What One Doctor Learned From Measuring 650 Women's Vulva

There's an odd contradiction at play when it comes to vaginas: on the one hand, you can't watch porn without being confronted with doll-like vulva (the external, visible bit). But on the other hand, the taboo surrounding female sexual and reproductive organs and how they work means that a worrying proportion of women don't know their own bodies.

The result? A warped perception of what a "normal", healthy vagina looks like. Women and girls are seeking unnecessary surgery (labiaplasty) to get a "Barbie pussy" and are being vagina-shamed by ignorant people with a narrow conception of female bodies.

Earlier this year, however, a team of Swiss researchers published a landmark study supporting what should have been clearer all along: the external female genitalia come in a huge range of shapes and sizes, and there's no such thing as "normal".

Published in the British Journal of Obstetrics and Gynaecology, the study was the largest of its kind to date and was based on data from 657 white women between the ages of 15 and 84. By measuring their patients' genitalia (including the clitoris, labia majora (outer labia) and labia minora (inner labia)) during routine appointments, they found that focusing on an average measurement is virtually useless because the range is so wide.

The average labia minora was found to be around 4.3 cm long, but lengths ranged from between 5 mm and 10 cm – a significant variation of 9.5 cm. There was also a huge difference between the participants' outer labia – while the average was 8 cm long, they ranged from 1.2 cm to 18 cm; and the same could be said for their clitoris'. The average was close to 7 mm long but they ranged from 0.5 mm to 3.4 cm in length.

One of the researchers involved in the important study was Dr Inês Vaz, an obstetrician and gynaecologist at Lucerne Cantonal Hospital in Switzerland. She said she and her team were largely motivated by the increasing normalisation of this often unnecessary surgery. "We had many incidents of patients wishing to have cosmetic surgery and with insurance companies trying to avoid any kind of costs," Vaz told Refinery29. "For example, we had an 18-year-old girl who came with her father wishing to reduce the size of her labia minora, and the father gave it to her as an 18th birthday present."

The study was far from perfect – it only analysed white women who had come in for routine consultations, because "we don't have many women of colour in Switzerland, so we were unable to perform such a study," Vaz explained when we asked about the lack of diversity. But the findings certainly provided reassurance to many, and can now be used as a reference by doctors with patients concerned about the appearance of their labia. (A 2017 report by the International Society of Aesthetic Plastic Surgery found that the number of women who underwent labiaplasty increased by 39% between 2015 and 2016.)

Vaz recalls a huge proportion of women voicing insecurities about the appearance of their vulva during the study. "Many of them didn't dare to talk about it at first, but as soon as we started talking about their relationships and sexual satisfaction, and when we examined their vulva with a mirror, they started explaining their concerns. Many of them had never done it before! They had no idea what they looked like down there."

Vaz was also shocked by the participants' lack of anatomical knowledge about their own bodies. "We asked the patients how they usually refer to their genitals and it was amazing how many women had never heard of the word 'vulva'. They just mixed it up with 'vagina'." (It's a similar picture among women and girls in the UK, where sexual health charity Brook recently launched an online resource to educate them about their anatomy.)

Vaz hopes the findings will highlight the diversity of the female body and encourage women to think twice before developing an insecurity about their intimate parts. "Being asymmetrical is normal, each vulva is different. The concept of 'big' and 'small' was created by the media. Women should think twice before they categorise themselves as 'abnormal'."

Accurate and detailed descriptions of female genitalia are rare even in 2018, Vaz believes, because of the way patriarchal Western culture refuses to budge. "The appearance of female genitalia is still a social and religious taboo. Throughout history there were many pieces of art and literature reporting the virility of men, and related to the dimensions of their genitals," she explained.

"Even nowadays there are lots of publications about male genital dimensions and close to none about women. The clitoris, for example, was first described by Maria Bonaparte less than a century ago. Many patients, even the younger ones, don’t know what the word vulva means. But of course everyone knows what penis means."

Western culture's focus on youth doesn't help either, Vaz explained. "The vulvas of porn stars or the so-called 'wonderful vulvas' in our culture are almost like a teenager's vulva. Women have problems accepting how their bodies change: the dark coloration of the vulva, the labia majora losing fat, and the labia minora that seem to be more prominent. After giving birth too, some struggle to accept their changing weight. But it is just normal!"

Women's sexual and reproductive health is crying out for more research, Vaz believes, and her team's next line of inquiry will be surgery that helps women who experience painful sex. "The whole of female sexuality requires further research. It's still a big mystery for many."

For more news and reporting on cosmetic and non-cosmetic procedures targeted at women's vaginas, visit our #YourVaginasFine microsite.