"If they truly have procedures that are safe and beneficial for women, I would think they would want to share this data with the scientific community," she said. "Women need to be educated that at this point, these procedures are not proven to be safe or effective, and carry risks of bleeding, infection, pain with intercourse, and scar tissue."
She and other critics also questioned potential sexual and long-term complications of aesthetic gynecologic surgery, because the labia minora contain clitoral tissue, and the labia undergo physical changes over a woman's lifetime.
"Papers are coming," promised Dr. Matlock, who said a large, multicenter outcomes study of cosmetic genital procedures has been completed and accepted for publication.
Up to now, a handful of papers in scientific journals have been dwarfed by coverage of the procedures in women's magazines and the lay press, driving requests for the procedure.
"It's obviously interesting to the media," said Dr. Matlock. "Sex sells."
Papers decrying the lack of objective outcomes "miss the point," he said. "Is the patient happy or unhappy? That's what it's all about."
"Despite the fact that ob.gyns. are involved their whole lives in dealing with women, [they] have no idea how to meet the needs of female patients," said the elder Dr. Pelosi. "If they are treating anything objective—pain, infections—they are extremely competent, but anything beyond that, they don't want to hear about."
Frequently the argument is made that women have not seen hundreds of vulvas and labias to compare to their own genital appearance, and should be educated during about the wide range of normal anatomy, including labia minora widths at midline ranging from 7-50 mm (BJOG 2005;112:643-6).
The Web site for Dr. Miklos and Dr. Moore explains that labiaplasty can result in a "sleeker, thinner ... more youthful" appearance of the labia, and "inner lips [that] do not protrude past the labia majora at all, giving them a much more appealing shape and eliminating many of the symptoms of enlarged labia."
To question women's decision to obtain a different aesthetic appearance of their genitals is arrogant and demeaning, said Dr. Matlock.
Meanwhile, in the Netherlands, Dr. Karen Marieke Paarlberg reviews a booklet of 38 pictures of normal vulvas with patients requesting labiaplasty and discusses with them alternative means of addressing discomfort, if that is an issue.
"I think that more than 50% of women can be reassured by a doctor who can listen very well and who tries to reassure the woman that she is perfectly normal," she said in an interview.