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(INDIANAPOLIS STAR) -- They call it a designer vagina.

A little tightening here. A little plumping there.



Yes. We're talking plastic surgery - down there.



Blame it on erotic media. Blame it on the fragile egos of some men. Blame it on Brazilian waxes that uncover what things really look like. Blame it on a relentless pursuit of perfection.



But the number of women seeking surgery in their nether regions is growing - and so is controversy surrounding the practice.



After all, Grandma didn't even talk about that area. Mom just lived with it. But with the advent of the Internet, Playboy, pornography and pop culture ("Dr. 90210" featured the subject on a recent episode), women realized they had options.



"It's like anything else. Once people become aware something can be done, they want to do it," said Dr. Janet Turkle, with Turkle & Associates Plastic & Reconstructive Surgeons in Carmel, Ind. "It's not that their vagina is abnormal. It's just not what they would like it to be."



In reality, what most women have down there is normal. After childbirth and with age, the opening loosens as muscle tone diminishes. As the vagina matures, the labia (outer and inner lips) also change. The color of the whole package becomes darker, less pink.



There's something to fix all of those nuisances. And women are taking advantage.



The number of purely cosmetic operations for vaginal rejuvenation, as the umbrella of surgeries is known, has spiked in the past five years, according to the American Academy of Cosmetic Surgery.



There are nearly 60,000 of those surgeries performed annually in the U.S., the academy estimates. Ten years ago? The category was virtually nonexistent.



"I don't think it's absolute 100 percent mainstream, but it's something that has become more and more so," Turkle said.



Indianapolis even has its own Laser Vaginal Rejuvenation Institute. The doctor there, James Brillhart, runs ads in local women's publications that read: "There are some places that exercise just can't tighten."



Brillhart did not respond to requests for an interview.



Neither did Michelle Jones Singer, a Fishers, Ind., cosmetic surgeon, who wrote a blog called "Can Vaginoplasty Get Your Sexy Back?"



In it, she explains: "As we age, things become looser everywhere. We start to wrinkle as our facial tissues become looser; our breasts start to droop with age; our butts lose volume and become droopy and flat and, unfortunately, so does our vaginal area."



Later, she claims, "Sex is righter when you're tighter."



As with any major surgery, there are risks. In rare instances, complications can include permanent scarring, a loss of sensation or botched appearance.



Vaginoplasty is one of the more common surgeries in the realm of gynecosmetology.



In essence, it tightens the vagina by getting rid of excess lining and tightening the soft tissues and muscles. The surgery, which costs an average of $6,000, is a two-hour procedure without overnight stay.



While the patient often claims she is the one who wants the surgery, local surgeons say they've heard otherwise.



"The 'significant other' claims there is a problem with them," Turkle said. "Sometimes the problem is not with the patient but with the lack of endowment of the other person. People are fixing things that may not be broke."



There are instances, however, when women want vaginal surgery for their own comfort, said Kay Eigenbrod, a gynecologist with St. Vincent Medical Group.



That comes in the form of a labiaplasty. As women get older, the inner labia often protrude and the outer labia shrink, she said.



"The inner lips kind of dangle," Eigenbrod said.



The protrusion can be uncomfortable when riding a bike and even having sex. But more often than not, women say they don't like the way it looks in a bikini or yoga pants.



"It's often more cosmetic than functional," Eigenbrod said.



Cosmetic has become the way of the vagina.



It started with a nice shave. Then the Brazilian wax. Today, you can get vajazzled, a treatment where pretty beads are glued to the labia. There is a dye on the market called My New Pink Button, aimed at bringing the vagina back to its youthful color.



And there are vulvacials. Think a facial for the vagina.



Surgery was just the next logical step in a society where women are really sprucing up, said Alex Kuczynski, who writes for The New York Times and is the author of "Beauty Junkies."



She actually had one of those vagina facials. And wrote about it. She hasn't been back.



As for the latest vaginal surgery craze?



"It seems vaginal rejuvenation is so mainstream now one of the 'Real Housewives' put the cost of hers in in her recent divorce settlement," Kuczynski wrote in an email interview. "Yeesh."



It all prompts the question: Why do women feel the need?



"Female beauty standards are incredibly narrow and do not allow for the natural variation that exists among women," said Ann Savage, a professor at Butler University who studies gender, women and sexuality.



Pornography presents women with manufactured and unnatural features, yet they feel they must live up.



On the other hand, Savage can see it as an empowering choice for a woman if it is her choice.



"I find it less problematic," she said, "if a woman chooses to have surgery for her sexual pleasure."

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