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Sophie Sandberg stands in the dim light of her bedroom, holding a mirror between her legs, trying to get a clear look at the shape of her vulva.
“I remember thinking it wasn’t how it was supposed to look,” she says. “And it wasn’t attractive. There were different colors. And being 14 at the time, I thought that was weird.”
While she didn’t have a clear picture of what a vulva, the external part of the genitals, often mistaken as the vagina, was supposed to look like, she knew it wasn’t what she saw in the mirror. “The image I had was more like a woman’s crotch area but not the actual labia.”
Sandberg, 26-year-old social justice activist and founder of Chalk Back, is describing the “Barbie Vulva,” coined by urogynecologist Dr. Red Alinsod in 2005.
While most vulvas don’t look like this, a common surgery called labiaplasty, known on social media as the Barbie procedure, trims the lips of the vagina trying to achieve this coveted look, and has been gaining popularity since 2002, increasing by 374% from 2020 – 2021.
Jade Womack, who got plastic surgery last May, says that she was insecure about her labia size since childhood. “I’ve been struggling with body image problems since I was 13,” she says. “After I had my daughter, it got worse. [My labia] was very large and very long.”
Womack says that she’s relatively happy with the results post-surgery. “One labia is still a little bit larger than the other, and there’s a little hole in one labia now, and that bothers me,” she says. “So it’s not perfect, but it’s a lot better than it was before.”
According to Dr. Ronald Blatt, labiaplasty surgeon at the Manhattan Center for Gynecology, about 80% of his patients get the surgery for cosmetic reasons, but because the surgery removes part of the labia, it is not reversible if it’s done poorly. “People will come to me sometimes if they got it done at another place and ask, doc, can you fix it?” he says. “But the trim method cuts off everything. There’s nothing left to fix.”
There is not enough research on the surgery for it to be as widespread as it is. According to Elizabeth Wood, sex educator and co-founder of VulvaLove, the surgery can permanently damage nerve endings in the vulva. “I have no judgment for anybody who does their research and gets the facts of this elective surgery and what results after the scar tissue heals,” she says. “But there’s a whole industry of repairs for botched surgeries. Plastic surgeons don’t necessarily save nerves, and many vulva owners report numbness, lack of sensation, and inability to climax.”
Alexandra Bertucci, pelvic floor therapist, says there are many reasons for wanting the surgery. “It could be that maybe one partner told them it didn’t look right, lack of education, lack of representation,” she says. “If you’ve seen two vulvas and they look sort of the same, but yours looks different, well, something must be wrong with yours then.”
The effects of the Barbie Vulva gaining traction were clear: the lack of representation led women to question their own appearance, and, as Wood explains, the more distress one has with the appearance of their vulva, the harder it is to receive pleasure.
When Sandberg was 14, someone she hooked up with told his friends that her vagina looked “ugly,” and word got back to her at school. “He said he didn’t want to sleep with me because my vagina was too ugly. And he’d rather just make out with another girl instead of having sex with me because he was not attracted to my vagina,” she says. “So I think shortly after that is when I looked at it and was like, Oh my God. It is so ugly and it’s not how it’s supposed to look.”
Sandberg says that her perception of her vulva changed how she had sex. “I did not enjoy people going down on me because I was worried they would look at my vagina,” Sandberg says. “It impacted my idea of myself as desirable and attractive. I still wanted to have sex with people and give them pleasure, but I had trouble receiving it for myself for a while. There were points where I saw something that I thought was unattractive and wanted to just slice it off.”
Media exposure is one of the most influential factors in women’s decisions to undergo labiaplasty. “That’s what happens if you don’t see diversity,” Lynn Enright, author of the book Vagina: A Re-Education, says. “If you don’t know what vulvas look like and the vulvas you see are in mainstream porn, where the performers may have had labiaplasty or labia that are quite symmetrical, it leaves people vulnerable to those feelings of inadequacy or shame.”
Dee Hartman, sexual health therapist and co-founder of VulvaLove, says that the ‘Barbie Vulva’ became standardized in porn. “A neat and tidy vulva is accepted as the cultural norm. In Australia, for instance, vulvas used to need to be a specific shape and size. And if not, they digitally [alter] them.”
While some women gained satisfaction with their genital appearance from the surgery, for most, it didn’t affect their self-esteem or sexual confidence. “I would rather help support somebody to fall in love with their vulva rather than cutting it and dismissing it and potentially ruining their sex lives forever,” Wood, sex educator, says. “I want people to know how delightfully involved the labia is in sexual arousal. It is the most pleasurable center in our body, rich, with 10,000 nerve endings, and we just keep losing them.”
In order to unravel the intense shame around vulva appearance, diversity and representation is crucial. “More representation would decrease the rate of labiaplasty cases and improve genital self-esteem,” Wood says. “Most of the people who suffer from this shame suffer in silence because we just don’t talk enough about sex. There’s a lack of education and a lack of imagery where people can identify themselves.”
Sandberg felt societal pressures come undone when she started seeing more representation, partially from The Vulva Gallery. “It’s a representation of vastly different pubes, colors, labia, and normalizing all of it,” she says. “Seeing different skin conditions or different things represented on Instagram was really helpful to know that everyone is loveable, no matter what stuff you have going on and no matter what you look like.”
Hilde Sam Atalanta, the illustrator, says that their purpose was just that. “I wanted to create a body of work to show that that normal doesn’t exist,” they say. “There’s an endless amount of ways a vulva can look and I wanted to make sure that any person who is insecure has access to a body of work that shows diversity, and they’ll be able to find a vulva that they feel represented by.”
Enright says that art is a helpful tool for spreading awareness because it’s easier to talk about without sexualizing it. “So many women fail at even labeling a diagram of a vagina,” she says. “We don’t usually see [anatomy] except in a sexualized way. Art gives the opportunity to talk more broadly.”
“When you see yourself, you know you belong, and there’s so much power to that,” Atalanta, founder of the gallery, says. “You think that there are people just like me, even when I have a crooked nose, a flat butt, or a certain type of labia. That’s part of the diversity that is out there, and it’s gorgeous and important and reminds you not to worry.”