text: The number of female genital cosmetic operations performed on the NHS has risen five-fold in the last decade as women worry they're not 'normal'. Labial reduction procedures - surgery to reduce the size of the inner ‘lips’ of the vagina - have risen five-fold in the past 10 years, with more than 2,000 operations performed in 2010. And the trend is reflected  in Australia where  procedures have more than doubled in the same time period. The labia are lips which protect the vagina. There are inner labia – the labia minora - which are thinner, and the outer labia – the labia majora, which have more tissue and fat. Labial reduction procedures - surgery to reduce the size of the inner ‘lips’ of the vagina - have risen five-fold in the past 10 years, with more than 2,000 operations performed on the NHS in 2010 . They naturally vary in size and shape, but some women are dissatisfied or distressed about the appearance of their labia, even when they are classified medically as perfectly normal. The surgery involves reducing the size of a woman's labia minora to make them more symmetrical and smaller than the labia majora. This is done by cutting away the ‘excess’ skin with a scalpel, or possibly a laser, and stitching up the loose edge with dissolvable stitches, until it heals. Experts at the Royal College of Obstetricians and Gynaecologists at the World Congress in Brisbane, have called for more research to try and better understand women's motivations. A study by the University of Melbourne explored the views of women aged 18 to 28. Interviews focused on participants' views of the 'normal' and 'ideal' vulval anatomy, on cosmetic surgery and the sources of information available. Calida Howarth, from the university, said: 'It is essential that doctors do not assume that women have an inherent knowledge of their genitalia and the anatomical terms used to describe it. 'This contemporary women's health issue requires further research and interdisciplinary collaboration if we are going to ensure best practice and achieve optimal outcomes for our patients.' A labiaplasty is a surgical procedure to reduce the size of the labia minora – the flaps of skin either side of the vaginal opening. Most labiaplasty operations are done by private clinics as cosmetic surgery, to change the appearance of the female genitals. Occasionally, there may be a medical need for the operation (for example, because the tissue is affected by disease), in which case it might be covered by the NHS. However, the NHS doesn't routinely provide this operation. It's natural and normal for a woman to have noticeable skin folds around the vaginal opening and, in most cases, this shouldn't cause any problems. Some women are dissatisfied with or distressed about the appearance of their labia, even when they look perfectly normal to the health professional examining them. A labiaplasty involves shortening or reshaping the vaginal lips, a bit like shortening a hem on a dress. It is usually performed by a gynaecologist or plastic surgeon. The unwanted tissue is cut away with a scalpel or possibly a laser, and the loose edge may be stitched up with fine, dissolvable stitches. It can be carried out using either a general anaesthetic or local anaesthetic with sedation, and the whole procedure takes about one to two hours. However there is a lack of research investigating how effective this procedure is. This means there's no guarantee it will achieve a long-lasting desired effect, and there are short- and long-term risks to consider. Source: NHS Choices . The researchers concluded that women would benefit from better access to information showing a range of normal vulval anatomy. Another study led by the University of New South Wales examined attitudes to pubic hair removal and the relationship with physical discomfort, viewing pornography, genital self-image and the consideration of labiaplasty. The study found no link between the removal of pubic hair and requests for the cosmetic surgery. However, the study also highlighted the need for careful recognition among the healthcare profession of the possible reasons for the increase in women seeking surgery. Cathy Cui, one of the researchers, said: 'While women request labiaplasty for physical and psychological reasons, the reasons for increasing numbers of surgeries in the last decade are not clear.' Research has exposed a lack of education regarding the management of patients requesting female genital cosmetic surgery. Tristan Harding, from the University of Melbourne, said: 'GPs would be greatly assisted by practice guidelines when faced with such requests. 'If they are able to provide adequate, accurate information to patients, this may prevent unnecessary surgery and alleviate patient anxiety. 'GPs should also consider referring women to a gynaecologist rather than a cosmetic surgeon when they wish to have surgery.' The studies highlight a need to improve clinical guidance for healthcare professionals, the experts said. And they called for further research around the surgery and patients' knowledge and perceptions of 'normal' vulval anatomy. Meanwhile a consultant plastic and aesthetic surgeon told MailOnline said many of his patients seek the surgery because they suffer problems ranging from pain and tearing to extreme psychological distress. Mr Miles Berry, who works at the Weymouth Street Hospital, London, said he believes the rise in operations is down to an increase in awareness and availability of the procedure. While many people believe these women are simply seeking a ‘designer vagina’, he said most are having the procedure for functional reasons or because they have been traumatised by having labia that are misshapen or low-hanging. Some will never enter into a relationship for fear of a partner seeing their genitalia, while others cannot undress in public or wear a bikini, he told MailOnline. Other women have labia that are so long that horse riding, cycling or having sex is painful. ‘One woman was part of the cycling team, she had persistent swelling and chafing. It stopped her cycling,’ Mr Berry said. Meanwhile consultant plastic and aesthetic surgeon Miles Berry told MailOnline said many of his patients seek the surgery because they suffer pain and tearing and extreme psychological distress . There are also women who have torn their labia during intercourse, or while horse riding, which as well as being excruciatingly painful, causes bleeding. ‘When women with this condition wear tight clothes, like jeans, they experience chafing,' added Mr Berry. ‘One lady used tampons to keep her labia inside because they were hanging down below her underwear. ‘I saw another lady who was getting recurrent thrush as she had all this extra tissue down there that was moist.’ His clinic carried out 49 procedures in 2014 compared to 27 in 2013 – an 80 per cent rise - while NHS figures show there were 2,000 labiaplasties performed in 2010 – a five-fold rise since 2001. Many women who come for a consultation with Mr Berry are so insecure about the way their labia looks it is impairing their life, he said. Women can be born with naturally long labia or that are shaped in a way that their owners deem unattractive, he explained. In some women, they stretch naturally over the course of a lifetime, while others experience stretching or tearing as a result of childbirth, and are embarrassed by the result. This is usually due to hormones associated with pregnancy, the stretching of the vagina during the birth or due to the loss of the pelvic floor muscles.
target: NHS labial reduction procedures risen five-fold in the last 10 years .
  More than 2,000 of the cosmetic operations were performed in 2010 .
  Trend is reflected in Australia with ops more than doubling in same time .
  Experts call for more information to help women understand what's normal .