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."