Nonna Venski [not her real name] thought she had it made: two beautiful kids, a good marriage, a nice house in a California suburb and a job she actually enjoyed. Things were perfect. That is, until her husband came to her with a problem.

"He told me that having sex with me wasn't as good as it was before," Venski says. "It wasn't that he didn't love me, or that I wasn't attractive. The problem was my vagina."

After two children and 40 years, Venski's vagina was, well, sagging. She'd noticed that she had a bit of difficulty holding urine when she sneezed or coughed, but she was utterly horrified to find that her husband had noticed changes in her vagina, too -- and that it was affecting their sex life.

"Sex is a very important part of a marriage, and I wanted to be the best I could for my husband," Venski says, her brown eyes half-filling with tears at remembering the night her husband told her about his deteriorating desire. "I had no idea what to do. Who could I talk to about this entirely embarrassing problem? Who could I ask?"

Panicking, Venski consulted a doctor who suggested Kegel exercises, the standard prescription for women worried about their vaginal tone. But hundreds of contractions later, neither she nor her husband had noticed any change. Faced with a decaying erotic life, Venski made a difficult choice -- she decided to go under the knife.

Cosmetic surgery is a well-known strategy for lifting a drooping breast or a sagging jawline, but a far more intimate surgery, vaginoplasty, is rarely discussed. Yet Venski credits this seldom-mentioned surgical procedure with saving her sex life.

Gynecologic oncologist Dr. Jenta Shen has performed scores of vaginoplasties, though he agrees that it's a little known and rarely utilized surgical option.

"Think of the vagina like a balloon," he urges, illustrating his analogy with a diagram of the female reproductive system. "If you blow it up like a baby does when it emerges, it will probably return into shape. But it won't be as strong and flexible as it was before it was blown up. When women have more children or larger babies, they're blowing up this balloon over and over again and it's likely these stresses will cause changes to the vagina."

These changes range from a slightly loosened vagina, like the one Venski suffered, to prolapsed uterus -- a problem that causes chills in even the most stolid of women. When a severely weakened vaginal structure can no longer hold the weight of the vagina and uterus, the entire mess can actually slide out of a woman's body and (in Dr. Shen's words) "dangle between the legs."

In all but these extreme cases Dr. Shen advises Kegel exercises, often combined with the insertion of a pessary, a flexible doughnut-shaped ring which stays inside the vagina and shores up the vaginal structure. But few patients are willing to do the literally thousands of Kegels necessary to bring results, or to endure the pessary, which has to be removed for vaginal intercourse and often causes vaginal irritation and odors. For these patients there is another option to tighten slack vaginas -- the vaginoplasty.

As Dr. Shen explains the vaginoplasty, it sounds like the tailoring of an oversized garment. The surgeon removes excess tissue on two sides of the vaginal canal and stitches up the sides, creating a snugger, smaller canal. It can help women with compromised vaginal structures, or women like Venski who have noticed that their vaginas seem stretched out of shape. But, as Venski notes, it also hurts like hell.

"Two kids I had without anesthesia and I can't even compare this pain," Venski says, rolling her eyes at the memory. "I was in bed for two weeks with constant sharp pain so bad I cried, and I had twinges of pain for over a month. I told everyone I had a hemorrhoid problem so they wouldn't ask why I was sitting on pillows."

Venski's experience underscores one of the problems with the vaginoplasty -- it's a little-known option because women are ashamed to admit they have vaginal difficulties, even to their doctors. And they're certainly not discussing their stretched-out status in the ladies' lounge.

"I know my vagina can't be as tight as a hand, or a mouth," Venski muses, "but I wondered if other women had the same problem. I've never heard anyone talking about it. I didn't even realize the surgery existed before I saw my old doctor, and my self-esteem was really suffering."

Dr. Shen agrees that vaginoplasties are underutilized and can do a lot for women suffering from loose or weak vaginas. But he urges women not to think of a vaginoplasty as an easy option or a cure-all.

"With any surgery there are dangers -- of infections, of going under anesthesia, of pain," Dr. Shen advises. "And with the vagina so very close to the bladder and rectum there can be difficulties when performing surgery in this area."

In other words: One false cut and a woman may end up in diapers for life.

"If a woman is going to have children and is worried about what a vaginal birth will do to her body, it's better to use preventative measures like Kegels, breathing exercises during the birth and avoiding excessive weight gain," Dr. Shen says. "But in extreme cases, yes, a vaginoplasty can make sex more satisfying for both partners."

Despite the pain and embarrassment, Venski says she's glad she went through with her vaginoplasty. "It didn't turn out 100 percent like I wanted, but my husband is pleased," Venski says. She describes their first post-surgical encounter as "tense and scary," but says, "I did what I could to salvage our sex life, that's what mattered to me. If I had it do to over again, I'd make the same choice."

Cut-and-paste pleasure? Sex is about more than a penis and a vagina; the tightest pussy in the world can belong to a woman who's lousy in bed. But for women having vaginal problems, surgical options exist -- it's just a little more extreme than popping a Viagra.