title: Plastic surgery trends parallel Playboy magazine: the pudenda preoccupation.
abstract: BACKGROUND
  Aesthetic vulvovaginal procedures are being performed with increased frequency. Many experts have suggested that the growing demand for these procedures relates to the availability and revealing nature of nude images on the Internet and in other media.
  
  
  OBJECTIVE
  The authors examined chronologically organized nude photographs from a popular magazine and objectively measured the position of the vulva relative to the center of focus to observe trends for the past 6 decades.
  
  
  METHODS
  Playboy magazine centerfold photographs from 1954 to 2013 were analyzed and categorized. The positions of the vaginal area (V-line) and the breast area (N-line) were measured in relation to the horizontal midline of the photograph. Images also were assessed for degree of grooming and exposure of the breast and pubic areas, as well as visibility of the pudendal cleft, labia majora, and labia minora.
  
  
  RESULTS
  Four hundred ninety images met inclusion criteria for the analysis. Full exposure of the V-line increased from 0 instances in the 1950s to 78.6% of images from 2010 through 2013 (P<.001). Moreover, the V-line position became 41.0% closer to the photographic midline (P=.045).
  
  
  CONCLUSIONS
  The results demonstrate a trend toward increased visibility and prominence of the female genitalia as the focal point of popular nude photographs.
authors.affiliation: Dr Placik is an Assistant Professor of Clinical Surgery-Plastic, Northwestern University Feinberg School of Medicine, Chicago, IllinoisMr Arkins is a clinical researcher at a private plastic surgery practice in Arlington Heights, Illinois otto@bodysculptor.com.
authors.forename: Otto J
authors.initials: OJ
authors.lastname: Placik
authors.affiliation: Dr Placik is an Assistant Professor of Clinical Surgery-Plastic, Northwestern University Feinberg School of Medicine, Chicago, IllinoisMr Arkins is a clinical researcher at a private plastic surgery practice in Arlington Heights, Illinois.
authors.forename: John P
authors.initials: JP
authors.lastname: Arkins
mesh_terms: D059925:Anatomic Landmarks; D001504:Beauty; D001828:Body Image; D005260:Female; D006801:Humans; D010506:Periodicals as Topic / Q000639:trends*; D010781:Photography / Q000639:trends*; D011639:Public Opinion; D019651:Plastic Surgery Procedures / Q000639:trends*; D013997:Time Factors; D014621:Vagina / Q000033:anatomy & histology* / Q000601:surgery*; D014844:Vulva / Q000033:anatomy & histology* / Q000601:surgery*
keywords: female external genital cosmetic surgery; labiaplasty; pop culture; societal norms; vulvovaginal surgery