In a world where young women are bombarded with ads and photo spreads featuring flawless models, it’s no surprise that they worry about their own physical imperfections. Girls have stressed over being overweight, the size of their breasts, body hair, a big nose… the list of concerns seems to get longer every day: The latest addition is the vulva.

Marketed as “vaginal rejuvenation,” labiaplasty consists of tightening the skin around the vagina and shaping the labia. Usually it is women who are older or have given birth who ask for the procedure. But lately, younger women have been requesting a cosmetic trim for their labia minora. The American Society for Aesthetic Plastic Surgery reported that 400 girls under the age of 18 had a labiaplasty last year, an 80 percent increase from 2014. This is a small number overall, but The New York Times reports that the uptick is likely understated because the report does not include procedures performed by gynecologists.

Dr. Julie Strickland, the chairwoman of the American College of Obstetricians and Gynecologists’ committee on adolescent health care said clinicians are “sort of baffled” about the increase in demand for surgery among teenagers. Regardless, the committee released a guide for physicians last week, reminding clinicians to reassure and teach patients that their body is normal and healthy, and to suggest alternatives to surgery that may alleviate discomfort in the area. The guide also urges them to screen patients for a possible psychiatric disorder that causes obsession over imagined physical defects.

The guide doesn’t have a strict guideline against labiaplasty for teens, since in some cases the surgery is requested because of pain or discomfort, but it does say the procedure is rarely appropriate.

“It should not be entertained until growth and development is complete,” Strickland said. “The big thing I tell my patients about labiaplasty is that there are a lot of unknowns. The labia have a lot of nerve endings in them, so there could be diminishment of sexual sensation after surgery, or numbness, or pain, or scarring.”

Though girls under 18 account for only 2 percent of cosmetic operations in general, they make up nearly 5 percent of all labiaplasties. Some doctors say more girls today shave or wax their public hair, visibly exposing the genital area. One 2012 study reported that over 70 percent of women aged 12 to 20 routinely shaved or waxed the pubic area. Another possible reason for the increase is access to the internet — girls today can find images of the vulva on the web. Doctors say many times these images are airbrushed and don’t portray the huge rage of normal variation in color, shape, size, and symmetry that’s possible in healthy vulvas.

Dr. Richard Swift, a board certified plastic surgeon with a practice in New York City, told the New York Post that while many women pursue labiaplasty for better sexual performance or to avoid discomfort, some want the surgery for purely cosmetic reasons, like their appearance in tight-fitting workout clothing.

“For those whose labia are enlarged, they can make them feel uncomfortable and exposed,” Swift said. “One of my patients was particularly self-conscious doing Pilates in a leotard — so much so that she was afraid to do certain moves.”

Depending on their intensity, these kinds of concerns could be symptoms of body dysmorphic disorder, in which a person develops a debilitating preoccupation with a physical defect. The committee’s new opinion mentions that doctors should screen for the disorder. Dr. Katherine Phillips, the director of the Body Dysmorphic Disorder Program at Rhode Island Hospital, said that cosmetic surgery doesn’t help the condition. “Sometimes, patients get a lot worse” after an operation, she said.