Women are now more concerned than ever about the appearance of their genitals. The convergence of the trend to remove pubic hair which leaves the vulva more visible and open to scrutiny, the normalization of oral sex, and the ubiquitous exposure to pornography and the unrealistic ideals it creates, have led an increasing number of women to feel serious anxiety about their own genitalia. Frequently this manifests as a lack of self-confidence or diminished body self-image; for an increasing number of women, the level of psychological distress is so severe that they undergo genital cosmetic surgery. Labiaplasty (reduction of the inner labia, most often for cosmetic purposes) is now the fastest growing type of cosmetic surgery and is in many ways following the same growth pattern and cultural acceptance as breast augmentation did in its early years.

While vulvas are more visible than ever, most women still have a strong sense of shame with regard to discussing or displaying their own, or looking at another's vulva. Pornography, whether online or in print, has come to serve as a very common tool by which women and men learn about sexual behavior and anatomy. Unfortunately, pornography depicts a severely limited scope of genital diversity. Analyses have found that there is a strong tendency to display genitals at the extreme end of the range of diversity: small, hairless and with little or no visible inner labia. This misrepresentation is dangerous as it conveys an artificial norm to which women often feel they need to conform.