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Tears streaming down her face, Debra Hooker gently pushed her husband off and shook her head.
Hurt and confused, Dan rolled over in bed and went to sleep, while Debra crept into the bathroom and wept.
It had been nine months since the once-passionate couple had made love. Since having son Samuel, retail Âmerchandiser Debra, 45, had refused sex.
It was nothing to do with having a newborn to care for, Debra was simply too ashamed of her body. But now, after designer vagina surgery, Debra?s marriage has been given a new lease of life.
And she?s not the only one to benefit. Statistics show that vaginal surgery is fast becoming one of the most requested surgical procedures.
According to Debra, from Swanscombe, Kent it wasn?t only her sex life that was given that vital boost.
?It?s absolutely the best thing I?ve ever done? she says. ?I was ashamed and embarrassed of the way I looked downstairs after having a baby, but it wasn?t just about appearance. There are physical health implications if your vagina becomes stretched and misshapen.?
?My sex life and marriage is great and I can exercise without discomfort and have lost almost four stone.?
Designer vagina procedures fall into two categories, labiaplasty, which iÂnvolves shortening the length of protruding inner labia, and Âvaginoplasty to tighten the wall of the vagina.
The most Ârecent NHS figures, Âreleased in 2009, show a 70% increase in the number of women having labiaplasty on the NHS on the previous year. There were 1,118 Âoperations in 2008 compared with 669 in 2007 and 404 in 2006.
And some clinics that perform the surgeries have seen a similar trend in recent years. Transform, one of the leading cosmetic surgery providers, has already performed 15 vaginal operations this year and predicts it will complete 90 over the 12-month period ? that?s a 58% increase on 2010, when it performed 57.
Dr Lawrence Mascarenhas is a Âconsultant gynaecologist for the NHS and private sector. He carries out, on average, 12 of these operations a month.
He says: ?Labiaplasty is more of a Âcosmetic procedure about improving Âsymmetry for an improved aesthetic Âappearance, while vaginoplasty is to rectify the problems which may arise from having the vagina wall stretched, for example Âduring a very difficult childbirth.?
He believes women are putting themselves at Âunnecessary risk to create the perfect vagina and should only have a Âlabiaplasty if they are Âsuffering complications.
?It?s the same as women Âseeing pictures of celebrities? breasts and bottoms and wanting to achieve the same perfection through surgery, they are now extending this to their vaginas.
?But with all surgery comes a risk. There?s little room for error with a Âprocedure like this because if you go too short you can cut off blood supply to the clitoris, meaning loss of sexual Âsensation, permanently.?
Some have even compared the procedure to genital Âmutilation, inflicted on women in some Third World Âcountries. ?I wouldn?t go that far but I would strongly urge that women do not go ahead purely on aesthetic grounds? he adds.
A recent study at Kings College London saw Âexperts link the growing demand in Âlabiaplasty to an increase in availability of pornographic images online.
It suggested women were Âtrying to emulate the look of actresses and models seen in intimate pictures.
Dr Mascarenhas says: ?That does make sense to me. Women compare themselves as they do with any other media image, but if someone came to me with a picture of a vagina they would like to create I would refer them to a psychologist.
?The images may be unrealistic, even digitally enhanced.?
But Debra is horrified by the supposed link between pornography and operations like hers.
She believes the rise in demand is simply a case of women being made aware that help is available.
She says: ?I think it?s hugely insulting to women like me. I wanted to look and feel like a normal women, how I used to feel. I didn?t want to look like a porn star, I wanted to be able to walk and to have sex with my partner without experiencing all of that pain and discomfort.
?These experts are doing a huge Âinjustice to people like me, who suffer with what?s already an embarrassing problem, without them making it worse.? It took Debra months to pluck up the courage to admit to Âhusband Dan, 38, what was wrong.
?Before Samuel was born we couldn?t keep our hands off each other, so of course he didn?t understand what he?d done wrong when I started turning him down when he wanted sex,? she says.
She?d had no problems after Georgina, now 17, by a previous partner, was born, but after delivering Samuel, now five, everything changed.
?He was a very big baby at 10lb 4oz and it wasn?t an easy birth,? she grimaces.
Weeks after the birth, Debra felt ready to make love, but the couple?s attempts ended miserably. ?To put it bluntly, despite being well Âendowed, my husband couldn?t stay inside because I had Âcompletely lost my shape Âdownstairs,? Debra says.
She was also suffering stress Âincontinence and this was further complicated by the changes to her labia, which had been stitched after the delivery.
?Skinny jeans were Âuncomfortable and sometimes even just walking caused friction because of the way I had been repaired, so my problems downstairs were starting to affect every aspect of my life. I was getting very depressed.?
With Dan?s support, Debra went to her GP who Âdiagnosed a uterine prolapse, which meant her bowel could be felt behind the damaged Âvagina walls.
She was offered a hysterectomy, but refused. ?I got more depressed. We grew apart and I accused Danny of fancying other Âwomen, simply because I felt so bad about my own body.?
In November 2008, Debra was Âresearching vaginal surgery when she saw an advert for the TV programme ÂEmbarrassing Bodies.
She contacted the team and met a Âsurgeon, who agreed she would benefit from both vaginoplasty and labiaplasty.
?Dan was shocked, but we couldn?t afford to have the operations privately and by then I didn?t care who saw me as long as I got my confidence and sex life back.?
During the 90-minute Âoperation at Transform, in North London, surgeons Ârepositioned her womb and strengthened the vaginal wall.
Debra was told to Âabstain for six weeks while she recovered.
?I was tender but could see things looked a lot neater. I felt tighter and more in place, so I marked the date on my calendar and started counting down.
?Dan I both agreed it was fantastic and well worth the wait,? she says.
?If more women are having the operation it?s because we?re finally able to talk about problems like this and the media has made us aware there is at last an answer, not because of pornography.?
Another patient, who asked not to be named, underwent a labiaplasty abroad last year.
She says: ?I was always unhappy with how I looked down there but after having children it got a lot worse.
?I was referred by my GP for Âvaginoplasty because my sex life had been destroyed by childbirth and I asked if my labia could be done at the same time.
?I would disagree that labiaplasty is cosmetic because for me it has eased a great deal of suffering. The fact it looks nicer is a happy bonus.?
But patients like these are in the Âminority. It?s only in extreme and rare cases that the labia causes a medical problem and this is usually after the delivery of a child, where the mother has been badly sutured.
For these patients, the benefits outweigh the risks, but not for those simply looking to create a perfect-looking vagina.
?Many women requesting this operation are young and have not had children yet.? Dr Mascarenhas says.
And while the procedure is unlikely to complicate childbirth, he urges young women considering the operation to Âconsider the perfect vaginas they have seen may not be real.
?There may be digital imagery involved and that is going to lead to disappointment for patients, because the ideal they are seeking is not achievable.?
GPs have reported girls as young as 13 complaining to them that their vaginas do not look normal.
?The first thing I say to women is that there is no normal,? says surgery adviser Linda Briggs.
She has also seen a massive surge in the request for designer vaginas. ?I get a lot of requests from young girls and it?s alarming because it?s just another part of their body they have to worry about.
?If our surgeons don?t think there is a genuine problem, they won?t operate and instead we suggest the patient see a GP for counselling.?
In the permanent quest for the perfect boobs, bottom and body, it seems people are now trying to be beautiful, even on the parts that people can?t see.
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