I am writing as a retired midwife.
One trivial point: it is not vaginal surgery, it is vulval surgery. The tendency to refer to the female genitalia in its entirety with the word vaginal is an American usage which is not accurate, and as a midwife I do like accuracy in this respect.
I get the impression that young women are learning what their genitalia 'should' look like from pornography widely available on the internet and what this pornography shows are essentially prepubescent genitalia. I think this is very interesting. What is considered attractive is juvenile: hairless and with the labia minora smaller than the labia majora. As a midwife I have seen hundreds of women's genitals and it is quite normal for a mature woman to have labia minora visible outside the labia majora. It is this cosmetically adjusted version which is abnormal. And this is in a society which is obsessed with how 'evil' paedophilia is.
The labia minora are crucial in sexual arousal. They become engorged with blood while the clitoral body, which is of course invisible because it is inside, during arousal is about the same size as an erect penis. So these women after surgery are probably never going to experience full sexual arousal again. This area is exquisitely sensitive and its sensitivity must be impaired if part of it is cut off. So what is considered desirable is juvenile and incapable of full sexual arousal.
I think the fact that this is available on the NHS is a travesty given the limited resources. I can understand private cosmetic surgeons whose motivation is to make money performing this very dubious procedure. I think that what the NHS should offer is education about what is normal.
Women's sexuality has been socially distorted. When I was young feminists disabused the notion of the vaginal orgasm and were happy to acknowledge and live with their body hair. Now women are choosing to remove their body hair and have bits of their genitalia cut off to conform with pornographic images which are driven by male sexual fantasies. I think this is analogous to the high rate of caesarean sections in southern England which are partially driven by the fear of litigation and partially the preference of obstetricians but partially the choice of women who would rather have their abdominal muscles and uterine muscles cut through than give birth normally. I am shocked by the extent to which the tolerance threshold of surgery, all of which has substantial risks attached, has been lowered.
This was written in response to an article in the Guardian of 20th November 2009. A highly edited version was printed on 27th November 2009 under the name Meg. In the original I omitted to mention that these small labia minora are not only prepubescent but postmenopausal. After the menopause women lose their pubic hair and their labia minora and internal organs atrophy. I doubt however that young women think these small labia minora are attractive because they are indicative of old age, so my original emphasis on the prepubescent was more pertinent. And I stand by my belief that the horrified emphasis on paedophilia reflects a fascination with it. I think this could be considered social iatrogenesis.