"That's when I noticed I was a little different," says Kelly, who's embarrassed to use her real name. The vaginal lips -- the labia -- on the woman in the picture didn't protrude like hers. Was she different?
Her question soon evolved into anxiety. Then shame.
"It was embarrassing," she says. "I've never been married, so when I was dating, I was always hesitant about a man seeing me for the first time, because I thought it was abnormal."
It wasn't something she could talk about. Not to boyfriends. Not to other women. Not even to her doctors. She preferred to keep her shame private.
There was also a practical side to her discomfort. Her labia would chafe from friction when she jogged. Riding an exercise bike was out of the question. She was constantly adjusting herself. "I felt like a man."
Then there was the awkwardness of sex. Sometimes her labia would get caught on her partner, leaving her to wonder if she was a freak.
"I just didn't want to bring attention to it," she says. "I felt I just looked different from other women . . . This was the center of my womanhood, and to bring negative attention to it, that was just too much to even consider. It was so private, and the way that I felt about it was so intense."
Her boyfriend didn't even notice, and wouldn't have thought anything if she'd never brought it up. For the longest time, she didn't. "I wasn't complaining about it," he says.
But by age 40, her anxiety got the best of her. On a visit to a plastic surgeon to discuss breast reduction, the question came up. Is there anything else you're concerned about?
She told Dr. Daniel Medalie about the physical discomfort, how embarrassing it was to wear tight pants.
He asked if he could examine her.
No. She was too self-conscious.
Medalie brought out a book filled with pictures of vaginas and asked her to point out which one looked like hers. "I was relieved that there were other women out there that I had something in common with, that I thought was so abnormal," she says. "You think you're alone."
She made an appointment. She finally told her boyfriend.
"That was a whole new thing I had to go through -- understanding why," he says. "Why does someone have this [procedure]? Is it vanity? Is it something psychological? Is it physical? I'm just sort of a deer in the headlights."
Vaginal surgeries have been around for decades. Labioplasty grew out of men wanting to be women. Other procedures were born to improve function, not form.
Vaginoplasty, for example, was developed for women who gave birth. On occasion, the muscles of the vaginal walls wouldn't heal right, leaving them loose.
Doctors figured out how to tighten them. It's supposed to help women better enjoy sex. But both procedures remained obscure, while the plastic surgery industry expanded in the '70s and '80s.
Then came the rise of VCRs and the internet. Suddenly, even good girls who would never grace porn shops had home access to them. What once could be observed only with a quick glance in a locker room could now be "paused" and stared at on a screen.
Many women were seeing other vaginas for the first time. Anxiety became a native byproduct. Is mine too big? Are my lips too long? Is my boyfriend OK with it? How come these porn stars don't look like me?
So they started talking to their doctors.
The popularity of both vaginal lip reduction and tightening began where such things usually do -- in L.A. and New York.
But like all trends, it's slowly worked its way to Flyover Country. Today, more and more women are coming up with $6,500 to $8,500 -- and enduring three hours of outpatient surgery -- to have their anxieties cured.
In the past year, Medalie -- who works at MetroHealth Medical Center -- has been fielding mounting queries. "Probably in a week I get about five e-mail inquiries . . . I have a little bit of a backlog."
He even gets a couple notes a month from women asking about hymenplasty, which surgically "revirginizes" women by replacing the hymen. He doesn't do the procedure. Not many doctors do. But it's all part of the growing industry of vaginal restoration.
The growth prompted Elyria's Dr. Kevin Wisler to fly to Beverly Hills to study laser vaginal rejuvenation under gynecologist David Matlock, who's been featured on the reality show Dr. 90210. Now Wisler's opening up his own institute at Elyria Memorial Hospital.
Of course, no such trend is without its critics. Getting a surgery because of physical discomfort is one thing, they'll say. Getting it because a woman on a sex tape has a vagina like a teenager is another.
In a report by British Medical Journal last month, authors warned of unknown risks with labioplasty -- especially when doctors are cutting around nerve endings. "It should be thought of as the last resort, not the first port of call," they wrote.
Beth Haiken, who wrote Venus Envy: A History of Cosmetic Surgery, says it's all part of our increasing pursuit of artificial enhancement. "It plays into the market," she says. "One surgeon called it 'happy surgery.' You're not dealing with things like cancer.
"There's a part of me that thinks that if that's the only thing you have to worry about, you have a pretty nice life," she adds. "And B: There's got to be a better place to spend your money. Get bigger pants."
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