Melanie Berliet, young, single and without children, arrived at a New York City medical clinic seeking a "complimentary consultation" for the latest in cosmetic surgery -- vaginal rejuvenation.
The 30-year-old writer posed as a patient in search of fodder for a story, and got an education in how doctors can tighten flabby tissue in a vaginoplasty, cut back the inner and outer lips of the labia and sometimes open the clitoral hood.
Berliet wrote about her experience in an article called "Designer Parts," for the Atlantic magazine.
The doctor was professional, Berliet told ABCNews.com, but after the physical exam, his "pushy" colleague, left alone with Berliet to answer her questions, was "an incredible enthusiast.
"She essentially told me my boyfriend would propose to me after the surgery was done," said Berliet. "If women are at all insecure and go for a consultation, it makes you feel more vulnerable and insecure. The vagina on the charts looked like a porn star."
Corrective gynecological surgery has been available for decades to help women with incontinence or sagging of the vaginal canal after childbirth.
But experts say thousands of women, especially younger ones, now seek such procedures as vaginoplasty and labiaplasty, which can cost between $3,000 and $10,000 and are not covered by insurance, to enhance the appearance of their genitalia or to achieve some sort of sexual ideal. The American College of Aesthetic Plastic Surgeons reports 2,140 women elected such surgeries in 2010. The International Society of Aesthetic Plastic Surgeons says twice as many have been performed in the U.S. annually -- nearly 5,200.
But these numbers might be on the low side. "We don't know the exact number, because a lot are done at surgery centers and it's hard to keep track," said Dr. Cheryl B. Iglesia, a reconstructive pelvic surgeon and director of the female program at the National Center for Advanced Pelvic Surgery in Washington, D.C. "There isn't a code that we have. And people are paying cash up front.
"It's really concerning, because [the trend] is really reaching younger ages, in their teens," Iglesia said. "I heard of a mother taking in a 16-year-old and 11-year-old wanting to get it done. It's just not right." In an editorial in the June issue of the journal Obstetrics and Gynecology, Iglesia said women were being "misled or confused about what is 'normal.'"
"There are great variations of "normal," Iglesia said. "Labia can be anywhere from 5 millimeters to 5 centimeters."
She said that Internet pornography and removing pubic hair through Brazilian waxing or shaving give women unrealistic expectations about their bodies -- or what they believe men like or want -- and goes as far as to compare vaginal rejuvenation procedures to "new age female circumcision."
In 2007, the American College of Obstetricians and Gynecologists warned about vaginoplasties and labiaplasties that were not medically indicated, questioning their safety and effectiveness.
The biggest risks in such procedures are infection, altered sensation, dyspareunia (painful contractions of the vagina), adhesions and scarring, according to ACOG, which says women need to be informed about the lack of data on these procedures and their "potential complications."
Iglesia said she had done reversal procedures for women whose vaginoplasties were so tight, they had pain during sex.
Others had labiaplasty that left them with labia that "looked like Swiss cheese," Iglesia said. Sometimes the nerves around the clitoris were damaged.
Online forums reveal numerous accounts of "botched" surgeries.
"Six weeks ago a surgeon ... sewed my perineum/labia up over the opening to my vagina, covering it like a biological chastity belt," wrote one woman on the site Real Self. "I can't have sex or a gyn exam and am in pain from the pulling/tearing at that spot. ... She tore the right labia minora and made it one third the size of left labia minora, but I'm not correcting that -- too painful."
Iglesia believes women have been "duped" by an entire culture that is oversexualized.
"Everyone sees 'Sex in the City' and are getting their public hair removed and looking down there," she said. "They are watching Internet porn and looking at Playboy and Penthouse with a lot of touched up and airbrushed pictures."
With pubic waxing and grooming, younger women are "comparing," she said. "They feel like they are abnormal."
Surgeon Covered Up Vagina Opening
Dr. Bernard Stern, an Alexandria, Va., ob/gyn certified in plastic surgery, who has performed nearly 3,000 vaginal rejuvenation procedures, acknowledged there were practitioners who were not properly trained but said it was up to women themselves to check for credentials and photos of results.
"I never suggest to any woman that she 'needs' vaginal cosmetic surgery," said Stern.
While Stern said he never explicitly tells women his procedure will make them more sexually attractive, his website, with a photo of him leaning over a sexy woman's backside on an exam table could suggest otherwise. The woman is wearing high heels and smiling.
Stern told ABCNews.com that he requires all his patients to undergo psychological testing before he will perform vaginal rejuvenation procedures, and he often turns women away, particularly if their husbands or partners are pressuring them to have the surgery.
All Stern's patients must sign a three-page consent form that explains the potential risks and benefits of vaginoplasty and labiaplasty.
"I have never had a patient lose sensation from a vaginoplasty and from a labiaplasty (done properly). The only thing lost is pain from stretching, pulling, getting stuck," said Stern.
"I am not guaranteeing increased sexual response," he said. "If a woman perceives her labia and or vagina as improved from vaginal cosmetic surgery, it can affect her quality of life and self-esteem, and therefore she may experience increased female sexual response."
The American College of Obstetricians and Gynecologists and Iglesia's biggest criticism of vaginal rejuvenation is the absence of blind studies, the scientific gold standard that requires the subject or the investigator (or both) is unaware of which subjects are in the experimental or control groups.
Stern said he had developed his own techniques that his studies have found to be safe. He acknowledged, though, that his studies were "retroactive" -- he surveyed patients after he'd treated them.
Berliet, the writer who went undercover to investigate vaginal rejuvenation for the Atlantic, said the doctor she saw was upfront about the risks and potential rewards of vaginal rejuvenation.
She doesn't fault the medical profession as much as a society that places more value on cosmetic surgery than sex education.
Berliet cited an August 2011 study in the British Journal of Medicine that found 40 percent of women who'd asked about genital reconstruction "reported the desire to go through with it even after being informed that their labias were normal."
"Young girls should know what anatomy looks like," said Berliet. "Male genitals just hang out and you can sense a variation in what a penis looks like. But girls' are tucked between their legs, and they assume the worst in the body part.
"We are a culture that embraces plastic surgery in other ways to improve ourselves," she said. "It's scary."
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