“I’m scared to be sexual with a boy because I think my vagina is ugly.”

“Having long labia has been affecting my self-confidence for as long as I can remember and I knew that the only way I’d ever be happy would be by having the operation.”

These stories of anxiety and body-consciousness are from the Experience Project online forum, in a thread discussing labiaplasty, a surgical procedure that involves the altering of the shape and size of the labia, the lips of the vagina.

On the Large Labia Project website, where women are encouraged to post pictures of their genitals to combat issues of body anxiety, similar concerns are present. Under a picture of her labia, one woman writes, “I know they’re normal, but I feel as though they are ugly and unattractive”.

Emma P, a 24-year-old from Sydney, started the blog as a way to help women who experience anxiety about the size of their labia. She first got the idea after watching an ABC documentary on Australian classification laws distorting women’s perceptions of their genitals. The investigation found that Australia’s censorship laws consider protruding labia as too explicit to be published in soft porn magazines and they are often photoshopped out. “The problem though is that these images of women aren’t portraying the reality that [women] actually do have vaginal lips,” Emma says.

On her blog, Emma says that she loves her labia, but was shocked to find that her body would be considered too explicit to be photographed.

“They aren’t the largest around, but my own labia minora are on the larger size. They protrude from between my outer lips, they are darker coloured tending to brown,” she says.

“They are also asymmetrical in shape and length with one side longer than the other. [It’s] perfectly normal, but had I been one of the models in those magazines my bits would have been digitally cut off, and that appalled me.”

While Emma notes the positive response to the website by women who have had what she calls ‘aha!’ moments in realising they are not abnormal, she has also heard particularly distressing stories.

“I am surprised and often shocked daily by the stories I hear, and it can’t help but have an effect on you. Hearing tragic stories of 14-year-old girls trying to cut off their labia with scissors.”

While still relatively rare, concerns about labia size and shape are translating into rising statistics of labiaplasty. According to Medicare statistics, labiaplasty and vulvoplasty procedures have risen in demand by over 50% from 640 a year in 2000-01 to 1,565 in 2010-11. The procedure is mostly undertaken by women aged between 15 to 24. In a report by Women’s Health Victoria, a not-for-profit health organisation, only 32% of 131 labiaplasty patients surveyed said they were having the surgery for functional reasons only. This leaves other 68% of patients that list aesthetic reasons as one of the reasons, or the sole reason, for having surgery.

Professor Ajay Rane, Vice President of the Royal Australian and New Zealand College of Obstetricians and Gynecologists, agrees. He told Australian Doctor in September last year that 70% of labiaplasties carried out in Australia were done so unnecessarily.

Co-editor of Big Porn Inc and media commentator Melinda Tankard Reist told Farrago that female anxiety over labia size and shape is due to the “pedophilic forms of sexuality” in video pornography. “A significant reason for this is the influence of pornography in parallel with Brazillian waxing,” she said. “Women and girls have been made to feel ashamed of their natural pubic hair. Now that the labia have become more visible, women think there is something wrong with them, because they don’t look like women in porn.”

Camille Nurka, lecturer in Gender Studies at the University of Melbourne says that a range of factors such as the unrealistic beauty ideals are contributing to the trend of body image concerns and surgery. However, to blame pornography as the only reason, she argues, is overly simplistic. “These bodies that we see in ads or on TV or in cinema, for example, don’t menstruate, sweat or excrete, have no or very little pubic hair, and they certainly don’t have camel-toe,” she says.

Despite concerns that the rise in genital surgery stems from an array of influences, many in the cosmetic surgery industry believe the choice belongs to individuals to enhance their body satisfaction. Dr Georgia Konrat from Brisbane Cosmetics specialises in labiasplasties and says that the growth in the surgery is due to greater awareness of a solution. While admitting that some women seek the surgery for aesthetic reasons, she does not believe that they have been affected by pornography or beauty ideals. “I don’t recall a patient ever coming to me with a concept of how a vagina or vulva should look like… Most will be content if they are happy with their own appearance.”

Meanwhile, the launch of numerous online projects suggests that some people are aiming to counter the rise of body image anxiety and genital surgery. Earlier this year Women’s Health Victoria launched an online ‘Labia Library’. The website provides information and a visual library of a range of vulvas to show the variety of female genitals. Speaking to Farrago, their executive director, Rita Butera said that she hopes the resource will give women a greater idea of the diversity of what female genitals look like by providing them with access to real images.

Emma P agrees, noting that more access and an increased awareness of what normal genitals look like will assist with decreasing body image anxiety. “The more we can do to reinforce the message that female bodies are different, unique, and normal, the greater the chance that the message will sink in and change attitudes.”