Intimate makeover

Many of the techniques have been practiced for decades by obstetricians and gynecologists to repair childbirth-related injuries, and by urologists and reconstructive surgeons who repair birth defects or perform sex-reassignment surgery. But in the late 1990s, a few surgeons began offering the procedures as a means to enhance the aesthetic appearance of women's genital organs and, in some cases, to improve sexual function.

Today, in a field that assiduously tracks the demand for tummy tucks, butt lifts and breast implants, there is no data to gauge the scale of demand for these procedures. But there are signs that genital plastic surgery has appeared on the radar screens of social trend-watchers and the medical profession itself.

Next year, the American Society of Plastic Surgeons expects to begin collecting data on the number of vulvar and vaginal procedures its members are performing. Several practitioners of the new procedures, including a pair of Los Angeles plastic surgeons, have been profiled on cable TV shows pitched to viewers hungry for news of the beautiful and famous. And members of the American College of Obstetricians and Gynecologists have begun grumbling that it's an issue on which they need to weigh in.

But Dr. V. Leroy Young, who chairs the Emerging Trends Task Force of the American Society for Aesthetic Plastic Surgery, says the true gauge of these procedures' popularity may lie precisely in the fact that, far from either coast, conservative heartland women are paying doctors like him to perform them.

Young performs about two to three vulvar procedures a month on women who "would never dare ask the question at a church social," but who can now learn about such procedures on the Internet and on TV. "It's right here in middle America," says Young, whose practice is based in Creve Coeur, Mo., a suburb of St. Louis.

Porn-star standards

Southern California -- the seat of the adult entertainment industry -- is undeniably the birthplace of this fledgling field of surgical alteration.

In 2000, many Americans learned about a new procedure called labiaplasty when a porn star known as Houston had her labia-reduction surgery filmed and distributed to subscribers, then later auctioned off the excised flesh over the Internet.