The aims of this study were to develop a new Genital Appearance Satisfaction (GAS) scale, to use this to describe genital appearance satisfaction in a general population sample, and to explore its relationship to self‐esteem, body satisfaction, and appearance schemas. This was prompted by a clinical need to respond appropriately to women requesting surgery to reduce the size of their labia minora. The questionnaire measures were completed by a general population sample of 135 women (63% response rate). Responses to individual GAS items covered the full range of the rating scale, confirming that there are measurable differences in women's reported satisfaction with all aspects of genital appearance. Principal components factor analysis revealed three factors, ‘Appearance of genitals’, ‘Impact on daily living’ and ‘Impact on sex’. Total GAS scores were very significantly correlated with appearance schemas (r = .28, p<.01), body satisfaction (r = .30, p<.01) and self‐esteem (r = −.41, p<.01), but multiple regression analysis showed that when all three variables were entered, only self‐esteem significantly predicted Genital Satisfaction (beta = −.38, p = .002). Dissatisfaction may be linked to psychosocial factors such as self‐esteem, and surgery may not appropriately address these concerns.