Editor's note: Wanderlust is a regular GlobalPost series on global sex and relationship issues written by Iva Skoch, who is now traveling the world writing a book on the subject.

PRAGUE, Czech Republic — It takes a lot to get a plastic surgeon to blush.

But a few years ago, when a Ukrainian sex worker walked in with a photo torn from a porn magazine, Dr. Vlastimil Visek couldn't help himself.

“Here,” she said, pointing to the vagina of a naked porn actress. “This is what I want mine to look like.”

Visek didn't make an exact replica. “Just like you can't take a photo and operate on a face to make it look the same, you can't do that with genitals,” he said. “Every one of them is different.”

But he did his best and released the prostitute back into the streets with a bigger smile and smaller labia.

He would always remember the Ukrainian as the first customer who requested a genital surgery purely for aesthetic reasons, and knowing exactly what she wanted.

Since then Visek has sculpted dozens of vulvas each year, even though the clinic where he works — Medicom VIP in Prague — doesn't actively advertise cosmetic vaginal plastic surgery.

In the last decade, aesthetic genital surgeries have become what some doctors refer to as the new “hit surgery.” The majority of the 70 plastic surgeons in the Czech Republic, for instance, now offer surgeries of the vulva, augmentation of the clitoris and other aesthetic vaginal procedures.

The surgeries cost, on average, about $900 (including hospital stay).

The most common in Prague is labiaplasty, or surgery of the folds of skin surrounding the vulva. A decade ago that procedure was performed almost exclusively on patients with severe genital defects or injuries. Today, it's just another way many Czech women go about perfecting their bodies.

According to the plastic surgery information portal Estheticon.com, labiaplasties made up 3 percent of all plastic surgery procedures on women in the Czech Republic last year. The vast majority of patients cite "increasing self-confidence,” not medical reasons, as their primary motivation.

Miriam Formanova, 27, is one of those women. Formanova, who requested her name be changed for this story because her current boyfriend doesn't know about the surgery, had a labiaplasty last year because she felt self-conscious about her labia minora being asymmetrical. “One of them was about a quarter inch longer than the other,” she said.

Her ex-boyfriend used to tease her about it, she says. So when she saw an advertisement for a clinic in Prague offering what she calls “prettification” of the vagina, Formanova was hooked.

Dr. Svatopluk Svoboda, a plastic surgeon who specializes in genital plastic surgeries in the Czech Republic. (Iva Skoch/GlobalPost)

“I feel so much better,” she said, adding that she no longer feels insecure about her Brazilian wax appointments. “Now, I look just like my ex-boyfriend's favorite pornstar.”

The plastic surgery trend is not limited to the Czech Republic.

Demand for cosmetic vaginal surgery is rising in the United States, as well, where the procedures typically cost upwards of $5,000. According to the American Society of Plastic Surgeons, 1,030 vaginal rejuvenations were performed in the U.S. in 2006, a 30 percent increase from the previous year (the group only tracked the procedure for those two years).

But unlike in the Czech Republic, cosmetic vaginal surgery has provoked a strong backlash by medical professionals in the United States and elsewhere.

"Many women don't realize that the appearance of external genitals varies significantly from woman to woman. As ob-gyns, we know this to be the case from years of experience," Abbey B. Berenson, MD, a member of the American College of Obstreticians and Gynocologists' Committee on Gynecologic Practice, said in a statement on the organization's website.

"There are always risks associated with a surgical procedure," she added. "It's important that women understand the potential risks of these procedures and that there is no scientific evidence regarding their benefits."

Virginia Braun, a senior lecturer in psychology at the University of Auckland, has also railed against the trend.

"We came to believe that, despite claims that they are about empowering women and improving women’s sexual pleasure, these surgeries were being recommended out of a misogynist disregard for women’s genital diversity and a willingness to exploit women’s lack of knowledge and confidence about their genitals," she wrote in a study called "The ‘Designer Vagina’ and the pathologisation of female genital diversity: Interventions for change," published in Radical Psychology earlier this year.

But, so far it seems, porn has proven more powerful than science.

According to Libuse Konopova, author of several books about female sexuality and an owner of the online store Shop4Ego.com that caters to women, pornography plays an increasingly important role in how women perceive their bodies.

“Women are becoming more significant consumers of pornography and are also becoming more involved in its production,” she said. As a result, female grooming preferences in the pubic area have largely followed the styles popular with female pornstars: no pubic hair at all.

Svatopluk Svoboda, a plastic surgeon who specializes in genital plastic surgeries in the Czech Republic, said that practically all his patients have started shaving in the last few years. “I can't even remember the last time I saw a hairy woman,” he said.

Critics of the vagina sculpting trend argue that exposed genitals give women yet another body part to scrutinize and compare in gym showers and nudist beaches. It also gives them another reason to end up in a plastic surgery clinic.

Dr. Svoboda has been a plastic surgeon since 1972, but until his 1998 fellowship in Brazil, he had never heard of plastic surgeries of the vagina.

His colleagues in South America explained that “Brazilian women wanted to be beautiful everywhere, even in the most intimate of parts." When he returned to Europe later that year and started offering the same surgeries in Czech Republic, other doctors questioned his sanity.

“At first we had one or two surgeries a year, but in the last six years, the demand has gone up sharply,” he said. The number of these intimate surgeries has doubled every year since Svoboda started offering them, he says. Last year, he completed well over 100.

“In 2004, sexologists attacked me for disfiguring women,” he said. But he assured them that there's no correlation between female genital mutilation and the aesthetic molding of the vagina. He says most women choose to have a labiaplasty for serious reasons, most commonly an elongated labia, which, apart from cosmetic concerns, can cause physical discomfort.

But once the sexologists backed off, Svoboda had another problem. He kept asking himself: “What does an ideal female genital look like?”

He asked his friend, an 87-year-old Czech painter and connoisseur of the female anatomy, to draw an ideal type for him. "It became obvious that the ideal look of this organ is very difficult to establish so he sketched an extensive and detailed catalog of almost 100 different vulvas, all out of memory," Svoboda said.

The doctor now uses this laminated, inch-thick vagina diary to help his patients decide what kind of new genitals they would like to own.

According to Svoboda, most women go for the soft, minimalist look. “Numbers 59 and 78 are most popular by far,“ he said.


Other Wanderlust columns:

Catholic priest becomes unlikely sex guru

Bride kidnapping in Kyrgyzstan

Gay-4-Pay in Prague

The world's eight strangest sex remedies

Japan: It's faketastic

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