WE HAVE heard about celebrities having their noses and boobs improved by cosmetic surgeons, but virginal surgery?

Believe it or not, but vaginoplasty and labiaplasty have been around for decades and the procedure is now the newest trend among upper- and middle-class South African women. They are not only becoming more popular but also socially acceptable.

According to Alan Combi, a plastic surgeon in Cape Town, many women seek the below-the-belt surgeries to recreate sexual excitement, restore self-esteem and rejuvenate their love life.

Combi says vaginoplasty, or vaginal rejuvenation and tightening, decreases the diameter of the vagina, which results in increased friction during intercourse.

He says after having the surgery women and their partners often experience increased levels of sexual gratification.

"The vaginal vault and pelvic floor are made tighter and the foundation muscles of the vagina are made stronger. Each procedure takes 60 to 90 minutes to perform and can be performed under either a local anesthetic with sedation or a general anesthetic," Combi says.

Plastic surgeon Chris van der Merwe says the most common procedure among young, rich and unmarried South Africans is hymenoplasty, which returns a ruptured hymen to its pre-sexual state.

"There is a growing demand , mostly due to ethnic, traditional and religious requirements, to reconstruct woman's hymens," Van der Merwe says.

" I get a lot of clients, especially for hymenoplasty procedures, from the Indian community and rich, young women from Swaziland and Botswana."

Vaginoplasty is popular among black middle-class women, especially celebrities and the wives of rich businessmen who have had vaginal births. Some do it without their partners knowing, while others are sent by their partners, Van der Merwe says.

Nomsa Malinga (not her real name) says she had to go for vaginoplasty after her businessman husband started complaining about the width of her vaginaafter she gave birth to twins.

"My man always complained about my width and after a while he lost interest in making love. A white friend of mine told me about vaginoplasty. Our sex life has since changed for the better."

Malinga says the procedure has restored her dignity and confidence and vaginoplasty has saved her marriage."

Gynecologist Namhla Giyose says after the long and difficult delivery of a large baby, when instruments are used or in the case of multiple births, the vagina and its supporting muscle and tissue mass become stretched and lose elasticity.

Another increasingly popular procedure is the G-spot sexual gratification enhancement. This procedure is intended for women who would like to increase sensitivity and their ability to achieve orgasm through vaginal stimulation.

Techniques for this procedure vary, but most doctors use a cosmetic-filler injection called Restylane. The injection enlarges the G-spot, making it easier to stimulate and achieve orgasm. The effects last for about three to six months.

The cost depends on the surgeon and geographic location. Vaginoplasty may cost anything between R21000 and R84000.

Complications are rare, but might occur.

Complications that can occur include, but are not limited to, the following:

l Infection - there may be a simple infection of the wound requiring antibiotics alone. However, a pelvic abscess could develop, requiring drainage;

lHaemorrhage - this is extremely rare. A haematoma may need drainage or further surgery;

lInjury to the rectum - if the instrument inserting the tape is passed through the rectum, this could lead to infection, but modern techniques make this complication extremely unlikely;

lDeep venous thrombosis - a possible complication of any surgery, but much less likely with this type of procedure because you are mobilised almost immediately.

In more significant repair procedures, special measures are instigated during and after surgery to minimise the risk of blood clots;

lRejection of tape, mesh or implants - in tape or mesh rejection, which can occur even several months after the procedure, the implant may be expelled or cause a heavy discharge. This problem has been dramatically reduced by the use of polypropylene implants, which evoke a minimal tissue reaction and the development of new surgical techniques;

lInjury to bowel - if the bowel is well down in the enterocoele sac, there is a small risk that it could be caught in the sutures;

lNerve damage - small nerves in the pelvis may become entrapped in sutures or damage by needles passed in suspension procedures. This problem is rare and usually temporary.