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.”