early post-operative period, because of the edema caused by the anaesthetic solution injected to swell the tissues. she is also instructed on the proper cleansing of the surgical wound site, and the application of a topical antibiotic ointment to the reduced labia, a regimen observed two to three times daily for several days after surgery. the woman's initial, post-labiaplasty follow up appointment with the surgeon is recommended within the week after surgery. she is advised to return to the surgeon's consultation room should she develop hematoma, an accumulation of blood outside the pertinent (venous and arterial) vascular system. depending on her progress, the woman can resume physically unstrenuous work three to four days after surgery. to allow the wounds to heal, she is instructed not to use tampons, not to wear tight clothes (e.g. thong underwear), and to abstain from sexual intercourse for four weeks after surgery. medical complications to a labiaplasty procedure are uncommon, yet occasional complications – bleeding, infection, labial asymmetry, poor wound-healing, undercorrection, overcorrection – do occur, and might require a revision surgery. an over-aggressive resection might damage the nerves, causing painful neuromas. performing a flap-technique labiaplasty occasionally presents a greater risk for necrosis of the labia minora tissues. criticism further information: body dysmorphic disorder, female genital mutilation, and labia pride movement protest march in london opposing cosmetic labiaplasty surgery labiaplasty is a controversial subject. critics argue that a woman's decision to undergo the procedure stems from an unhealthy self-image induced by their comparison of themselves to the prepubescent-like images of women they see in commercials or pornography. in australia, the royal australian college of general practitioners has issued guidelines on referring patients with dissatisfaction with their genitals to specialists. a change in requirements of publicly funded australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the numbers of surgeries performed. unlike public hospitals, cosmetic surgeons in private practise are not required to follow these rules, and critics say that "unscrupulous" providers are charging to perform the procedure on women who would not undergo it if they had more information. increasing numbers of women in western countries are also using brazilian waxing to remove pubic hair, and choosing to wear tight-fitting swimwear and clothing. this has led to increased numbers of women complaining of pain and discomfort from chafing of the labia minora, as well as cosmetic concerns around how the appearance of genitals. in many countries, media regulation classifies "hardcore" and "softcore" pornography – demanding that magazines with "hardcore" pornography be wrapped in black plastic and sold only to people over 18 who show photo id. sales of magazines in black plastic tend to be low, and thus many magazine publishers choose to comply with the "softcore" standards. in australian magazines, images of vulvas that do not look like "a single crease" are digitally modified to comply with the censorship standard. an australian pornographic actress says that images of her own genitals sold to pornographic magazines in different countries are digitally manipulated to change the size and shape of the labia according to censorship standards in different countries. community opposition to sex education limits the access that young women have to information about natural variation in labias. linda cardozo, a gynaecologist at king's college hospital, london, told the newspaper that women were placing themselves at risk in an industry that is largely unregulated. nina hartley says that "she’s seen every type of vulva in her three decades working in the industry. when young women start out in porn, producers don’t send them off for a routine labiaplasty." although female genital mutilation – the practice of cutting off a woman's labia and sometimes clitoris, and in some cases creating a seal across her entire vulva – is illegal across the western world, davis argues that "when you really look carefully at the language used in some of those laws, they would also make illegal the labiaplasties that are being done by plastic surgeons in the u.s." the world health organization (who) defines female genital mutilation as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons." the who writes that the term is not generally applied to elective procedures such as labiaplasty. the american college of obstetricians and gynecologists (acog) published an opinion in the september 2007 issue of obstetrics & gynecology that several "vaginal rejuvenation" procedures were not medically indicated, and that there was no documentation of their safety and effectiveness. acog argued that it was deceptive to give the impression that the procedures were accepted and routine surgical practices. it recommended that women seeking such surgeries must be given the available surgical-safety statistics, and warned of the potential risks of infection, altered sensation caused by damaged nerves, dyspareunia (painful sexual intercourse), tissue adhesions, and painful scarring. in the uk, lih mei liao and sarah m. creighton of the university college london institute for women's health wrote in the british medical journal in 2007 that "the few reports that exist on patients' satisfaction with labial reductions are generally positive, but assessments are short-term and lack methodological rigour." they wrote that the increased demand for cosmetic genitoplasty (labiaplasty) may reflect a "narrow social definition of normal." the national health service performed double the number of genitoplasty procedures in the year 2006 than in the 2001–2005 period. the authors noted that "the patients consistently wanted their vulvas to be flat, with no protrusion beyond the labia majora ... some women brought along images to illustrate the desired appearance, usually from adverts or pornography that may have been digitally altered." the royal australian and new zealand college of obstetricians and gynæcologists published the same concern about the exploitation of psychologically insecure women. the international society for the study of women's sexual medicine produced a report in 2007 concluding that "vulvar plastic surgery may be warranted only after counseling if it is still the patient's preference, provided that it is conducted in a safe manner and not solely for the purpose of performing surgery".