No (Wo)Man Is an Island—The Influence of Physicians' Personal Predisposition to Labia Minora Appearance on Their Clinical Decision Making: A Cross-Sectional Survey

Abstract

Introduction Physicians are increasingly presented with women requesting a labia minora reduction procedure. Aim To assess the influencing factor of personal predisposition in general practitioners, gynecologists, and plastic surgeons to labia minora appearance in relation to their willingness to refer for, or perform, a surgical labia minora reduction. Methods Cross-sectional self-administered questionnaire survey. Between May 2009 and August 2009, 210 physicians were surveyed. Primary care: general practitioners working in the north of the Netherlands. Secondary care: gynecologists and plastic surgeons working in five hospitals in the north of the Netherlands. Main Outcome Measures A five-point Likert scale appraisal of four pictures showing a vulva, each displaying different sizes of labia minora, indicating a physician's personal predisposition, manifesting as willingness to refer for, or perform, a labia minora reduction. Results A total of 164/210 (78.1%) physicians completed the questionnaire, consisting of 80 general practitioners, 41 gynecologists, and 43 plastic surgeons (96 males, 68 females). Ninety percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents society's ideal (2–5 on the Likert scale). More plastic surgeons regarded the picture with the largest labia minora as distasteful and unnatural, compared with general practitioners and gynecologists (P < 0.01), and regarded such a woman as a candidate for a labia minora reduction procedure (P < 0.001). Irrespective of the woman's labia minora size and the absence of physical complaints, plastic surgeons were significantly more open to performing a labia minora reduction procedure than gynecologists (P < 0.001). Male physicians were more inclined to opt for a surgical reduction procedure than their female colleagues (P < 0.01). Conclusions The personal predisposition of physicians (taking account of their specific gender and specialty) concerning labia minora size and appearance influences their clinical decision making regarding a labia minora reduction procedure. Heightened awareness of one's personal predisposition vis-à-vis referral and willingness to operate is needed.

Survey of male perceptions regarding the vulva

“…Media images, Internet advertising, physical discomfort, impedance of sexual activity, and dissatisfaction with appearance have been cited as indications. [5][6][7][8] Recently, research has evaluated female opinions of their own vulvar appearance as well as patient and physician definitions of normal anatomy to shed light on these issues. 4,9 In both US and European population surveys, most women were satisfied with their vulvar appearance; nevertheless, approximately 7% would consider labiaplasty.…”

Advances in diagnosis and care of persons with DSD over the last decade

“…A study that has been cited in the media and was even discussed at the Australian Senate is a 2009 Dutch study that examined a physician's personal reactions to the labia minora appearance on their decision to refer or perform surgical reduction. The study found that plastic surgeons were more likely to find larger labia minora "distasteful and unnatural" compared to general practitioners and gynecologists [14]. Although the study does not directly apply to DSD, it has been used extensively to illustrate the biases that can influence clinical decision making, our difficulties to objectively define "normal" genital appearance and to argue against early genital reconstruction.…”

Fashions in Genital Fashion: Where Is the Line for Physicians? Commentary on Veale and Daniels (2011)

“…Plastic surgeons compared to general practitioners and gynecologists felt that large labia minora were distasteful and were more willing to operate given the same anatomy and patient concerns. Male practitioners were more inclined to opt for reduction than their female counterparts in the same specialties (Reitsma, Mourits, Koning, Pascal, & van der Lei, 2011). Women who are distressed with their genital appearance are likely to be unaware of the absence of standards for how labiaplasties are to done (Mirzabeigi et al, 2011).…”