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RCOG/BritSPAG: New booklet empowers young people to understand normal vulva appearance

News 12 March 2018

A new resource aimed at educating young people on normal female anatomy – specifically vulva appearance – will be launched at the Annual Update in Paediatric and Adolescent Gynaecology, a joint event by the Royal College of Obstetricians and Gynaecologists and the British Society for Paediatric and Adolescent Gynaecology today.

The resource consists of a booklet titled 'So what is a vulva anyway?' and has been developed in response to an increasing number of girls and women with cosmetic genital concerns requesting surgery despite having normal anatomy. 

According to NHS figures, in 2015-16 more than 200 girls under 18 had labiaplasty and more than 150 of the girls were under 15. These numbers do not include girls and young women having the procedure privately. Experts say these operations do not have a medical justification.

The British Association of Paediatric and Adolescent Gynaecology (BritsPAG), a specialist society of the Royal College of Obstetricians and Gynaecologists, commissioned the resource that aims to empower young people to understand normal female anatomy through education. 

Female genital cosmetic surgery refers to cosmetic surgical procedures which change the structure and appearance of the healthy external genitalia of women. It includes the most common procedure, labiaplasty which involves the lips of the vagina being shortened or reshaped.

The booklet uses illustrations to describe variation in appearance in order to normalise vulva appearance and details the changes which happen at puberty and beyond. It is based on recommendations made by BritsPAG and the RCOG on ethical concerns for women requesting cosmetic genital surgery. 

The team that developed the booklet conducted discussion groups with young women in order to gauge their current level of understanding and whether they feel as though this resource would be useful. The consensus is that these young women felt there is a lack of understanding about the vulva and that they are not taught enough in school and are likely to conduct their own research online. 

The team has been working in partnership with Brook, a young people’s sexual health and wellbeing charity, in order to develop the booklet which will be available on their website, reaching around 630,000 users each year. 

The resource also aims to convey the message that if a young person does have concerns about their body that it is a positive thing to do to reach out and speak to a healthcare professional, such as a GP.

The booklet will also be available on the BritsPAG website as a download for clinicians, including GPs, practice nurses and sexual health staff to be able to give out when meeting young people with genital cosmetic concerns and signpost them to further resources which promote healthy body image. 

Ms Louise Williams, clinical nurse specialist at University College Hospital and co-lead of the project, said:

“We see many patients in our paediatric and adolescent gynaecology clinic who have a poor understanding of the function of parts of the anatomy and also of normal genital variation. This educational resource will help young people to understand their vulva and how it develops during puberty, particularly if they are worried about how they look or feel. We hope it will reassure young people that vulvas come in a variety of shapes and sizes, and if they need advice and support, they can know where to go" 

Dr Naomi Crouch, consultant gynaecologist and spokesperson for the RCOG and chair of BritsPAG, said: 

“There is absolutely no scientific evidence to support the practice of labiaplasty and the risk of harm is significant, particularly for teenagers who are still in stages of development both physically and psychologically. We hope this resource will provide information for girls and young women that their vulva is unique and will change throughout their life, and that this is entirely normal and healthy.”

Ms Laura West, participation and volunteering manager at Brook, said: 

“All young people deserve education, support and advice about anatomy, but unfortunately there is a lack of accurate and sensitive information available as part of the school curriculum and on the internet. This new booklet will help to address this need and will inform doctors, girls, young women and their families, as to what is normal and where to seek further help and support if required."


Note to Editors

For media enquiries please contact the RCOG press office on +44 (0)20 7045 6773 or email

Link to booklet

When asked why they feel this resource is necessary, participants from the focus group said: 

“This normalises and educates about the multiple appearances of a vulva”

“No-one talks about anatomy at school or in SRE and too many young people (of all genders) barely know anything about basic anatomy of genitalia”

“Many people know very little about their own vulvas and I have many friends who worry about their vulvas' appearance as it looks different to porn”

More information about the Annual Update in Paediatric and Adolescent Gynaecology.

Clear guidance on the role of gynaecologists when seeing adolescents with labial symptoms was published in 2013 by the RCOG:
 “Ethical considerations in relation to female genital cosmetic surgery (FGCS)”.

Labial reduction surgery (labiaplasty) in adolescents”, a position statement published by BritSpag in 2013.

NHS Figures on labiaplasty are included in this BBC news report.

The booklet was commissioned by BritSpag, a specialist society of the RCOG, and developed by Louise Williams, clinical nurse specialist at UCLH, Hazel Isabella Learner, O&G trainee at UCLH, and Clare Oakland, PhD student at UCL. 

About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.