At Dr. Robert Stubbs's office, they call it the Toronto Trim.

For the past 12 years, women have come to him from all over North America to have their labia minora -- the flaps of skin that form the lips of a woman's genitalia and surround the clitoris and vaginal opening -- reduced. It's not a cosmetic alteration that ranks up there in popularity with breast augmentation, but recently Dr. Stubbs has been performing the surgery more than ever -- as often as once a month.

A recent issue of Cosmopolitan magazine declared that "sexual-enhancement" surgery such as labiaplasty and vaginal tightening (which Dr. Stubbs also performs) is the hottest trend in plastic surgery. Dr. Stubbs, a plastic surgeon, chalks up interest in labiaplasty to a prevailing hyperesthetic: after all the benchmarks of beauty have been obtained -- Barbie Doll breasts, youthful face, sporty thighs -- it appears that for a certain segment of female society, tidy genitals are worth the $1,500 to $2,500 price tag. If the labia are oversized, asymetrical, too loose or triangular, they don't measure up to the ideal and are a candidate for cutting.

But esthetic motives are only half the story, according to Jane (not her real name), who called from somewhere in the United States and wouldn't say where. The 37-year-old athletic professional said she recently flew to Toronto and had the operation for reasons that were 50% esthetic and 50% physical. Oversized labia are uncomfortable, Jane said. "I experienced physical discomfort during sex. And I would feel pinching while riding a bike or a horse."

Indeed, Dr. Stubbs said clients for this procedure usually fall into one of two groups: the 25- to 35-year-old trophy wives of sports figures for whom the sexual and physiological ideal is the price of entry into that world, and women of all ages who have abnormally large labia that may be interfering with their sexual confidence and performance. Dr. Stubbs said some women's labia are so large that they get caught in the process of penetration, causing pain during sex. In other cases, the labia completely cover the clitoris in a hood of skin. "Some women report to me they have had an orgasm for the first time after I have unhooded the clitoris. When they complained about their sex lives to other doctors, they are often told just to try a new position," he said.

Did sexy looks or the quest for better sexual function spawn the Toronto Trim? In a culture where everything, including the genitals, are affected by the exacting scrutiny of the look-see 1990s, it cannot help be both. "It's another exploitation of body image," said Toronto-based sex therapist Joan Marsman. "But there are people who will want this surgery so strongly, it's hard to say it isn't right for them."

Though anonymous, Jane is neither squeamish nor apologetic. "I'm not a person that's insecure," she said. "But if something can be done, and you have the money, what's the big deal?"