Does Size Matter? Genital Self-Image, Genital Size, Pornography Use and Openness Toward Cosmetic Genital Surgery in 3503 Swedish Men and Women

Abstract

Background Dissatisfaction with the appearance and size of one’s genitalia is a common issue, and the use of cosmetic genital surgery is increasing among people with normal genitalia. Aim This cross-sectional study aimed to investigate the distribution of genital self-image in a large sample of males and females, and whether selected factors could predict genital self-image. Methods Three thousand five hundred three anonymous participants completed online questionnaires. Multiple linear regressions were used to identify the association between genital self-image and genital size (length of penis or protrusion of labia minora), consumption of sexually explicit material (SEM), sexual activity, avoidance and safety seeking behaviors, openness toward genital cosmetic surgery and age. Outcomes Total scores on the Female and Male Genital Self Image Scale were used as the main outcome measures. Results Overall, 3.6% of females and 5.5% of males had a severely low genital self-image (defined as 2 SD below the mean) and 33.8% of all individuals reported dissatisfaction with the appearance of their genitalia, with 13.7% of females and 11.3% of males considering undergoing cosmetic genital surgery. Mean protrusion of labia minora and stretched flaccid penis length in the population was estimated to 0.76 cm (95% CI 0.63–0.89 cm) and 12.5 cm (95% CI 12.33–12.76 cm), respectively. A higher genital self-image score was predicted by having a larger penis or less protruding labia minora, but not by the degree of SEM consumption, although 93.6% of males and 57.5% of females had consumed SEM in the past three months. The degree of avoidance and safety seeking behaviors, sexual activity, and openness toward genital cosmetic surgery predicted a low genital self-image. Being older was associated with a better genital self-image in females. Clinical Implications The results show that a psychological intervention may be needed as an alternative to cosmetic genital surgery for people who are dissatisfied with the appearance of their genitals. Strengths and Limitations This is one of few available studies investigating the association between actual genital size and genital dissatisfaction. The vast sample size and high response rate are also strengths. Limitations include the cross-sectional design, and possible bias in the study sample due to self-selection. Conclusion Overall, a low genital self-image and dissatisfaction with one’s genitalia is relatively common and is influenced not only by genital size, but also behaviors performed to alleviate worry about one’s genitals.

Psychosexual counseling intervention to improve women's genital self‐image: Study protocol for a randomized controlled trial based on a multistage mixed method design

“…According to the available data, it has been determined that up to one‐third of women are unhappy with the way their genitalia look 44 poor GSI is linked to several detrimental effects, such as decreased sexual activity behavior, 1,5,45 increased sexual distress, 46,47 increased negative cognitive‐affective reactions, 5 and worse genital health decision‐making 10 . It may increase the demand for cosmetic procedures, and many people with normal genitalia now have cosmetic genital surgery 44 . Although estimating the exact number of cosmetic genital surgery in Iran is not possible due to the lack of information, the demand for that, is remarkable 48 …”

“…The prevalence of poor GSI in the general population appears to be higher than anticipated. According to the available data, it has been determined that up to one-third of women are unhappy with the way their genitalia look 44 poor GSI is linked to several detrimental effects, such as decreased sexual activity behavior, 1,5,45 increased sexual distress, 46,47 increased negative cognitive-affective reactions, 5 and worse genital health decision-making. 10 It may increase the demand for cosmetic procedures, and many people with normal genitalia now have cosmetic genital surgery.…”

“…10 It may increase the demand for cosmetic procedures, and many people with normal genitalia now have cosmetic genital surgery. 44 Although estimating the exact number of cosmetic genital surgery in Iran is not possible due to the lack of information, the demand for that, is remarkable. 48 Therefore, this study aims to identify the best intervention program as an effective step to promote GSI and consequently, sexual and reproductive health of Iranian women aged 15-49 years.…”

Maintaining vulvar, vaginal and perineal health: Clinical considerations

“… 57 In a cross-sectional study investigating genital self-image, 3.6% of women had severely low self-image, with 13.7% of women considering undergoing cosmetic genital surgery. 56 Moreover, better genital self-image was associated with a smaller protrusion of the labia minora. 56 Healthcare providers should educate their patients on the acceptance of normal genital diversity, to reduce body dissatisfaction and the fashion-driven request for intimate aesthetic procedures.…”

“…However, this might stem from low genital self-image and dissatisfaction with female genitalia, often encountered by young women. 56 In addition, societal beauty ideals among adolescents, which are increasingly modulated by photograph-based social media platforms, can also affect genital self-image and desire for intimate aesthetic procedures. 57 In a cross-sectional study investigating genital self-image, 3.6% of women had severely low self-image, with 13.7% of women considering undergoing cosmetic genital surgery.…”