Young echoes an often-heard conviction of plastic surgeons offering the new procedures: "I don't want to hear from a patient that they're doing it for someone else, that 'my husband or boyfriend said he doesn't like the way I look,' " he says. "That's a dead-end."
But he acknowledges there's at best a "subtle difference" between a woman seeking surgery to increase her own self-confidence and the one who does so in hopes of pleasing the man or men in her life.
Many women who come to Alter's office are more focused on improving the look of their genitals than correcting a defect in their function, he says. But he refuses to dismiss their concerns as a form of "body dysmorphia" -- the kind of wildly distorted body image that afflicts, for instance, those suffering the eating disorder anorexia nervosa.
For women whose sexuality is profoundly linked to self-esteem, Alter insists that improving appearance does improve sexual function, and helping women improve the quality of their lives is worth the risks that come with surgery.
"I hear people say, 'Who cares anyhow how someone looks down there?' " says Alter, who performs about 15 labia reduction surgeries, one of his specialties, a month. "My response is, 'You look down there and the other person who counts most of all, your partner, does, and that's enough. People do look down there, and no one likes to feel they're a freak.
"My view is that the operations I do are extremely safe, they have negligible risks and an incredibly high satisfaction rate. What's the problem?" Alter says.
The problem, says Mitchell of the Adult Industry Medical Healthcare Foundation, is that women, whether they are porn stars or would like to look like them, would do better to accept themselves -- to "dance naked in front of the mirror until they like what they see."
And those tempted to go under the knife after admiring the genital proportions of a porn star should remember, she adds, that there is more than just youth and beauty at work in adult films: There is considerable cinematic sleight of hand.
"It's still a fantasy, still a projection," says Mitchell, who notes that vaginal wrinkles or asymmetrical labia can be airbrushed as readily as a pimple. "This is still moviemaking, regardless of how cheap."
