A mother has said her teenage daughter's genitalia is "abnormal" and she needs plastic surgery to get a "designer vagina".
Daughter Alana, not her real name, has been told by her mother her vagina is untidy and helped her seek medical help, news.com.au reported.
Her inner labia protrudes past the outer labia and her mother is fighting doctors to change the appearance.
"Normal women are neater," the mother told doctors.
"She will never be able to have sex looking like that."
Alana is not suffering from any medical condition that requires her to get a labiaplasty, and it's completely for cosmetic reasons.
The unbelievable story has emerged as a case study in a new book When Doctors and Patients Disagree.
Its release comes just weeks after 6-year-old Oshin Kiszko's family won a court case against doctors, to stop giving the young boy cancer treatment.
When Alana and her mother went to see their doctor, the GP told them there was a range of different labia sizes, but the mother was insistent that Alana needed the surgery.
Alana remained quiet during the consultation and when the doctor asked what she thought about the surgery, she shrugged her shoulders and said she would like to have it done.
Research fellow at the Children's Bioethics Centre and Royal Children's Hospital in Melbourne, Merle Spriggs, said in the book this cosmetic genital surgery case was not driven by a medical condition, but by beliefs and preferences about appearance.
Dr Spriggs said an audit of referral letters for labiaplasty surgery at the Royal Children's Hospital showed about 25 per cent were mothers raising the idea.
A large inner labia can leave some women embarrassed and it can sometimes even rub, causing uncomfortable chaffing, but only in extreme cases.
Incoming president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Professor Steve Robson, said labiaplasty surgeries were an emotive issue.
"It's really taken off," he said.
"Over the past few years people have been trying to work out why there has been such a surge."
Professor Robson said it was incredibly risky performing plastic surgery on anybody under 18.
"Every single adolescent, whether male or female, goes through a phase of questioning whether they're normal or not," he said.
"Having your mum say a man wouldn't want to make love with you because you're untidy is not particularly helpful parenting.
"The thing we need to stress to both young men and women is intimate relationships are about being a good person and the quality of your heart and not the quality of your genitalia."
Professor Robson said people were impressionable in their teenage years and focusing on the appearance of your genitalia was a "terrible message for society".
He said the surgery was becoming more popular because the trend of removing pubic hair made the labia more noticeable.
"There's also been a huge explosion in the availability of intimate images over the internet and both men and woman have been watching porn, thinking that's what they're meant to look like," Professor Robson said.
"There's a huge variation of normal shapes and sizes of the labia and it's not appreciated by people. Women won't look at other women, they look in magazines and get unrealistic expectations of what is normal. There are some cases where it is abnormal and uncomfortable for women but labiaplasty requests are often made by women in relationships."
Professor Robson said many labiaplasty surgeries were unnecessary.
"On one occasion I saw a woman who was completely in the range of normal but she said 'you really have to do an operation on my labia, my boyfriend says he doesn't like the look of it and won't make love to me'. The problem is with her boyfriend, not her labia," Professor Robson said.
News.com.au reported earlier this year an increasing number of Australian teenage girls had "genital anatomy anxiety".
A third of GPs had consultations with girls younger than 18 wanting to trim their genitalia.
The GPs said women who requested the surgery could be suffering from a range of mental health issues, including anxiety, body dysmorphic disorder, depression or eating disorders.
Between 2000 and 2011, Medicare claims for vulvoplasty and labiaplasty grew from 640 annually to 1565 per year, according to a Women's Health Victoria report.
"It would be a really valuable thing for women to get their head around what's normal is not what you see in images. It should be all about the connection of minds, hearts and how things feel rather than how it looks," Professor Robson said.
Dr Spriggs outlines in the book that there aren't common physical complications with labiaplasty surgery, but Alana could suffer from possible psychological burdens.
"Alana's mother is basing her request for cosmetic surgery on Alana's appearance," she said.
"Adolescene is a time of heightened vulnerability to the opinions of others and body image is an important issue for teenagers as they undergo major changes."
Research fellow in ethics at the Children's Bioethics Centre and at the Centre for Health Equity at the University of Melbourne, Rosalind McDougall, contributed to the book about conflicts between doctors and parents.
"With parents' access to online information, disagreements between doctors and parents are more likely that in the past," she said.
"Parents are more likely to arrive at a consultation with strong views about how their child should be treated."
Dr McDougall said doctors and parents mostly agreed on the best treatment for a child, but when deep disagreements did occur, it could be challenging for doctors and families.
"Parents might prefer natural therapies, parents might have religious views that preclude particular treatments such as blood transfusion, parents might have heard about possible treatments though social media or overseas-based websites," she said.
"Our book is exploring the idea that it is ethical for doctors to accept a good-enough option, rather than insist on the best possible treatment when there is a deep disagreement with the parents.
"Parental discretion ends at the point where their decision is harmful to the child."