A young woman dialled Vancouver gynecologist Roy Jackson from Boston, confessing the details of her mediocre sex life: Frequent and loving, she said, but not enough orgasms.
Soon the entrepreneur, in her late 20s, lay in Dr. Jackson's clinic. Using a syringe, he pumped a small dose of collagen into her Grafenberg spot, or G spot, doubling its size to the diameter of a quarter.
Just like that, Dr. Jackson said, a fabled and elusive trigger of the female orgasm - located behind the pubic bone and accessible through the anterior wall of the vagina, according to sexologists - had become a much easier target.
The injection - called the G-Shot, or G spot amplification, and now available at clinics in Vancouver, Winnipeg and Toronto at a cost of about $1,000 apiece - is the latest quick fix promising sexual enhancement for women. Driven by what some plastic surgeons say is increasing demand from women, doctors and pharmaceuticals companies are rushing to produce new creams, supplements, pills and vaginal surgeries to amplify female arousal.
The two-dozen women who have had the G-Shot in his office "have been very happy with the outcome," says Dr. Jackson, a provider for the past 18 months.
But if the injection sounds like the antidote to an age-old problem, some academics and sexologists are concerned that it's being administered to women without any credible evidence that it works. Others oppose the idea that great sex can be obtained with a single pill or shot.
The G-Shot was patented in 2002 by David Matlock, a gynecologist and plastic surgeon in Los Angeles. Since then he has given the shot to 300 women at his clinic on Sunset Boulevard. Most patients are in their late 20s and 30s, he says, and looking to "enhance" their sex lives.
Dr. Matlock has shipped his trademarked G-Shot kits to 36 doctors in recent years, including Dr. Jackson. In the past few months, Dr. Matlock has begun "taking it to the masses," he says, shipping his kits to 30 more doctors as far away as Japan and South Africa.
In June, a kit containing a 30-minute instructional video, collagen doses approved by the U.S. Food and Drug Administration and brochures arrived at the Winnipeg office of Anthony Lockwood. The plastic surgeon spends most of his business week augmenting breasts. On Fridays, he operates on vaginas; three each week, he says.
So far, only two "curious" women in their 30s have received the G-Shot, but Dr. Lockwood expects demand to grow as more women hear about it.
"I think times have changed," he says. "These gals ... know what they want and expect to get it."
Dr. Lockwood is one of several plastic surgeons who say there is a growing demand for vaginal enhancement - for both appearance and function.
Surgeries that shorten or plump labias, tighten vaginal muscles, shrink the skin covering the clitoris and reconstruct hymens have all become available in Canada in recent years. Dr. Lockwood says the growth is so steep that he hopes to make gynecological services the largest portion of his practice.
While the Canadian Society of Plastic Surgeons does not keep statistics on what surgeries are performed, the American Society of Plastic Surgeons estimates 793 women had surgery on their genitals in 2005, the first year the society kept track. Last year, the number rose to 1,030.
Some women seek so-called "designer vaginas." Others, whose inner labia extends beyond the outer lips, pay for labiaplasties to ease discomfort.
But desire for better sex drives most women who opt for the G-Shot or vaginal tightening procedures, often after childbirth, said Dr. Jackson.
"The women are doing it for themselves as opposed to for their partners," he said. "I don't want to feel that they have a gun to their head."
One 40-year-old mother of two underwent a $9,000 vaginal tightening procedure at Dr. Jackson's clinic in early May, plus cosmetic surgery on her outer labia.
"This was only for me," said the woman, who did not want to be named.
Her husband discouraged her, she said, asking, "Why would you want to do this to yourself?"
After giving birth to her children, now teenagers, she didn't have the same sensation during sex as she used to and wanted to feel more confident about her appearance.
Now, she says, her sex life is an eight or nine out of 10, up from a five, and she only wishes she'd had the surgery earlier.
Dr. Matlock says 87 per cent of his patients report the G-Shot enhanced their sex lives for up to four months.
However, that number comes from a 2002 pilot study based on a 20-patient sample.
No research on the G-Shot has been published in a peer-reviewed journal.
Using a treatment that has not been tested in double-blind, placebo-controlled studies is worrisome, says sexologist Beverly Whipple, an author and professor emeritus at Rutgers University in New Jersey, who has spent 40 years researching female sexual arousal.
She says by marketing products like the G-Shot to women who do not have clinically diagnosed sexual dysfunctions, healthy women "are getting the message that, 'Oh, there's something wrong with you.' "
In fact, she says, core differences between male and female sexual arousal is what makes it so difficult to find a quick-fix for women.
While male sexual arousal is linear, starting with arousal and ending at ejaculation, women's arousal is circular, and what turns women on varies from woman to woman.
The focus only on orgasms may not be the most effective route for women, Dr. Whipple says.
It puts the focus on, " 'What's wrong with me?' Instead of, 'What do I find pleasurable?' ," she adds.
(Some sexologists and noted gynecologists have disputed the G spot's very existence, arguing that studies have shown no evidence of its location or only dubious results.)
Other critics say the G-Shot is being marketed using the same powerful ingredient - insecurity - that has fuelled the meteoric rise of cosmetic and plastic surgery industries, flogging everything from deodorant to nose jobs.
"The vulva has emerged as an area for modification and insecurity creation," said Lenore Tiefer, a psychiatrist at the New York University's school of medicine.
"This market is huge and growing, because insecurity is constant and unremitting."
Dr. Tiefer, who studied the historical rise of many plastic surgery procedures, says vaginal surgeries and female sex enhancement drugs are just the latest golden goose for the cosmetic surgery business.
"It's the same arguments that have been used for the past hundred years," she says. "The demand doesn't come from women. The demand is created by society, the media, women's magazines and pornography. People see their body as a project not only to be perfected ... It's more that if I don't do something, I'm going to suffer for it. I won't be popular, I won't be sexually successful."
To gather opposition to the idea that sexuality can be enhanced through medicine and drugs, she co-founded a group of academics, health professionals and therapists in 2002 called the New View Campaign.
Membership is now in the hundreds.