Intimate makeover

SINCE the dawn of its days as a medical specialty, plastic surgery has been marching inexorably down women's bodies, straightening, slimming, tucking as it goes, restoring the appearance of youth to features sagging with age and smoothing those marked by eccentricity.

Plastic surgery's southward expansion has now entered territory long thought sacred. Today, the vagina and its neighbors -- the labia majora, the labia minora, the clitoral hood -- are the latest bit of feminine real estate considered to be blighted by age or otherwise in need of renovation, beautification and rejuvenation.

Across the country, post-pubescent and peri-menopausal women alike are having their vaginas tightened, their mons pubis liposuctioned, their labial folds nipped and their clitoral hoods tucked. Most are seeking to restore what plastic surgeons are calling "a more youthful look" to this long-secreted corner of the female anatomy and often to improve their sex lives in the process. (In some cases, women with few pretensions to virginity are surprising their partners by having their hymens surgically restored.)

Other women, bothered by the imperfect proportions of their genitalia, undergo surgery just to bolster their self-image -- a boost that often pays sexual dividends as well.

"I was the type who always wanted to have the lights down low" when having sex, says Holly, a 50-year-old medical assistant who recently had surgery to trim her labia minora and who asked that her last name not be used to maintain her privacy. "Just being comfortable with my body, this was huge for me. I was able to be sexually confident."

Even as the small but growing group of genital plastic surgeons devise new and better surgical techniques, they acknowledge the standards women hope to achieve are set mostly by adult film actresses, strippers and nude denizens of the Internet.

"I know what women want," says Dr. David L. Matlock of Los Angeles, an obstetrician turned plastic surgeon who has been a pioneer in devising and popularizing the procedures. He knows, he says, because so many of his patients tote their husband's or boyfriend's magazines into his office and point to photos almost as explicit as the before-and-after ones posted on many surgeons' websites.

More traditional plastic surgeons and gynecologists may be reluctant to endorse such procedures, but the demand is undeniable. Vulvar and vaginal plastic surgery is one of the fastest-growing areas in plastic surgery, say some in the field.