So, in case you haven’t had the pleasure, allow me to introduce you to the labia.

It’s the little-known anatomical term for the inner and outer folds of the vaginal opening, sometimes called lips or flaps.

Despite aeons of fascination with the female form, the pink bits in particular, very few of us know what a labia is and how it “should” look. Those of us who own one rarely get to see it, though rising rates of genital cosmetic surgery – in particular, a procedure known as labiaplasty – indicate many women are unhappy with what’s down there.

So where did this outbreak of apparent labia anxiety come from? And what might be done to respond to it? These are questions Emma Barnard – who is completing a PhD at the University of Melbourne on the labiaplasty phenomenon – is anxious to resolve.

The number of labiaplasty procedures performed in Australia under Medicare has increased more than three-fold over the past decade.

Barnard is researching genital plastic surgery among young Australian women. She is looking into why young women are interested in getting surgery which alters the appearance of what are otherwise healthy external genitalia.

“When people talk about female genital cosmetic surgery they’re mostly talking about a labiaplasty, which is a surgery designed to reduce the size of the labia minora,” Barnard explains.

“Usually the surgery is performed because [a woman’s labia] can be quite large, visible or asymmetrical, and sometimes people don’t like the way it looks.”

The rate of labiaplasties performed on women in Australia is on the rise, although the numbers overall are hard to track.

Between 2003 and 2013, 12,190 women in Australia accessed Medicare benefits for vulvoplasty and labiaplasty. The number of labiaplasty procedures performed in Australia under Medicare has increased more than three-fold over the past decade, from 444 in 2000 to 1,605 in 2013.

However, these figures likely tell only a fraction of the real story,  as they account only for surgeries performed within the public health system.

“We don’t have robust data because most genital cosmetic surgeries happen in the private system,” says Barnard. “But we do know there is an upward trend towards genital cosmetic surgery in Australia and internationally.

“We also know there is a younger cohort of people interested in and accessing this surgery.”

Barnard’s research is supervised by pediatric and adolescent gynecologist, Professor Sonia Grover, who has noticed an upward trend of young women requesting labiaplasty over the last 10 years.

“[Professor Grover] noticed she was seeing requests from younger and younger people for cosmetic genital procedures,” says Barnard. “Although she does not perform cosmetic procedures herself, she was interested in the fact that 10 years ago this was not a regular feature of her clinical practice.” Indeed, a recent survey of Australian General Practictioners revealed one in three GPs have received requests for labiaplasty from girls aged under 18 years.

Why don’t some young women like their lady bits?

This is a complex question, Barnard says, and one for which we likely won’t ever have a neat, definitive explanation. However, it appears a large part of this story is the fact female genitalia doesn’t make it into conversation very often – outside of Barnard’s office, that is. (Or her website, which you can access by clicking the illustration above.)

A common thread appearing from her research so far has been that many young girls are unsure if their genitals are “normal”.

“I think it would be difficult if a young woman set out to understand what a normal labia might be and then make that connection as to whether or not they are normal,” she says.

“The women I’ve spoken with in my research, often describe a moment where they saw an image of genitals or a TV show where labiaplasty was being discussed and thought —  ‘oh, I don’t look like that” or ‘I’ve been worried about this and this show has confirmed for me that I’m not normal’.”

Barnard was anticipating that images of genitals in porn might well come up as an influence, but so far it hasn’t really factored in the research. The women she  has interviewed talked more about medical diagrams brought up in settings such as school-based sex education.

“More often than not, those images are medical diagrams that depict very stylised images of vaginas. They are usually line drawings which don’t show the huge range of genital diverseness.”

What is “normal”?

That’s hard to say. The natural variation of female genital appearance is vast. The Labia Library is a unique online resource with photographs of female genitalia that show this variety. It was established to address the growing interest in genital cosmetic surgery.

“After seeing media reports about women seeking female genital cosmetic surgery, we became worried that this type of surgery was increasing because many people have no idea what healthy female genitals actually look like,” the Labia Library website states.

Barnard points out that what constitutes “normal” genitalia is not well defined even within the medical community.

“The opinion of a gynaecologist about what is ostensibly normal could vary very much so from a cosmetic physician because there is no clinically accepted normal range for a labia,” she says.

“My sense is that parents might not know what is “normal” too.” There are indeed functional reasons why people may get female genital surgery. Barnard explains large labia can interfere with daily functional processes or cause discomfort in some sports, such as horse riding and gymnastics. That said, she offers an interesting counterpoint. “If you think about boys, their external genitals are far more prominent and in-the-way. It’s worth thinking about that boys don’t get surgery on their genitals for the same sorts of reasons.”

Emma Barnard is undertaking further research to understand more about how young women with genital appearance concerns approach cosmetic genital surgery. She also runs LabiaTalk, a blog which explores issues about female genital cosmetic surgery.

Regardless of whether you proceeded with surgery or not, she would love to hear from you if you are a Victorian woman, aged between 18 and 29, and have ever consulted a health professional about any concerns about your labial or genital appearance.