The Labia Library: A Unique Health PromotionResource to Increase Knowledge of Female Genital Diversity

Malone, J, O’Halloran ABZ - Women's Health Victoria, Melbourne, Australia. September 2014

BackgroundFemale genital cosmetic surgery refers to any procedure that aims to change aesthetic (or functional) aspects of a woman’s genitalia, which is not medically indicated1. Female genital cosmetic surgery incorporates a range of procedures, including labioplasty and vulvoplasty.

The ideal labia minora, promoted by female genital cosmetic surgery, is small2, ‘clean’3 , ‘discreet’ and ‘tucked away’4. This ideal fails to recognise the diverse and healthy range of natural female genitals.

The number of women undertaking genital cosmetic surgery in Australia is increasing5 (Figure 1). The trend towards female genital cosmetic surgery represents a cultural preference for hidden, symmetrical labia minora1. This is an arbitrary and subjective judgement based on sociocultural messages about attractiveness1.

Women’s Health Victoria developed an Issues Paper to explore female genital cosmetic surgery in Australia6, which demonstrated the need for a health promotion resource on female genital diversity.

Figure 1. Number of Medicare

claims for vulvoplasty and

labioplasty (Medicare claim

number 35533) between

January 2001- December 2011.

Source: Department of Health

and Ageing, Australia.

MethodDevelopment of The Labia LibraryWomen’s Health Victoria developed a website, The Labia Library, to equip women with information about the diversity of women’s genitals and to support positive genital body image. The website was developed with input from young women and health professionals from general practice, gynaecology, and psychology.

Online surveyAll visitors to the website are invited to complete a short, online survey. ResultsThe Labia Library website (www.labialibrary.org.au) was launched on 17 September 2013 (Figure 2). It addresses common concerns and provides advice to women on issues like labia size and shape. The website also features a photo gallery that shows images of 20 real vulvas from two different angles. Between September 2013 and 27 August 2014:

There have been 541 911 visits to the website, 89.3 per cent of which have been unique users.

Visitors spend an average of 1:59 minutes at the site and view an average 2.88 pages per visit.

There have been over 1.56 million page views.

The majority of visits to The Labia Library website originated from outside Australia (Figure 4). Most visits originating within Australia come from New South Wales and Victoria (Figure 3).

Online surveyAs at 27 August 2014, 4 985 people had responded to the online survey (response rate 1.0 per cent):

96.1 per cent of visitors surveyed responded that they found The Labia Library website useful.

93.4 per cent of visitors surveyed responded that they were visiting the website for their own interest, while 6.6 per cent were visiting for work.

Survey respondents reported high levels of increased knowledge (Figure 5).

Comments from survey respondents“This is a fabulous resource and very reassuring. I was considering labiaplasty, mainly due to sensitivity of my protruding labia, but also because of appearance. This site … has pretty much changed my mind.”

”The library is a great idea… Most women and teenagers I know feel pressure to look the same as women in the porn industry.”

“I found this site extremely helpful for my own personal knowledge and reassurance. I'm a teenager and I felt a little odd about how my Labia Minora looked like and how different it was from my friends. After reading several articles on this site I felt relieved knowing that my vulva is normal and not to be embarrassed of.”

”I am a sex therapist… I found the site great to show my clients pictures of normal vulvas.”

“I was coming close to considering surgery until I saw this website... I do not feel ashamed now. I want to make a general comment though, it’s not just in pornography and magazines that we see tidy looking vulvas but even on health websites... that's why I got so confused because no one (including health websites) are saying that the vulva can look so different… I am grateful though to see this website. Thank you.”

DiscussionVisitors to the website have provided overwhelmingly positive feedback about the website and the information on genital diversity. Direct feedback suggests that women are using The Labia Library as a tool to allay concerns they have about their labia and, as a result, are avoiding costly and invasive genital cosmetic surgery.

ConclusionsThe Labia Library is a comprehensive health promotion resource for both women and health professionals. It can inform future health promotion interventions on genital diversity and address emerging concerns related to genital body image. A review will be undertaken in 2015 to explore how the website can be strengthened.

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healthy empowered equal

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Figure 5. Responses of online

survey respondents. Normal

genital appearance (n=4948);

How different everyone’s

genitals are (n=4917); Pictures

of genitals in magazines and

pornography (n=4876); How to

access support if you are

worried (n=4849).

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Figure 3: Percentage of total website

visits originating within Australia

(n=114 505) by State/Territory between

website launch and 27 August 2014.

Western Australia7.7%

Queensland13.9%

NorthernTerritory

0.1%

SouthAustralia

5.1%New South

Wales37.1%

Victoria32.4%

Tasmania1.2%

Figure 2. View of The Labia Library website home page.

labialibrary@whv.org.au

www.whv.org.au

www.labialibrary.org.au

References 1. Braun V. Female genital cosmetic surgery: a critical review of current knowledge and contemporary debates. Journal of Women’s Health. 2010;19(7):1393-407. 2. Liao L-M, Creighton SM. Female genital cosmetic surgery: a new dilemma for GPs. The British Journal of General Practice: TheJournal of The Royal College of General Practitioners. 2011; 61(582):7-8. 3. Braun V, Tiefer L. The 'designer vagina' and the pathologisation of female genital diversity: interventions for change. Radical Psychology. 2010;8(1). 4. Braun V, Wilkinson S. The vagina: liability or asset? Psychology of Women Section Review. 2003;5(2):28-42. 5. Australia. Department of Health and Ageing. Medicare Benefits Schedule item statistics report : Item 35533 [Requested Medicare items processed from January 2000 to December 2011]. Canberra: Australia. Department of Health and Ageing; [2012]. [cited 26 June 2012].

Acknowledgements The Labia Library was developed with a grant from the Victorian Women’s Benevolent Trust. Photographs included in The Labia Library are reproduced with kind permission from Show Off Books. Photographs are taken from the book I’ll Show You Mine. Photographer: Katie Huisman. Photographs © 2011 Show Off Books. All rights reserved

Figure 4. Percentage of total

website visits (n=541 911) by

country of origin, between

website launch and

27 August 2014.