Kiwi teenagers are having cosmetic surgery on their genitals because of concerns they do not look "normal".
Experts say online pornography, Brazilian wax, fashion and perceptions of beauty were all playing a major role in skewing women's perception of what a normal vagina should look like.
Auckland genital cosmetic surgeon, Dr Murray Beagley, said the majority of his patients were young women aged between 18 and 30 including teenagers who visited him accompanied by their mothers.
Beagley said he performed about 40 operations a year and the numbers were growing.
He learnt his technique in Beverly Hills and New York.
Beagley said his patients opted for the surgery because they were dissatisfied with their genitalia.
"They don't like how it appears and looks."
Another surgeon, who wished to stay anonymous to protect his school-aged patients, said he did about 10 genital enhancement operations a year.
"There was nothing for 13 years, but about five years ago everybody wanted to have one."
He said he had operated on a teenager under the age of 18 on GP referral for abnormally large labia on one side.
The teenager, he said, had felt embarrassed and self-conscious when using common changing rooms at school.
The surgeon said he had turned down others who he felt were within the normal range.
Former President of Association of Plastic Surgeons, Dr Sally Langley said labiaplasty numbers were on the rise because more women were aware of the appearance of their vagina.
"They see pictures on the Internet etc. They are more likely to talk about it. They might think that males, partners, boyfriends are also more aware and they want to look 'normal' or typical."
Auckland Gynaecology Group clinical director Dr Guy Gudex said his clinic only did vaginal surgery for medical reasons and he had talked women out of doing it for cosmetic reasons.
"I have turned down at least two or three people including a teenager who thought she was ugly.
Langley said it was important that women were presented with all the information including recovery, discomfort/pain, complications and cost.
"It is up to them to take it further or not."
"With respect to girls under 18 years of age, we would be opposed to that.
"We should not be doing cosmetic surgery in that age group."
Christchurch-based GP Leigh Hooper said she had performed labiaplasty in her surgery on one woman and had referred a young patient to a plastic surgeon.
She had noticed a greater awareness of vaginal surgery among women.
"Now women are much more comfortable talking about it."
Association of Plastic Surgeons president John Kenealy said labiaplasty, if performed correctly, was a very effective procedure for problematically large labia, and could have a significant positive impact on quality of life and self-esteem.
A retrospective study of six women who had labiaplasty surgery for cosmetic reasons in the UK showed all women had felt 'odd' or 'weird' before surgery and thought their long labia made them into 'freaks'.
In some cultures long labia minora is deemed desirable.
A study published in the Culture, Health and Sexuality journal stated that labia minora elongation is a common practice among the members of the Baganda ethnic group in Uganda.