Settle, petal … vagina anxiety has led to the publication of two books, <i>Heart of the Flower</i> and <i>I'll Show You Mine</i>.

Settle, petal … vagina anxiety has led to the publication of two books, Heart of the Flower and I'll Show You Mine. Photo: iStockphoto.com

Karissa was 22 when she decided there was something wrong with the way she looked "down there". It was definitely not normal. How could it be? It had folds of skin that stuck out. Despite having never seen another woman's vulva, and with "less consideration than buying a pair of shoes", she decided to have labiaplasty surgery.

Post-surgery, she had a classic case of buyer's remorse. The result was not the ultra-trim model she had requested, so she convinced the surgeon to redo it. Determined to achieve the look she wanted, she scoured the internet for an image of perfect labia, only to find that they do not, in fact, exist.

In Australia over the past 10 years, medical rebates for labiaplasty (surgical reduction of the inner or outer labia) and vulvoplasty (surgical remodelling of the vulva) have risen from 640 claims in 2000-01 to 1565 in 2010-11, though the real number of procedures is thought to be much more. At the same time, mainstream pornography has become more explicit, showing extreme close-ups of hairless female genitalia.

Previously hidden behind a bush of hair, labia are now under close scrutiny. The type typically featured in pornography are known as the "Barbie" or "clamshell" variety, where everything is neatly tucked away. And just to complicate the matter, Australian censorship and print publication guidelines dictate that the inner labia must not protrude beyond the outer labia. Houston, we have a problem. Many women are not designed this way and have started to question whether they are "normal".

But there are signs of a fightback, a nascent fury at the idea that women need to surgically alter their genitals to fit some purported ideal. This year, Women's Health Victoria landed a punch by launching the "labia library" (labialibrary.org.au) containing information, advice and a photo gallery of 20 labia from the book I'll Show You Mine, edited by Wrenna Robertson.

Rita Butera, the executive director of Women's Health Victoria, said the site was prompted by concerns about the increase of labiaplasty surgery and what this might mean for women's body image. "Most women have no idea what other women's genitals look like, and that's largely because female genitals in magazines and porn are Photoshopped," says Butera. "They're all basically neat and tidy and that's not an accurate representation of what is normal." She says the site aims to show that the labia "are just another part of the body that come in many shapes and sizes".

When I went to browse the online labia library, I initially felt conflicted. I was alone in my bedroom on a computer looking at women's genitals. Surely I was doing something wrong. I would have to clear my browser history. But that thought was short-lived because, devoid of the lingerie, the ambient surroundings and orgasmic groans of pornography, it was fascinating. I never knew what other women actually looked like down there. It was strangely liberating.

It turns out I'm not alone – Butera says the site survey has been "overwhelmed by positive comments". Hannah Cooper, 38, a personal assistant from Sydney, says of the library, "When a friend suggested I check it out, I thought eeek ... but it wasn't gross and it wasn't sexy. They were all just so different and it makes sense. Everyone has a different face – it follows that people would have different labia."

The labia library is not an isolated project, but part of a growing movement of women reclaiming a vital and sacred part of themselves. Hannah Ryan, an editor of the University of Sydney's student newspaper, Honi Soit, ran a controversial cover story in August showing the genitals of 18 women.

The magazine wanted to make a statement about the way women's genitals, unlike men's, are shrouded in secrecy. "We wanted to make the vulva as public as the penis, so we decided to photograph as many as possible. We thought we'd be lucky to get four," Ryan says. It was only after the images were formatted for print that the editors realised the vast differences between the women. "It wasn't what we set out to do, it was secondary, but it was amazing. They were all so different – about half had inner [labia] and half outer."

However, Ryan's view that the cover was an empowering statement for women was not shared by lawyers for the Students' Representative Council, who advised them to take all copies off the stands and guillotine the cover because the black bars used to hide the "offensive" parts were slightly transparent.

"By presenting 18 incredibly different vulvae, we hoped to demonstrate to our (young) women audience that their own vaginas were normal, that they needn't worry that they were ugly," Ryan wrote on Fairfax Media's dailylife.com.au. "Covering those images and then seizing all printed copies from the public eye ... perversely reinforced everything we were fighting."

All of this is no surprise to relationship and sexuality coach Yvonne Lumsden, who says many of the women she works with have a feeling of "genital inadequacy". Fed up with the idea that women's vulvae should look a certain way, appalled at the rise in labiaplasty, and frustrated with Australian censorship laws that make it illegal to show inner labia, she co-authored the book Heart of the Flower to help women reclaim and celebrate their diversity.

The book features 50 close-up photographs of digitally unaltered yoni, a Sanskrit word for the vagina that also has connotations of divine procreative energy. Each yoni is juxtaposed with an image of a flower. "I wanted to show beauty and diversity through nature," Lumsden says.

Interestingly, Heart of the Flower shows that not everyone shares an appreciation for the perfectly moulded labia of the modern-day porn film. 36-year-old Kai writes, "My husband is Bulgarian and told me that he found Australian men's obsessions with 'designer vaginas' to be weird. The 'tucked in' version doesn't appear to be 'juicy' or 'fruit-like' enough to be erotic to him."

The book also documents the aforementioned Karissa's journey of self-acceptance following her labiaplasty surgery. The extreme close-up shots reveal her genital scarring and her words show the heartfelt realisation that "there was nothing wrong with me in the first place".

Plastic surgeon Dr Ashley Granot, of Melbourne's The Me Clinic, explains the popularity of labiaplasty: "People are like sheep, they follow fashion. Most tight clothing and swimwear are not appealing for a person with large labia minora [inner labia]. If you happened to be born in a Rubenesque time, the fashion was for flesh and curves, but we live in a different time. Who are any of us to judge what someone does to make themselves feel better about themselves?"

The trend for complete hair removal is probably an even greater contributing factor, Granot says. "There is no doubt in my mind that the Brazilian wax has a lot to answer for. Previously it was covered, it was protected by a bush of hair, but now it's exposed and susceptible to more chafing and irritation."

Labiaplasty is only one of a number of procedures aimed at "improving" the look of the vulva. Melbourne cosmetic surgeon and dermatologist Dr Daniel Lanzer offers enhancement procedures at his Malvern clinic that involve injecting fat into the labia to give it "a fuller, more youthful look, in the same way that it would for someone's face". When asked about ethical issues relating to this procedure, he says "it comes down to someone's self-esteem".

Cosmetic surgeon Dr Laith Barnouti, who offers this procedure along with vaginoplasty (tightening of the vagina) and labiaplasty at his three Sydney clinics, also believes that the decision to have surgery is about "confidence". He agrees "there is too much emphasis on the way we look and the way we appear, but that is society, that is the world we live in".

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), however, takes a different position. It issued a statement in 2008 labelling the trend "dangerous, expensive (costing up to $10,000) and unwarranted", and another in 2011 saying it was "concerned that such surgery may exploit vulnerable women".

RANZCOG's vice-president, Professor Ajay Rane, says, "There are genuine complications – scarring, infection, altered sexual sensations – in this very delicate and highly vascular area, even in experienced hands. Time and again we have teens and preteens producing pornographic magazines and saying, 'Make me look like this.' This is scary stuff."

Rane adds that "recent literature suggests that less than a third of requested labiaplasties are clinically indicated".

Lola, 44, was in that group. "I couldn't wear tight-fitting clothes or a swimming costume, I suffered incredible discomfort from chafing, and sex never felt quite right." She read up on the procedures and met two surgeons – "one was in a huge rush" and the other was "just all about the money" – before settling on one she was happy with.

Lola advises women with similar problems to do their research. "It's surgery ... and in that first 24 hours, when the anaesthetic wears off, I would describe the pain as traumatic. And it's expensive; I had to save up the $7000, but for me it was worth it."

It's been almost 20 years since Eve Ensler penned these words in the controversial play The Vagina Monologues: "I was worried about my own vagina. It needed a context of other vaginas – a community, a culture of vaginas. There's so much darkness and secrecy surrounding them – like the Bermuda Triangle."

Ensler was instrumental in starting the conversation. Thanks to other ground-breaking projects such as the labia library and Heart of the Flower, we can see the yoni in all its uniqueness. Big and small labia. Thick and thin. Dark and light. Hairy and hairless. Innies and outies. Many of them, most of them (including mine), look nothing remotely like the neat clamshells of the pornography world. And nor should they.

- Sunday Life

Lead-in image: iStockphoto.com.