Teenage girls are increasingly asking their doctors to perform cosmetic surgery on their labia.
The number of girls aged 18 and under undergoing labiaplasties has nearly doubled. In 2014, 222 girls underwent the procedure, up to 400 in 2015, according to the American Society of Aesthetic Plastic Surgery.
Labiaplasty surgery reduces the size of the labia, and is mainly requested for cosmetic reasons.
The American College of Obstetricians and Gynecologists has issued guidelines about how doctors should talk to adolescents about labiaplasty.
“Variety in the shape, size, appearance and symmetry of labia can have particularly distressing psychological effects on young women,” said Julie Strickland, the chair of ACOG’s Adolescent Health Care Committee and the lead author of the guidelines.
Ms Strickland told Vocativ the surgery comes with the risk of serious complications, including, pain, infection and scarring.
The paper suggests young women are increasingly considering labiaplasty because of "increasing trends in pubic hair removal, exposure to idealised images of genital anatomy, and increasing awareness of cosmetic vaginal surgery".
It also encourages gynaecologists to recommend nonsurgical alternatives and educate and reassure adolescents seeking medical treatment.
In 2014, Theresa May warned "designer vagina" cosmetic surgery in the UK could fall into the same category of crime as female genital mutilation.