Cosmetic Surgery's New Frontier

Most women, she said, have no concept of what is normal when it comes to genital appearance or functioning. "We are particularly vulnerable to believing there is something wrong," especially if a partner says something negative, she said. She added that many women do not realize that incontinence often can be successfully treated with far less invasive methods such as exercises, biofeedback and medication.

Matlock says the exercises don't work and that laser rejuvenation is a modification of standard operations called anterior and posterior repair to fix a sagging bladder or rectum. But, he added, laser rejuvenation "goes way beyond" these procedures.

Gynecologists say that some women do report improved sexual satisfaction after standard repairs. But they note that this is incidental to the functional reasons for surgery, which carries inherent risks.

'I Did It for Both of Us'

Critics and supporters of vaginal cosmetic surgery say the mainstreaming of graphic images, including pornography, is fueling demand.

Warner and Matlock say that patients frequently request "a nice sleek look" similar to images seen in Playboy magazine and on some cable TV channels. "Women tell us they want to look like they're 18 again," Matlock said.

David Sarwer, an associate professor of psychiatry at the University of Pennsylvania School of Medicine's Center for Human Appearance, said he believes some of these patients could have body dysmorphic disorder, a psychiatric condition that affects between 7 and 15 percent of plastic surgery patients. The disorder is characterized by an obsessive focus on a minor or nonexistent physical flaw.

"Maybe some of these individuals would be better off changing the way they think about their bodies than the bodies themselves," Sarwer said.

Some women, including 32-year-old Lisseth Figueroa, an office manager in Los Angeles, say rejuvenation surgery helped rescue a foundering marriage.

Figueroa said she suffered from stress incontinence after four pregnancies and felt she was being rejected sexually. Two years ago, after hearing a friend extol the virtues of surgery, she borrowed from her mother and her boss to help pay Matlock's $15,000 fee; her husband gave her $8,000.

"I did it for both of us," said Figueroa, adding that their marriage has improved as a result of laser rejuvenation and a procedure she said Matlock suggested to beautify her genitals. "Before the surgery I felt really old . . . and ugly. Since the surgery that's changed. I'm very happy with it -- and so is my husband."

Sometimes rejuvenation is a family affair. Julie Barragan, a 31-year-old single mother who lives outside Los Angeles, underwent vaginal surgery several months after one of her relatives. Another family member followed suit.

Last July, Barragan had what Matlock calls his "Wonder Woman Makeover": several vaginal procedures, breast implants and a breast lift, abdominal liposuction and a "Brazilian butt augmentation," which involves reshaping the buttocks through a combination of liposuction and fat injections.