What's normal? Influencing women's perceptions of normal genitalia: an experiment involving exposure to modified and nonmodified images.

OBJECTIVE: Examine women's perceptions of what is 'normal' and 'desirable' in female genital appearance.

DESIGN: Experiment with random allocation across three conditions.

SETTING: Community.

SAMPLE: A total of 97 women aged 18-30 years.

METHODS: Women were randomly assigned to view a series of images of (1) surgically modified vulvas or (2) nonmodified vulvas, or (3) no images. They then viewed and rated ten target images of surgically modified vulvas and ten of unmodified vulvas.

MAIN OUTCOME MEASURES: Women used a four-point Likert scale ('strongly agree' to 'strongly disagree'), to rate each target image for 'looks normal' and 'represents society's ideal'. For each woman, we created two summary scores that represented the extent to which she rated the unmodified vulvas as more 'normal' and more 'society's ideal' than the modified vulvas.

RESULTS: For ratings of 'normality,' there was a significant effect for condition (F2,94  = 2.75 P = 0.007, radj2 = 0.082): women who had first viewed the modified images rated the modified target vulvas as more normal than the nonmodified vulvas, significantly different from the control group, who rated them as less normal. For ratings of 'society's ideal', there was again a significant effect for condition (F2,92  = 7.72, P < 0.001, radj2 = 0.125); all three groups rated modified target vulvas as more like society's ideal than the nonmodified target vulvas, with the effect significantly strongest for the women who had viewed the modified images.

CONCLUSIONS: Exposure to images of modified vulvas may change women's perceptions of what is normal and desirable. This may explain why some healthy women seek labiaplasty.