context: Vaginoplasty is a procedure that aims to "tighten up" a vagina that's become slack or loose from vaginal childbirth or aging. Some surgeons claim it can even improve sensitivity -- a claim the American College of Obstetricians and Gynecologists ( ACOG) has strongly challenged. While it's true that vaginal tissues can stretch, surgically tightening the vaginal tissue in itself cannot guarantee a heightened sexual response, since desire, arousal, and orgasm are complex, highly personal responses, conditioned as much by emotional, spiritual, and interpersonal factors as aesthetic ones. In addition, sexual "sensitivity" doesn't automatically lead to more pleasure - it can actually lead to pain. Labiaplasty, plastic surgery on the labia (the âlips" surrounding the vagina), can be performed alone or with vaginoplasty. Surgery can be performed on the labia major (the larger, outer vaginal lips), or the labia minor (the smaller, inner vaginal lips). Labiaplasty changes the size or shape of the labia, typically making them smaller or correcting an asymmetry between them. In order to decide if you should consider vaginoplasty or labiaplasty, it's important to understand the difference between reconstructive surgery and cosmetic surgery. Reconstructive surgery improves the function of a body part, while cosmetic surgery changes the aesthetics of essentially normal anatomy. You can think of it like a nose job: a surgeon can restructure the interior nasal cavities to help you breathe better or reshape the nose, just for the sake of appearances. It's a critical distinction, because the American College of Obstetricians and Gynecologists evaluates surgeries and outcomes to fix functional problems, such as urinary incontinence. But ACOG remains skeptical and cautious about cosmetic vaginal surgery due to its risks and lack of scientific data on safety and effectiveness. Some vaginoplasty procedures, for instance, were originally developed as reconstructive surgeries to repair birth defects when the vagina was malformed, too short, or absent (such as in vaginal agensis), so that a girl could grow up to have normal urination, menstruation, and intercourse. More recently, vaginoplasty has grown into a group of cosmetic surgeries marketed as "vaginal rejuvenation" and "designer vagina" procedures. Plastic surgeons and gynecologists are marketing their own array of designer vaginoplasty surgeries, claiming the same benefits to women as with other cosmetic surgeries, such as beauty, self-esteem, and confidence. In fact, says ACOG, women's genitals naturally have a wide range of normal appearances that are anatomically correct. There's no one "look" or right way for a vagina and labia to be formed. Recently, laser technology has been introduced by some surgeons for "vaginal rejuvenation" and other vaginal surgeries to replace the traditional scalpel. Individual doctors who are members of the American Society of Plastic Surgery ( ASPS) offer various "vaginal rejuvenation" procedures, but the ASPS itself does not endorse particular surgeries and cautions that "vaginal rejuvenation" surgery may need further scientific study to determine efficacy and success. None of the cosmetic vaginoplasty surgeries are considered accepted, routine procedures by ACOG. Here are some examples of "vaginal rejuvenation" and "designer vagina" procedures: " Revirgination." The hymen, the thin tissue at the entrance to the vagina, normally "breaks" the first time a woman has intercourse. A surgery called a hymenoplasty repairs the hymen to mimic its original, virginal state, before a woman was sexually active. Because of the strong religious convictions surrounding the importance of virginity in some cultures, this is among the most controversial of cosmetic vaginal surgeries. Clitoral unhooding. Some surgeons are marketing a procedure called clitoral unhooding, which removes the tissue that normally covers the clitoris. G-spot amplification. The front wall of the vagina, some experts believe, holds the highly erotic G-spot, an especially sensitive stimulation site for female arousal and orgasm. The G-spot amplification procedure involves injecting collagen into the front wall of the vagina, theoretically to increase pleasure. Women's long-term satisfaction and complication rates from vaginoplasty and labiaplasty have not been tracked. Further, because these surgeries have not been evaluated in peer-reviewed medical journals the way other surgeries have been -- some procedures are proprietary and trademarked -- ACOG considers them "unproven." The risks of vaginal cosmetic surgery include: Infection Permanent changes in sensation Ongoing pain Scarring The best advice for women considering vaginal surgery: talk openly with your doctor about your feelings and concerns about your genitals, as well as your expectations for surgery and any possible non-surgical options. Targeted Kegel-like exercises can tone weak, loose vaginal muscles, for instance, and enhance sexual arousal; and counseling can address issues of sexual self-esteem and confidence. Some questions to ask your surgeon include: What are the short-term and long-term risks and complications of surgery? What are the benefits? Will I experience reduced sensation in my vagina or clitoris after surgery? Will surgery affect my ability to have an orgasm? Are there any restrictions on use of feminine hygiene products, such as tampons, after surgery? Will surgery affect future pregnancy and childbirth? Are my expectations for surgery realistic? What are the non-surgical options? Most health insurance plans don't cover vaginoplasty, labiaplasty, or other plastic surgery that's elective rather than medically necessary. Only occasionally, according to ACOG, is labiaplasty medically necessary, such as with labia hypertrophy (overgrowth) caused by excess testosterone, congenital conditions, or chronic irritation.