Author's Response

By basing their letter on “normality” not being the issue, Dr Spriggs and Prof Gillam appear to miss the crucial importance of defining normality, so that deviations from the norm can be explored and managed appropriately. Most requests for labial reduction are not linked to labial hypertrophy and our mini-review dealt exclusively with these requests in adolescence. Spriggs and Gillam concentrate on the effect of the group of women with body dysmorphic disorder (BDD) and refer to two as yet unpublished pieces of work, one of which refers to interviews with clinicians who deal with labiaplasty (plastic surgeons?). They conclude that there are situations in which labiaplasty might be justifiable ethically and might justify surgery. The problem is that the outcomes of surgery in the adolescent population are not only not defined, but that surgery in this age group would then be performed at a time that the labia continue to grow into adulthood. Surgery per se is not therefore a simple solution to a complex BDD diagnosis, certainly in adolescence, but recognition of BDD and its wider management is important. For girls who still have major concerns after “standard” reassurance then conservative supportive management should be advocated as the next ongoing line of treatment. Defining normality as being a distraction is a statement with which we cannot agree. It should be interesting to see what proportion of adolescents who request labiaplasty actually suffer from BDD, and the alleviation of psychological distress by the surgeon's scalpel does not necessarily follow (and nor is there any evidence to suggest that surgery is specifically justified in this age group). Surgery is not the easy option in this age group.