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In the U.S., the cosmetic procedures are advertised mostly online and come with promises of increased sexual fulfillment. Vaginoplasty, for example, which costs some $6,500 and is popular with women in their late 30s who have had children, is designed to restore vaginal tightness. The surgery, according to Stern's Web site, "can usually correct the problem of stretched vaginal muscles resulting from childbirth(s), and is a direct means of enhancing one's sexual life once again. The procedure typically tones vaginal muscle, resulting in greater contraction strength and control, thereby permitting greater sensation during sexual experiences." "Women ask, 'Will I have an orgasm if I never had one before?' and I tell them no," Stern says. "This operation will restore the vagina to the way it was when you were 18 or 20 years old, before you had children." Equally popular is labiaplasty, which costs some $5,500. Stern says women come to him distressed by large or disproportionate labias and though he admits there's no real need for "pretty labia," he says that the operation can also have a functional aspect. Some women, he says, wish to rid themselves of the discomfort from wearing tight pants or horseback riding. His Web site, www.cosmeticsurgery2.com, includes before and after pictures of patients who have undergone the procedure.

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