenital defects, trauma, infection, or disease) or cosmetic procedures performed to reshape normal structures may improve function, appearance, and self-esteem, not all adolescents are suited for surgical intervention. Appropriate counseling and guidance of adolescents with these concerns require a comprehensive and thoughtful approach, special knowledge of normal physical and psychosocial growth and development, and assessment of the physical maturity and emotional readiness of the patient. 
 
 Counseling Issues 
 
 A thoughtful approach is needed when discussing correction or enhancement of the breast or genitalia with adolescents and their families who seek advice. The adolescent and her parents or guardians should have specifics of the surgery, benefits, and possible risks discussed in detail. The indications and motivation for surgical procedures also should be reviewed. Adolescents who request to have plastic surgery typically have different motivations and goals compared with adults seeking these procedures, such as a desire to “fit in” as opposed to being distinctive (3). Assessing the emotional maturity of the adolescent and her ability to make autonomous decisions free from peer or family pressures is essential. The American Society of Plastic Surgeons notes that surgical procedures initiated by the adolescent are associated with more favorable outcomes than those initiated by family members (4). The obstetrician–gynecologist also should assess whether or not the adolescent has realistic goals of the outcomes and benefits of surgery preoperatively. Surgical procedures are not recommended for adolescents with behavioral or emotional disorders (3). 
 
 Individuals should be screened for body dysmorphic disorder, which according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria include a preoccupation with an imagined physical defect or exaggerated concern about a physical defect that would not be apparent to the casual observer, or a history of repetitive or obsessive behaviors (such as repeated examination or attempts to conceal the flaw, or continually seeking reassurance from others) (5). Body dysmorphic disorder often begins during adolescence and leads to requests for repeated surgical correction without relief of symptoms. If an obstetrician–gynecologist suspects an adolescent has body dysmorphic disorder, referral to a mental health professional is appropriate. 
 
 Labiaplasty 
 
 At the time of puberty, the labia minora enlarge and grow to adult size. The normal labia minora can have marked variation in size, shape, and appearance (6). Asymmetry is common and may be seen as a normal variant. Despite increased awareness and focus on the appearance of the external genitalia, no consensus on the definition of labial hypertrophy or criteria for surgical intervention has been established (7). Mechanisms proposed for labial hypertrophy include congenital malformations, trauma, infection, and manual manipulation (through stretching or pressure). Surgical correction has been suggested based on length, appearance, and functional symptoms. Increasing trends in pubic hair removal, exposure to idealized images of genital anatomy, and increasing awareness of cosmetic vaginal surgery have been proposed as reasons for the increased interest in labial surgery (8, 9). The size of the labia minora can be functionally or psychologically distressing to adolescents. Symptoms of irritation, pain (especially with activity), and interference with menstrual hygiene or sexual relations may be reported. The adolescent patient also may express distress about the cosmetic appearance or visibility of the labia minora through formfitting clothing. Parents, unaware of the normal variation of labia minora anatomy, also may have concerns about their children’s anatomical differences based on their own body appearance. Although there may be a perception that labiaplasty is a minor procedure, serious complications can occur (eg, pain, painful scarring, dyspareunia, hematoma, edema, and infection). 
 
 When adolescents seek medical treatment, the first step is often education and reassurance regarding normal variation in anatomy, growth, and development. Nonsurgical comfort and cosmetic measures may be offered, including supportive garments, personal hygiene measures (such as use of emollients), arrangement of the labia minora during exercise, and use of formfitting clothing. Surgical correction (labiaplasty) in girls younger than 18 years should be considered only in those with significant congenital malformation, or persistent symptoms that the physician believes are caused directly by labial anatomy, or both. Physicians should be aware that surgical alteration of the labia that is not necessary to the health of the adolescent, who is younger than 18 years, is a violation of federal criminal law (10). At least half of the states also have laws criminalizing labiaplasty under certain circumstances, and some of these laws apply to minors and adults. Obstetrician–gynecologists should be aware of federal and state laws that affect this and similar procedures. 
 
 Breast Reduction Surgery 
 
 Breast reduction surgery in adolescents with large breasts can relieve back, shoulder, and neck pain. Surgical correction in adolescents has been associated with improvement of self-esteem, with a greater than 75% satisfaction rate in adolescents undergoing reduction mammoplasty (11, 12). In 2010, more than 4,600 breast reduction surgeries were performed on females aged 13–19 years (4). Recommendations for timing of surgery include postponing surgery until breast maturity is reached, waiting until there is stability in cup size over 6 months, and waiting until the age of 18 years. Although there is no one consensus on timing, it may reasonably be determined by the severity of symptoms. An assessment of the adolescent’s emotional, physiologic, and physical maturity is recommended. The surgeon should be confident that the adolescent’s goals are realistic and that she and her family have a clear sense of risks, benefits, and limitations of breast reduction (4). Nonsurgical alternatives may include proper garment fitting and support and, in some cases, weight reduction. Breast reduction surgery in adolescence typically does not affect the ability to breastfeed later in life (13). 
 
 Breast Augmentation 
 
 More than 8,200 breast augmentations were performed on 18–19-year-old women in 2013 (4). Breast augmentation in adolescents may be performed for reconstruction of congenital conditions with deformity or severe asymmetry or as an elective procedure to augment small breast size or mild asymmetry (3). The American Society of Plastic Surgeons has the following three recommendations for females considering breast augmentation: 1) they should be at least 18 years of age before undergoing the surgery; 2) they have the necessary physical and emotional maturity to ensure the most positive outcome; and 3) they have a realistic understanding of the potential results, as well as the possible need for additional surgery. Saline-filled implants are the only type of implant approved by the U.S. Food and Drug Administration for females younger than 22 years. Saline-filled implants typically have a 10-year lifespan. Before surgery, the adolescent may be referred to specialty shops for assistance with pads or prostheses to wear with her clothing. 
 
 Conclusion 
 
 The obstetrician–gynecologist may receive requests from adolescents and their families for advice, surgery, or referral for conditions of the breast or vulva to improve appearance and function. It is important that the obstetrician–gynecologist be equipped to discuss normal sexual development, the wide variability in appearance of the breast and genitalia, nonsurgical treatment options, and autonomous decision making. Appropriate patient counseling and assessment of the adolescent’s physical maturity and emotional readiness are necessary before surgical management or referral. As with other surgical procedures, credentialing for cosmetic procedures should be based on education, training, experience, and demonstrated competence (14). ||||| "Mom! Nikki has a penis!" My little sister shrieked through giggles as she pointed between my legs. We were taking what I'd decided would be our last bath together. I closed my knees and slapped her. 
 
 I was 11, and this was the first time I remember feeling insecure about my vulva, which from this point forward I will incorrectly refer to as my vagina to keep from sounding like a textbook. Before that, it was a thing I peed from that stung when I got soap in it. Now it was a burden. 
 
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 I looked into the bathwater. It wasn't a penis, but I could see what she was talking about — that wrinkly bump thing that resembled a flesh-colored Slimer from Ghostbusters. The technical term is clitoral hood, which sounds like what my clitoris would wear if it were robbing a liquor store. 
 
 My mom arrived on the scene. "Oh, Lauren, be quiet!" was all she said, which to me, sounded like, "Oh, Lauren, we all know about Nikki's secret penis!" 
 
 The sting of shame that followed that bath was soon replaced by the collage of insecurities I pasted on top of it. By the time I was in high school, there were too many other things to hate about my body (frizzy hair that refused to straighten like Jennifer Aniston's, inexplicably muscular calves) for me to focus solely on this thing between my legs. I looked at it like my armpit: I wasn't eager to show it off or have someone touch it, and it often felt damp for no reason. 
 
 In college, with the haphazard consumption of well vodka, I started creeping around the bases, and it seemed inevitable that a boy might finally come into contact with the thing that I couldn't even remember if I should hate or not. Because as my motto at the time went: "If you can't compare yourself to others, then how do you know if you're allowed to like yourself?" I once caught a glimpse of my mom's vagina, but it looked like the Wolf Boy I had seen on Ripley's Believe It or Not! I needed to see ones like my own, where the foliage was sparse enough that you could make out what was happening on the forest floor. 
 
 It was around this time that I started doing stand-up, listening to comedians' albums nonstop, trying to learn everything I could about comedy. Soon, I would also learn something about myself: My vagina was gross and undesirable. 
 
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 I remember the exact moment it happened. I was listening to the newest Dane Cook album. He declared that one of his turn-offs was girls "with a lot of lips." My ears perked up. Why are people laughing? "I don't like when it looks like a box of cow tongues." More laughter. I couldn't help but feel victimized by this joke, even there in the privacy of my own bedroom. 
 
 I pulled down my shorts and stared it down. Yep, I saw some tongues. Not cow tongues, but puppy-dog tongues. The bit kept going. He related going down on a girl to getting lost in "a high school play curtain." The crowd exploded. Shame fell over me. 
 
 I spent the next hour feverishly Googling vagina lips. Some were shorter, some were longer than mine, some were two different lengths. And sure, some did look like mine, but those vaginas were always the "before" photo. And to the right was the "after" vagina, which looked tidy and bare. That was the one I wanted. What I needed was a labiaplasty. The surgery of my destiny, I thought. Just a quick snip-snip and my vagina would be acceptable to society. (Or at least to Dane Cook!) 
 
 I decided right then that as soon as I could afford it, I'd have it done. And so with my newfound confidence in the future vagina I would one day curate, I felt more comfortable talking about the one I currently loathed. 
 
 One tipsy night in college, I told my two closest girlfriends, let's call them Cara and Kaitlin, that someday I planned to have surgery. They were confused. Like the old me, they didn't know that having longer labia meant that you were an unlovable aberration. Oh, how I would enlighten them! They would soon understand my plight. 
 
 We headed to the bathroom. I whipped down my pants first. "See!" I pointed. "Look how gross they are!" I pulled them as long as they would stretch. Cara screamed. "That's what mine look like normal!" She quickly dropped trou. She was right — they were longer. She started panicking. 
 
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 To make matters worse, Kaitlin pointed at herself and asked, "Guys, is mine weird?" It wasn't. It was perfect. It looked like a paper cut. "Fuck you, Kaitlin!" we yelled together. Cara was shaken. I realized that in an attempt to make myself feel better about my vagina, I had ruined hers. 
 
 Before I could pull up my pants, Cara was calling her ex-boyfriend. 
 
 "Steve? It's Cara. I have a question. Do I have long labia?" 
 
 We waited. 
 
 She repeated the question. By this time, we had gathered around her cell phone to hear the verdict. 
 
 "I mean, I guess," he stammered. 
 
 Cara prodded. "The longest you've been with?" 
 
 "Yeah." 
 
 More silence. 
 
 "Is that a bad thing?" 
 
 "I mean … it is what it is." 
 
 And with that response, she hung up. We laughed until we cried … or maybe we cried until we laughed. It was a defining moment for all of us. 
 
 In the years that followed, I avoided letting anyone touch me down there. The night I was finally first fingered, I held my breath waiting for his reaction. But there wasn't one. He didn't seem deterred. Neither did the next guy. 
 
 Sure, I still hear men talk disparagingly about vaginas. A guy I dated described his ex's vagina as "stroke pussy" (I know how to pick 'em!) because one lip was longer than the other. I'm sure his current girlfriend knows me as "Rolodex pussy," but I don't care. He was lucky I ever let him search through it. 
 
 I still do not love my vagina. "Love" is a strong word. I like it. I will give it a friendly nod when I see it in the shower. I no longer want to chop it off, and for that, I am proud. 
 
 A couple of months ago, I mentioned to my boyfriend of three years that at one point in my life, I had considered cutting off my labia. He was mystified. "Why would you want to do something like that?" 
 
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 "Because I thought they were long and gross." 
 
 "That's insane. You have the best vagina going. You know that, right?" 
 
 "It is what it is." 
 
 This article was originally published as "Love Letter to My Labia" in the February issue of Cosmopolitan. ||||| More than a third of Brits worry their genitals aren't "normal", a new report has revealed. 
 
 The study found that concerns over what genitals look and smell like, as well as worrying about unusual lumps and discharge, is having a serious affect on our sex lives. 
 
 It also flagged an alarming disparity between the number of women who are concerned over the appearance of their vaginas, in comparison to men and their penis worries. 
 
 The survey questioned 2,313 Britons (aged 18-30) on their genital worries. 
 
 More than a third of respondents believed their private parts weren't normal - 73% of which were female and 27% male. 
 
 Their main concerns were: 
 
 1. "My genitals look different to those I see online and in the media" (43%) 
 
 2. "I always feel as if my smell isn’t normal" / "I don’t know what it’s meant to smell like" (18%) 
 
 3. "There are lumps on my genitals and I’m not sure if they’re meant to be there" (13%) 
 
 4. "It just doesn’t look attractive to me" (11%) 
 
 5. "I’m unsure whether the discharge I have is considered normal or not" (3%) 
 
 Respondents were then asked if their concerns ever affected their sex lives - 26% of which said yes. 
 
 More than three quarters of those who said they worried about their genitals being "normal" said their worries distracted them so much during sex that they were unable to achieve orgasm. 
 
 Michael Ross, spokesperson for MedExpress who conducted the survey, commented: "These results really shocked us as one would like to assume that genital worries and confidence issues end after the period of adolescence. 
 
 "It really scares me that adults still compare themselves to the actors that they see in porn films as these are definitely not ‘ideal’ and they shouldn’t be taken seriously. 
 
 "It just shows that we still need to learn that genitals come in all forms of different shapes and sizes." 
 
 He continued: "Having said that, a number of the results in our study were slightly worrying and probably need to be addressed. If you feel like you might smell or you have a lump or mark ‘down below’, please do book an appointment with your GP or take a trip to your local GUM clinic. 
 
 "Even if it does turn out to be nothing, which it probably is, it will reassure you that you are completely normal and healthy and that you shouldn’t let your worries ruin your sex life." 
 
 Natika H Halil, chief executive at sexual health charity FPA is not surprised by the survey results as "as a society we’re still not great at talking openly about our own bodies and things which might affect our sexual confidence and pleasure". 
 
 
 
 "Sexual health professionals have reported more men and women seem to be dissatisfied with their bodies, which in some cases could be linked to comparing themselves to what are portrayed as pornographic ideals, particularly around genital size and a desire to have little or no pubic hair to ‘not be dirty’," she tells HuffPost UK Lifestyle. 
 
 
 
 "A huge increase in labiaplasty (surgery to reduce the size of the labia, the folds of skin around the vulva) has also, in some cases, been linked to pornography and women thinking they should have genitalia which looks the same as the actors. 
 
 
 
 "Lots of women are concerned about vaginal discharge, and in many cases don’t know what’s normal and not, what it should look and smell like." 
 
 She goes on to explain that vaginal discharge is "perfectly normal" and women may notice that it changes in colour and consistency during their menstrual cycle. 
 
 "Some women might be tempted to use perfumed washes and wipes to clean their genital area, in an attempt to mask smells and get rid of discharge. This is unnecessary and could actually be harmful as some products can disrupt the natural balance of bacteria in the vagina," she says. 
 
 "It’s a good idea to use plain, unperfumed soap and water to clean the vulva regularly. Douching, or flushing water into the vagina, can also upset the balance of the normal bacteria, and is unnecessary. 
 
 
 
 "If women are concerned about a smell or notice a change from their normal discharge, it’s important not to try and mask this. Equally if you notice any unusual lumps or bumps on your genitals, it’s important to see a health professional, as it could be a sign of an infection or other problem." 
 
 Halil believes it's really important for men and women to familiarise themselves with their bodies sot that they are aware of any changes. 
 
 "It’s also important to remember that everyone is different and people’s genitals vary in appearance – in their shape, size, and colour," she adds. 
 
 "It would be great if all young people growing up learnt about this natural variety and weren’t left with worries about how they compare to people they see in the media or pornography." 
 
 Most Common STIs And Symptoms
– Adult women can choose to have their labia reshaped as part of a "vaginal rejuvenation" surgery, in which the muscles of the vagina are tightened. Now teenage girls apparently want in on the action, too. Doctors say they're increasingly getting requests from young girls to have their labia trimmed—sometimes to relieve discomfort or a risk of infection, but more often because they're unhappy with the way it looks, reports the New York Times. Some 400 girls 18 or under had labiaplasty last year; that's an 80% increase over 2014, according to the American Society for Aesthetic Plastic Surgery (that count doesn't include operations performed by gynecologists). Why the jump? Experts cite the preponderance of young girls who shave or wax their pubic hair, thereby making the flesh there more visible. What they see might not jibe with their often-skewed expectations regarding size, shape, and color. And when it comes to those characteristics, there's a huge range of what's "normal," reports Health. It cites a study that found length can range from three-quarters of an inch to nearly 4 inches, and width from a quarter of an inch to 2 inches. Teens might also feel self-conscious in tight clothing, per HealthDay. "This age group may be under particular stress regarding these issues because of societal conceptions of the ideal female body," the American College of Obstetricians and Gynecologists explains in new guidelines for adolescent labiaplasty. A recent study showed many British women were worried their genitals weren't normal, per the Huffington Post, and even comedian Nikki Glaser debated labiaplasty as a youth. (Temporary "vacation breasts" may soon be available.)