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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.

J Sex Med. 2011 Aug;8(8):2377-85. 2011 May 19.

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.

Reitsma W, Mourits MJ, Koning M, Pascal A, van der Lei B.

Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

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.

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