Some women complain that wearing tight clothes or riding a bike is uncomfortable, while others say they are embarrassed in front of a sexual partner.

But the research paper challenged the ethics of offering women surgery to address such insecurities, suggesting it was advertisements for a "homogenised, pre-pubescent genital appearance" which created these anxieties in the first place.

Any pain apparently caused by protrusion may well have a psychological root - noting that male genitalia protrude far further without causing major discomfort.

"Furthermore, quality research is needed to improve our understanding of the psychological drivers behind women's decision to sacrifice sexually sensitive tissue that contributes to erotic experiences, for a certain genital appearance that used to be an obligation only for some glamour models," said Dr SM Creighton, Consultant Gynaecologist, University College London and her colleagues.

Counselling and support could therefore be a preferable alternative to surgery, they argue.

The British review investigated the quality and content of published reports relating to labial surgery for well women. Electronic databases were searched for relevant articles between 1950 and April 2009. Forty articles were identified, 18 of which included patient data. The specification of the study design was unavailable in 15 of the 18 papers; the remaining three were retrospective reports.

No prospective, randomised or controlled studies were found. All reports claimed high levels of patient satisfaction and contained anecdotes pertaining to success, but there is nothing conclusive about the data thus far available.

But cosmetic surgeons are incensed and said the report was tantamount to terrorizing patients.

"I have seen women who I have sent away because I don't think they have a problem, but for women with serious hypertrophy - when the tissue is dark and hangs down - there is a simple way to deal with it. The feedback I receive is very positive indeed," asserted Dr.Angelica Kavouni.

"They've gone a bit over the top. Essentially this is just about removing a bit of loose flesh, leaving behind an elegant-looking labia with minimum scarring. The procedure won't interfere with sexual function,“ Douglas McGeorge, past president of the the British Association of Aesthetic Plastic Surgeons told BBC.

"Women want this for a number of reasons - some find it uncomfortable to ride a bike for instance, but for the majority it is aesthetic, that's true.

"Lads' mags are looked at by girlfriends, and make them think more about the way they look. We live in times where we are much more open about our bodies - and changing them - and labioplasty is simply a part of this."

BJOG editor Professor Philip Steer said the study "underlines the need for multidisciplinary research to investigate the range of factors that affect women's sexual function and wellbeing.

"Reliable information on the risks and benefits of labial surgery, as well as alternative approaches, is vital to ensuring informed choice for women."



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