More woman are seeking to reshape the folds of skin surrounding their vulva than ever before. New research has found that most women who desire surgery to reduce the size of their labia minora are driven by emotional rather than medical considerations.

“The present research findings shed new light on why women consider undergoing labia reduction surgery,” Sandra Zwier of the University of Amsterdam wrote in her study. “Extant research so far was almost exclusively conducted in a clinical context, where women aim to be accepted for the surgery and may feel awkward talking about sensitive emotional issues. Motivations recounted in the anonymous, unsolicited context of online communities are less confined by these restrictions.”

The study, published in the scientific journal Sexual Medicine, examined user comments about labial reduction surgery at four online communities: the Dutch website Medisch Foruma, the online British edition of Cosmopolitan, and the American websites The Fabulous Vagina and Experience Project.

The researcher found that most women reported only emotional motivations for considering labial reduction surgery, while a smaller percentage reported a combination of emotional and functional issues, and just 16 percent reported only functional motivations.

Overall, 71 percent of woman said they desired labial reduction surgery because the appearance of their labia minora was a source of emotional discomfort.

“Within this category of emotional discomfort, issues that focus primarily on the self (such as self-loathing and feeling ‘freakish’) were mentioned by nearly half of the members and concerned nearly one in five of all the different motivations mentioned,” Zwier said.

One woman in the study said of her genitalia: “It’s like a tongue sticking out for heavens sake!”

About half of women said they desired labial reduction surgery due to functional discomfort.

“Interestingly, however, these were mentioned by 75–100 percent of clients in clinical contexts. Particularly, functional interference with exercise, sexual intercourse, and tight-fitting clothes was reported by more than half of the women in a series of clinical studies, while each of these issues was mentioned by less than 30 percent of the members of the women’s online communities,” the researcher wrote.

“Reluctance to talk about this sensitive emotional issue, as well as fear to not be accepted for the surgery and the desire to obtain health insurance coverage, may drive women to emphasize the functional aspects in the clinical encounter more.”