Table 6

General practitioners who have seen women requesting female genital cosmetic surgery suspect the following modifiable social factors influencing women's decisions (n=242)

Quantitative component: what social influences impact patients who ask about FGCS?General practitioners
n=242 (%, 95% CI)
Qualitative component: examples of ‘free text’ responses which reveal subthemes also listed in table 7
Fashion (comfort in clothes)242 (100%, 98% to 100%)“some women do have extremely large labia minora that protrude and are visible in swimwear, are uncomfortable” (female, aged 47, 20 years in outer metropolitan practice, women's health interest, trained in Australia)
Perception of beauty242 (100%, 98% to 100%)“Reflects a social shift to the importance of appearance over values and substance and perhaps another way we devalue and objectify women” (male, aged 55, 20 years rural practice, Obstetric interest, trained in Australia)
Pornography242 (100%, 98% to 100%)“Most patients I see requesting genital cosmetic surgery are extremely poorly informed about normal anatomy, based on porn” (female, aged 45, 8 years urban practice, sexual health interest, trained in Australia)
Perception of normal206 (85%, 80% to 89%)“The trend for ‘full Brazilian’ hair removal has ‘uncovered’ vulvas and made them more ‘visible’ to women and their partners. Many people think that a ‘normal’ vulva is supposed to look somewhat pre-pubertal” (female, aged 60, 35 years urban practice, women's health, trained in Australia)
Spouse/partner comments132 (55%, 48% to 61%)“It is a dangerous fashion—relates a lot to partner pressure and young males watching easily available internet pornography in my opinion” (female, aged 64, 35 years in outer metropolitan practice, women's health, trained in UK)
Had been coerced to have FGCS by her ex-husband who humiliated her and made her feel she was abnormal and unlovable” (female, aged 56, 30 years urban practice, women's health, trained in UK)
Physical discomfort102 (42%, 36% to 48%)“Excessive labia minora may be very uncomfortable with excessive discharge and irritation” (female aged 57, 25 years in urban practice, women's health, trained in Australia)
The majority of requests have been due to media presenting skewed version of normality, influencing both partners. Only one patient request due to physical discomfort” (female, aged 57, 20 years in urban practice, women's health interest, trained in Australia)
Consumer websites69 (29%, 23% to 25%)“In the vast majority of patients I think they have been swayed by the media/ online information re what is normal. I really don't think females used to be overly concerned until recently” (male, aged 57, 21 years in urban practice, obstetric interest, trained in Australia)
I think the overwhelming access to internet visual images is a major factor in women's perception of ‘normal’ even if they do not disclose this to us” (female, aged 54, 30 years in urban practice, women's health, trained in Australia)
Fashion (appearance in clothes)54 (22%, 18% to 28%)“Fashions change—even sexual and genital cosmetic fashions. Loss of genital tissue to comply with fashion,…” (male, aged 51, 23 years in outer metropolitan urban practice, women's health interest, trained in Australia)
Peer comments41 (17%, 13% to 22%)“Peer group pressure, in younger age groups, seems to be one of the most important factors promoting the decision to seek FGCS” (male, aged 60, 31 years in urban practice, women's health interest, trained in UK)