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No (Wo)Man Is an Island—The Influence of Physicians' Personal Predisposition to Labia Minora Appearance on Their Clinical Decision Making: A Cross-Sectional Survey

Authors

  • Welmoed Reitsma MD,

    1. Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Marian J.E. Mourits MD, PhD,

    1. Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Merel Koning MD,

    1. Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Astrid Pascal MD,

    1. Department of Sexual Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Berend van der Lei MD, PhD

    Corresponding author
    1. Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Financial Support: None declared.

  • Copyright/License for Publication: The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors an exclusive licence on a worldwide basis to the Journal of Sexual Medicine (JSM), to permit this article to be published in JSM and to exploit the subsidiary rights.

  • Ethical Approval: According to Dutch law, this study did not require approval from the Institutional Review Board of the University Medical Center Groningen. Participants gave informed consent before taking part of the survey.

  • Data Sharing: Technical appendix, statistical code, and data set are available from the corresponding author at e-mail address b.van.der.lei@plchir.umcg.nl.

Berend van der Lei, MD, PhD, University Medical Center Groningen, Department of Plastic Surgery, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. Tel: +31-5036-16161; Fax: +31-5036-13043; E-mail: b.van.der.lei@plchir.umcg.nl

ABSTRACT

Introduction.  Physicians are increasingly presented with women requesting a labia minora reduction procedure.

Aim.  To assess the influencing factor of personal predisposition in general practitioners, gynecologists, and plastic surgeons to labia minora appearance in relation to their willingness to refer for, or perform, a surgical labia minora reduction.

Methods.  Cross-sectional self-administered questionnaire survey. Between May 2009 and August 2009, 210 physicians were surveyed. Primary care: general practitioners working in the north of the Netherlands. Secondary care: gynecologists and plastic surgeons working in five hospitals in the north of the Netherlands.

Main Outcome Measures.  A five-point Likert scale appraisal of four pictures showing a vulva, each displaying different sizes of labia minora, indicating a physician's personal predisposition, manifesting as willingness to refer for, or perform, a labia minora reduction.

Results.  A total of 164/210 (78.1%) physicians completed the questionnaire, consisting of 80 general practitioners, 41 gynecologists, and 43 plastic surgeons (96 males, 68 females). Ninety percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents society's ideal (2–5 on the Likert scale). More plastic surgeons regarded the picture with the largest labia minora as distasteful and unnatural, compared with general practitioners and gynecologists (P < 0.01), and regarded such a woman as a candidate for a labia minora reduction procedure (P < 0.001). Irrespective of the woman's labia minora size and the absence of physical complaints, plastic surgeons were significantly more open to performing a labia minora reduction procedure than gynecologists (P < 0.001). Male physicians were more inclined to opt for a surgical reduction procedure than their female colleagues (P < 0.01).

Conclusions.  The personal predisposition of physicians (taking account of their specific gender and specialty) concerning labia minora size and appearance influences their clinical decision making regarding a labia minora reduction procedure. Heightened awareness of one's personal predisposition vis-à-vis referral and willingness to operate is needed. Reitsma W, Mourits MJE, Koning M, Pascal A, and van der Lei B. No (wo)man is an island—The influence of physicians' personal predisposition to labia minora appearance on their clinical decision making: A cross-sectional survey. J Sex Med 2011;8:2377–2385.

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