What significant factors have caused the increased popularity of vaginoplasty and labiaplasty in recent years? There are no known surveys that have analyzed the reasons that more women are seeking these operations, but there is plenty of unofficial--anecdotal--evidence that helps us understand the increase. And it helps us to decide whether this higher interest is merely a temporary fad or a long-term shift in attitudes.

The stories I hear from women lead me to believe there are four primary areas that motivate more and more of them to seek a labiaplasty or vaginoplasty.

First, many women experience physical irritation, and even pain, of the labia minora. This pain and irritation is aggravated when they become physically active. As the sensitive and fragile labia minora begins protruding beyond the labia majora, they are more likely to experience contact with outer forces. These forces could be anything from wearing tight clothing to bike-riding, horse-riding, or other physical activities. There are many more examples we could cite of causes of patients' labial discomfort.

A second motivation that causes many women to seek a labiaplasty is previous embarrassing experiences in which their labia were inadvertently exposed to the view of the public when they wore some fashions or styles of clothing. For instance, there's the thong bathing suit or sheer panties that might cause this kind of embarrassment. Many women have bodies that would be quite flattering to these styles were it not for the protruding labia minora.

A third motivation for women to seek labiaplasty is the recent popularity of what is known as "Brazilian Grooming." This is the practice of removing hair from a woman's pubic region through waxing, shaving or laser removal. This has the unintended effect of making quite apparent any protrusion within the woman's labia minora.

For many of these women, it comes down to trying to look normal--although "normal" regarding labial appearance might come in many forms. Mother Nature has dictated that normal could encompass many shapes and sizes. However, women who seek labiaplasty are usually more concerned with society's definition of normal. And it's when they feel uncomfortable comparing themselves to this standard of normal that they often seek labiaplasty and vaginoplasty.

And, like it or not, society's perception of what is and isn't normal is evolving and rapidly changing. Because of this, many women have a more focused concept of what appearance they want. This is because there is more scrutiny of other women's genital appearance, thanks in part to the media. Today, we can easily and regularly view the naked human body in the movies, on the Internet, and in magazines, to say nothing of in the women's locker-room. And this shifting concept of normal has left many women feeling somewhat lacking in self-confidence. For them, labiaplasty and vaginoplasty has helped correct this situation.

None of this is to say that it's positive or negative that women's definition of normal has been altered in this way. Rather, we're merely abiding by culture as it exists. And that culture, for many reason, has made labiaplasty all the more attractive.