“My patients rarely have a solid idea about what their own vulva looks like.”

The “Barbie doll look” is when your vulva folds are narrow and invisible, giving the impression that the vaginal opening is tight.

Other words for it? “Clean slit.” “Symmetrical.” “Perfect.” It’s also a look that some researchers call “pre-pubic.”

However, more and more women are requesting this look, or impression, when it comes to female genital cosmetic surgery, or — as it’s more commonly advertised as — vaginal rejuvenation surgery.

“Once my husband and I were watching a TV show
together and a character made a joke about a woman with my type of labia. I
felt humiliated in front of my husband.”

But before we unpack these psychological motivations behind vaginal rejuvenation and where they may stem from, it’s worthwhile to first discuss terminology.

The word vagina has a history of misuse in the media. While “vagina” refers to the internal vaginal canal, people often use it interchangeably to refer to the labia, clitoris, or pubic mound. Thus, the term “vaginal rejuvenation” has come to describe more procedures than it technically represents.

When you look up vaginal rejuvenation online, you’ll find procedures that address both surgical and nonsurgical techniques on the female genitalia as a whole. This includes:

  • labiaplasty
  • vaginoplasty or “designer vaginoplasty”
  • hymenoplasty (also known as “re-virginizing”)
  • the O-shot, or G-spot amplification
  • clitoral hood reduction
  • labial brightening
  • mons pubic reduction
  • vaginal tightening or resizing

Many of these procedures, and the reasons to get them, are controversial and ethically questionable.

Researchers in the International Journal of Women’s Health found that the interventions were mainly sought and performed for aesthetic or sexual reasons and little for medical need.

More recently, the U.S. Food and Drug Administration (FDA) issued a warning to seven companies marketing vaginal rejuvenation procedures.

The advertisements sold promises to women their techniques would “tighten and refresh” their vaginas. Some were targeted toward improving postmenopausal symptoms, like vaginal dryness or pain during sex.

But there’s one problem. Given the absence of long-term studies, there’s barely any proof these therapies actually work or are safe.

An analysis of 10 women’s magazines
found that in pictures of women naked or wearing tight clothing, the pubic area
is usually obscured or represented as forming a smooth, flat curve between the

While the FDA’s involvement will help women’s health be more regulated and safe moving forward, vaginal rejuvenation is still gaining traction.

A 2017 report from the American Society of Plastic Surgeons reveals that labiaplasty procedures increased by 39 percent in 2016, with over 12,000 surgeries. Labiaplasties usually involve trimming the labia minora (inner labia) so they don’t hang below the labia majora (outer labia).

However, the American College of Obstetricians and Gynecologists (ACOG) warns against these procedures, calling the marketing process — specifically those that imply these surgeries are accepted and routine — deceptive.

When it comes to sexual dysfunctions, ACOG recommends women should go through a careful evaluation and be thoroughly informed of possible complications as well as the lack of evidence supporting these procedures for treatment.

According to a 2014 study in the journal Sexual Medicine, researchers found that most individuals seek vaginal rejuvenation for emotional reasons, primarily rooted in self-consciousness.

Here are a few excerpts from women in the study:

  • “I hate mine, hate, hate, HATE it! It’s like a
    tongue sticking out for heaven’s sake!”
  • “What if they told everyone in school, ‘Yeah,
    she’s pretty but there’s something wrong down there.’”

Dr. Karen Horton, a San Francisco-based plastic surgeon who specializes in labiaplasties, agrees that the procedure can be driven by aesthetics.

“Women wish their labia minora were tucked up, neat, and tidy, and don’t want to see the labia minora hanging down,” she says.

One patient told her she “just wished it looked prettier down there.”

Where does the basis of ‘prettier’ come from?

Due to the lack of education and open dialogue around what’s normal when it comes to the appearance and function of female genitalia, the quest for a perfect vagina is possibly never-ending.

Some women may feel inclined to sign up for procedures like labiaplasty and the O-shot to fix issues they “hate” or consider abnormal. And where they get the idea to hate their bodies likely comes from media sources, like women’s magazines that portray airbrushed, unrealistic genitals.

These images may be instilling insecurity or expectations of what’s “normal” in viewers, and therefore contributing to the uptick in vaginal rejuvenation procedures.

An analysis of 10 women’s magazines found that in pictures of women naked or wearing tight clothing, the pubic area is usually obscured or represented as forming a smooth, flat curve between the thighs.

Forget about displaying a protruding inner labia. There’s not even an outline of the labia majora.

Making the labia look small or nonexistent — a completely unrealistic representation — can falsely inform and influence how women think their labia should appear.

“My patients have no idea what ‘normal’ vulvas are
supposed to look like and rarely have a solid idea about what their own looks
like.” — Annemarie Everett

Some people, like Meredith Tomlinson, believe that pornography is what’s driving the quest for the perfect vulva and vagina.

“Where else are we seeing a close-up of another woman’s private parts?” she asks.

And she may be right. Pornhub, a popular pornography website, hosted more than 28.5 billion visitors in the past year. In their annual report, they revealed the most popular search phrase of 2017 was “porn for women.” There was a 359 percent growth among female users.

Experts from King’s College London suggest the “pornification” of modern culture may be driving up vaginal rejuvenation rates, since men and women have more exposure to porn via the internet than ever.

“Honestly, I think the idea of the ‘perfect vagina and vulva’ stems from a lack of accurate information about what vulvas look like,” says Annemarie Everett, a board-certified women’s health specialist and certified pelvic and obstetrics physical therapist.

“If the only thing we have to reference is porn and the general idea that vulvas are supposed to be small and dainty, then anything outside of that seems less acceptable, and we don’t have a way to challenge that assumption,” she says.

However, there’s also evidence suggesting porn may not be to blame.

A 2015 study aimed at understanding women’s genital satisfaction, openness to labiaplasty, and the drivers of their happiness and interest in vaginal rejuvenation looked into this. They discovered that while watching pornography was associated with an openness to labiaplasty, it wasn’t a predictor of genital satisfaction.

These findings cast doubt on the assumption that pornography is the primary driver of vaginal rejuvenation, and that “there are additional predictors that must be included in future models.”

More women than men listed their dislikes than likes
about their vulva and vagina.

In other words, while porn isn’t solely to blame, it may be one of many contributing factors. Another factor may be that women only have perceived notions of what men want and of what’s considered normal when it comes to the vagina and vulva.

“My patients have no idea what ‘normal’ vulvas are supposed to look like and rarely have a solid idea about what their own looks like,” Everett says. “Culturally, we spend a lot of time trying to hide our anatomies and very little time orienting young people to what the range of normal is.”

Little girls who grow up seeing Barbie’s perfectly etched, plastic “V” as the sole representation of an “average” vulva is hardly helping things, either.

A 2015 study asked 186 men and 480 women about their likes and dislikes regarding the vulva and vagina to better understand attitudes toward female genitalia as a result of cultural and social messages.

Participants were asked, “What things do you dislike about women’s genitals? Are there certain qualities that you like less than others?” Of the men who responded, the fourth most common response was “nothing.”

The most common dislike was smell, followed by pubic hair.

One man said, “How can you dislike them? No matter what the individual topology of each female is, there is always beauty and uniqueness.”

Men also frequently described liking diverse genitals. “I love the variety of shapes and sizes of the labia and clitoris,” one responded.

Another reported, in very specific detail, “I like long, smooth, symmetrical lips — something voluptuous, that captures the gaze and imagination. I like large clits, but I don’t get as excited over them as I do over lips and hoods. I like a vulva to be big, lips unfurled, and deep in its cleft.”

In fact, more women than men listed their dislikes than likes about their vulva and vagina, leading the authors to conclude: “Given the high volume of dislikes mentioned by women, one possible explanation for these findings is women are more readily internalizing negative messages about their genitals and fixating on criticisms.”

Six weeks and $8,500 dollars of out-of-pocket expenses
later, Meredith has a healed vulva — and a healed sense of self.

And the negative messages, when they come, can be cruel and mean, especially when you consider that there’s no perfect V.

Men who described their dislikes resorted to cruel words, such as “big,” “flappy,” “flabby,” “protruding,” or “too long.” One woman reported that a male sexual partner was horrified by her larger inner lips and used the phrase “meat curtain” to describe them. Another man said, “I think hairy genitals on a woman is gross, it makes her look neglectful of her private area.”

If magazines portrayed real women’s vulvas in all of their large, small, hairy, or hairless glory, perhaps these stinging, hurtful descriptions would make less of an impact.

If there was greater education around how a woman’s vulva and vagina may look over their lifetime, perhaps a path toward more body acceptance and positivity might be encouraged.

But what happens in the meantime for the generations who have gone without vaginal education or see a need for vaginal rejuvenation?

Meredith, mentioned earlier, had always been self-conscious of her labia since she was a little girl. Specifically, this was because her inner labia hung much lower than her outer labia, a number of centimeters below her labia majora.

“I always suspected I was different, but I noticed when I was naked around other girls that I was actually different,” she says.

As a result, Meredith avoided swimsuits at all costs. She didn’t want to risk her inner labia slipping out for the world to see. She felt she couldn’t wear those tight, fashionable yoga pants either, since they hinted at the shape and anatomy of her vulva.

When she wore jeans, she had to use a maxi pad, just in case her labia began to chafe and bleed. “Once, after a day of biking,” she recalls, “I discovered my labia were bleeding. It was so painful.”

This also affected her previous relationships, as Meredith would get nervous about being seen naked and touched down there. What if they stared, cracked a joke about ‘roast beef vaginas,’ or thought it was a turn off?

And even after getting married, Meredith still experienced insecurity.

“Once my husband and I were watching a TV show together and a character made a joke about a woman with my type of labia,” she recalls. “I felt humiliated in front of my husband.”

After reading an online article about plastic surgery, Meredith stumbled across the term “labiaplasty” — a type of plastic surgery procedure that trims a woman’s inner labia.

“This was the first time I discovered there was a way to change what I was struggling with and that many were in the same situation as me,” she remembers. “It’s easy to feel isolated with these issues. This was liberating.”

Soon after her internet discovery, Meredith went in for a consultation with Dr. Karen Horton. “I didn’t have a picture, but Dr. Horton made suggestions for where to trim my inner labia,” she says.

And Meredith’s husband never suggested or pressured her to pursue a labiaplasty. “He was surprised but supportive,” she remembers. “He told me that he did not care and that I did not have to do it, but that he would support me no matter what.”

A few weeks later, Meredith received a labiaplasty, a one-day procedure she describes as “simple, fast, and straightforward,” though general anesthesia is required. Dr. Horton recommended taking a week off work, avoiding exercise for three weeks, and abstaining from sex for six weeks.

But Meredith felt strong enough to go back to work the very next day.

Six weeks and $8,500 dollars of out-of-pocket expenses later, Meredith has a healed vulva — and a healed sense of self.

“I have no regrets, and it was totally worth it,” she says. “I’m not hiding anymore. I feel normal.” And yes — she now wears bikini bottoms, jeans without a maxi pad, and regularly hops on her bike for long rides.

Since the surgery, Meredith and her husband have barely discussed the procedure. “I did it completely for myself. It was a personal decision.”

English Taylor is a San Francisco-based women’s health and wellness writer and birth doula. Her work has been featured in The Atlantic, Refinery29, NYLON, LOLA, and THINX. Follow English and her work on Medium or on Instagram.