With face lifts, tummy tucks and breast augmentations now commonplace in the realm of plastic surgery, the newest frontier in the quest for the fountain of youth lies in a woman's most private of places.

Cosmetic vaginal surgeries have grown in popularity since their start in the blossoming pornography industry in the 1990s. Now doctors across the country offer the controversial procedures - including Pharr's Dr. Jose Fernandez.

These operations promise to increase sexual pleasure and restore sexual confidence, claims that have drawn the ire of the Society of Gynecological Surgeons. Labiaplasties and vaginal tightening surgeries aren't the miracle operations they might seem to be, Dr. Thomas Stovall, a former president of the organization told the New York Times in 2006. Women face the danger of developing infection and scar tissue, which can decrease sensation in their genitals or even cause pain.

Stovall also insists that "there is no scientific basis" to support claims that the procedures can increase sexual gratification - although he did concede they might make sex more pleasurable for a patient's partner.

In 2005 the American Society of Plastic Surgeons reported 793 vaginal rejuvenation surgeries, but the actual figure is probably higher. The organization stopped keeping record of the surgeries in 2006, but reported 1030 surgeries that year, according to a spokesperson. Many doctors who perform genital reconstructive surgery are gynecologists, but the American College of Obstetricians and Gynecologists does not record such statistics.

There are three types of genital reconstruction.
>> Vaginoplasty reconstructs the vulva and includes procedures such a trimming the labia minora or majora, elevating the pubis and unhooding the clitoris.
>> Vaginal rejuvenation refers to tightening vaginal muscles which have become "loose," usually after childbirth. Although this surgery has been performed in the United States for more than a decade, its original purpose was to treat urinary incontinence, not to increase sexual satisfaction.
>> Hymenoplasty restores the hymen, and thus the appearance of virginity.

San Antonio-based Ob/Gyn Troy Robbin Hailparn of the Laser Vaginal Rejuvenation Institute of San Antonio argues such procedures are transformative, necessary and safe. In the past five years, she has performed 1,200 operations on 750 women. She argues that the field of gynecology has consistently ignored sexual function problems that can occur after childbirth.

"Nobody's addressing sexual issues if a woman's not having bladder or rectal problems," she said.

Hailparn tries to give women back their sexual confidence through surgery, but also finds herself fixing anatomical problems that in many cases cause embarrassment or discomfort during sex.

She's treated women as young as 14 and as old as 74.

"Everybody deserves to have good sex till they're dead," she said.

Dr. Ricardo Rodriguez, a plastic surgeon in Baltimore, believes the trend in labiaplasty is linked to more women shaving their pubic areas, who tend to notice details about their exposed anatomy they would have otherwise overlooked.

"The pubic hair was obscuring those details," he said.

Although Rodriguez performs a fair amount of labiaplasties, with 60 percent of his patients coming from out of town, he does not do functional vaginal operations, which he believes are men's way of simplifying sex.

"Women look at sex in a whole lot more global way than a guy," he said. "I think that a woman's sexuality is much more complicated than a G-spot or making it tighter. That's a man way of thinking about. Any women tying all of her sexually to one part of their body ... have a lot of other issues."

Labiaplasties are merely cosmetic, with no promise of functional change. Most of the patients he sees are simply uncomfortable with their protruding labia but lack an overlay of other psychological problems, Rodriguez said.

Before agreeing to perform the operation Rodriguez asks his patients why they want the surgery --- if they say, for example, they are having a bad relationship with their husband and feel this operation will make the problems go away, he refers them to counseling.

Fernandez, the doctor in Pharr, did not respond to multiple requests for an interview.

Let Nature Be

But while the number of doctors performing this surgery is increasing, a growing number of feminists are rebelling against what they deem as yet another label being placed upon them.

The porn industry has set many standards of how women should look, said Jennifer Mata, coordinator of the Women's Studies at UTPA. Many of those standards were constructed by men to please their fantasies, not the fantasies of women.

Because few women do not have the opportunity to see the genitalia of other women, the images women see in pornography are often the standard - although unrealistic - that they compare their bodies to, Mata said. In that sense the idea of a "perfect" vagina is imposed on women by a society. The pornography industry is very misogynistic and that can be hazardous to women, Mata said.

"I think women do internalize that (and it creates an) inferiority complex when they see standards they can't live up to," she said.
This idea of beauty is echoed in the pictures that women bring to the offices of doctors who perform these procedures. Many of those are graphic shots of women's genitals as they are captured on the pages of Playboy and other magazines, as well as the internet.

"This construction of an idealized beauty that isn't natural," Mata said. "That does lead to control of women in the bigger picture, women can never really look like that and feel bad about themselves and never be truly empowered."
Paige Lauren Deiner covers features and entertainment for The Monitor. You can reach her at (956) 683-4425. You can reach her at (956) 683-4425.