-- Is it the latest panacea to improve your love life?
Karen Roberts scheduled an appointment with her plastic surgeon at the end of a long day. The 22-year-old student at Solano Community College attended morning classes, caught up with homework and took her 4-year-old daughter to a matinee.
By 4 p.m. she sat inside Dr. Justin Salerno's office, readying to become the surgeon's first patient to receive an injection called a G-Shot, also known as G-spot Amplification. With a 3 1/2-inch needle, Salerno would pump a small dose of collagen into his patient's Grafenberg Spot and make it swell to the size of a quarter.
The G-spot has been the subject of lore and controversy since it was first identified in 1950 by the German gynecologist Ernst Gräfenberg. Some sexologists believe the small area behind the pubic bone and accessible through the anterior wall of the vagina is an erogenous zone that when stimulated leads to heightened sexual arousal and powerful orgasms. Others dispute the zone's very existence, arguing that studies have turned up no scientific evidence of the G-spot's location, or only highly questionable results.
In the case of Roberts (a pseudonym used at her request to protect her privacy), she was unsure whether the G-spot existed, and if it truly held the key to a vibrant sex life. But she was willing to find out.
"If I could come home like my husband, have sex and feel that release," Roberts said before her appointment, "I'd be one happy woman. But instead I come home, I spend all this time concentrating, hoping something will happen and I just end up frustrated."
The procedure, which has been performed on approximately 250 women nationally in the past two years at a cost of $1,850 each, appealed to Roberts because she felt life's rigmarole had left her fatigued by the end of the day, hardly in an amorous mood. Even when she felt the surge of excitement, reaching an orgasm was a time-consuming endeavor that took more effort and energy than she and her husband had to offer.
If the arrival of the G-Shot sounds like an easy fix to an age-old dilemma, it's also viewed by sexologists and academics as a reminder that in today's post-Viagra world, a dynamic sex life has become a cultural expectation. The focus on orgasms -- great, multiple, easily attainable -- has been in full swing since the sexual revolution of the 1960s, but it has reached a fevered pitch in recent years, sociologists and sex researchers say, now that billions of dollars are spent on medical and pharmaceutical remedies that promise sexual enlightenment in a single pill or, in the case of the G-Shot, a single injection.
In Vacaville, a bedroom community of 97,000, Roberts may have been the first to sign up for the new procedure, but she probably won't long be the only woman to have done so.
The G-Shot was invented and trademarked in 2005 by Dr. David Matlock, a Los Angeles gynecologist and plastic surgeon. Matlock had performed every G-Shot injection from his Sunset Boulevard office until early April, when he shipped his trademarked G-Shot kits to 35 associates, including Salerno, across the country. The package included a 30-minute instructional video, the FDA-approved collagen dosages and brochures that hail the procedure as a "revolutionary scientific breakthrough."
Within a week of placing the brochures on display at his office, six patients had scheduled consultations, Salerno said.
Roberts, who has also had work done on her lips and thighs, said the procedure offered her a chance to change her life. The failed attempts at satisfactory sex with her husband had diminished her sex drive overall, she said, and had triggered a deeper tension in the relationship.
"If you have more orgasms, you'll want more sex," Roberts said. "And if you're 22 and your sex drive is going down, then you better do something to bring it back up."
Salerno's office is located just across the street from an immaculate city park. The 52-year-old surgeon from Pennsylvania chose to set up shop in Vacaville two years ago because he saw it as the last affordable suburb in the Bay Area with a high potential for clientele growth.
An ob/gyn for 25 years, Salerno has delivered, by his count, 6,000 babies. But a little more than two years ago, while in bed watching a late-night episode of "Dr. Beverly Hills 90210," an E! Channel show that featured Matlock's plastic surgery, Salerno became intrigued. He was looking for a new career path; the artistry behind Matlock's "aesthetic gynecology" led him to what he now calls, "my true calling."
Within months, Salerno had visited Matlock's newly opened Laser Vaginal Rejuvenation Institute of America in Los Angeles, where the doctor, in addition to inventing the G-Shot, has become the most renowned practitioner in a small but incrementally growing field. In 2005, the first year the American Society of Plastic Surgeons kept statistics on vaginal alterations, 79 women had work performed on their genitals. Last year, the number rose to 1,030. Sandy Gart, 56, a Southern California nurse who was one of Matlock's first G-Shot recipients, said she got the injection to rekindle her sex drive. Gart said it worked so well, she's had three more injections; the collagen reabsorbs into the body within four months, and Matlock says 60 percent of his patients have returned at least once.
"It was good the first time, and it's kept on working," Gart said.
Matlock, from his home in Los Angeles, said he'd performed liposuction on women for 19 years while listening to hundreds complain about the appearance of their genitalia. One woman had asked if there was anything he could do to tighten the skin around the vagina; Matlock obliged, and six weeks later, the couple thanked him.
"That's when I modified my thoughts," Matlock recalled. "I knew then I could help people enhance their sex lives, and I said, 'Let's just come out and say it.' "
Matlock opened the institute and has continued his work, enlisting associates such as Salerno, who number 150 worldwide. He has also written two self-published books, "Sex by Design," and the forthcoming "Dr. Spot," which will promote his latest technique. Matlock said he has heard plenty from critics who say his work contributes to an artificial world, in which vanity and inauthentic beauty are promoted.
"Each procedure I've developed was based on the requests from women," Matlock said. "I didn't tell them what I wanted to do. I listened to what they wanted."
As Roberts sat in Salerno's examination room, she felt a pulse of nervous energy. Even though she'd undergone plastic surgery by Salerno's hands before, she knew this procedure called for client assistance. Since the G-spot is a sensitive tissue area, Roberts would need to manually locate it and give her doctor instructions. According to Dr. Beverly Whipple, a sexuality scholar at Rutgers University and perhaps the world's most prominent G-spot expert, the small area cannot be accessed unless the woman is in a state of arousal; when the woman is excited the tissue palpitates, making the G-spot accessible.
Matlock disputed that arousal was necessary to administer his product to patients. Rather, Matlock explained, they needed to be "in tune" with the area to verbally direct the doctor. Roberts said she was relieved when she didn't have to reach arousal; she was able to direct Salerno to the area by explaining where she felt a sensation.
After Salerno numbed the area with a rub-on agent, he administered the collagen injection.
"By the time I could say 'ouch' it was done," Roberts said. "It wasn't even worth the ouch."
Although patients may feel little discomfort from the procedure, some sexologists and researchers are concerned that the G-Shot could further change the cultural standard of what is good sex. They oppose the medical intervention being sold as a "scientific breakthrough" because it is aimed not at people with clinically diagnosed sexual dysfunctions, but those who want to enhance their sex life.
"The G-Shot capitalizes on this assumed reality," said Lenore Tiefer, a psychiatrist at the NYU School of Medicine. "In the post-Viagra world there are escalating expectations, based on false and pseudoscientific information. That in itself creates a cultural insecurity around sex."
Traditionally, Tiefer said, sexual enhancement, as the G-Shot is also advertised, has been the domain of sex stores, via such merchandise as pornography and sex toys. But now, as a glorified sex life has become something of a national obsession, the role has shifted from the sex store to the doctor's office. To gather opposition around the idea that sexuality can be enhanced through medical procedures and pharmacology, Tiefer co-founded a group of academics, medical clinicians and therapists in 2002 called the New View Campaign.
Instead of doctor intervention to promote sex, Tiefer's group advocates that couples open the lines of verbal communication, or turn to talk therapy.
Debby Herbenick, a researcher at the Kinsey Institute at Indiana University and a New View Campaign member who studies genital health and has performed studies on Viagra, said female sexual enhancers have not been scientifically proven.
"I am open to the thought women may be enhancing their sex lives through medicine, and even surgeries," Herbenick said. "But as of yet, the research to prove any of it works is just not there."
Tiefer and Herbenick question the efficacy of the G-Shot, noting the lack of a double-blind study, which would inject some patients with collagen and others with a water solution. In sex research, Tiefer said, placebo effects are not uncommon. If a doctor tells a client she's going to have great sex after taking a shot, without a double-blind study, it's hard to tell if it's true.
Matlock said he conducted a pilot study based on a 20-person sample. He asked patients, "Did it work or did it not?" and of those who responded, he reported 85 percent said the G-Shot was successful.
But Matlock refused to share the study or make the names of participants available. He also said a double-blind study would be ineffective for the G-Shot, as the client can feel the collagen bump, while a water-based injection would merely dissolve.
To date, Matlock has not published a peer-reviewed study of any kind. He said he's gathering data to offer to medical peers and will release the findings on his Web site in coming months.
Matlock is adamant that the G-Shot is not a cure for sexual dysfunction but only an enhancer. He said Viagra gets used as an enhancement now, and he believes there's a gender-based hypocrisy in the medical establishment's rush to market drugs for males but not push through similar drugs for females.
"Women have been left behind on this," he said. "If this were a male problem, they'd call it serious research, approve it and move on."
Like Matlock, Salerno is familiar with the critics of plastic surgery and expected his new offering to draw similar complaints.
"Is it right?" he asked. "I don't know. As long as you don't become a slave to it, until there's nothing left of you as a person, then why not? Why not give yourself the things you want to be happy?" In late March, Matlock embarked on a mini-European tour to promote the G-Shot to his international colleagues. He gave a talk at the World Congress on Anti Aging in Paris, at the Plastic Surgery Society in Milan the following week and at another conference in Amsterdam the first week of April.
"Everybody is already clamoring for it," Matlock said before he left. He said he was forced to prioritize the initial G-Shot kit shipments to his associates who are registered at his institute, such as Salerno, and resisted selling the product to plastic surgeons whom he doesn't know.
"If I did, it'd be a madhouse," he said.
Gart, the 56-year-old patient who has had multiple G-Shots, said her sex life has been at a "heightened state" for the past two years and she'll gladly get more. "It makes me horny," Gart said. "It makes me want to have sex, like I did when I was younger."
After Roberts returned home, she felt giddy. The healing time for a shot is only a couple hours, and she was eager to try out her "new" body. Roberts said she was mentally prepared to experience no difference from the procedure; she didn't want to get her hopes up.
Yet three days after her appointment with Salerno, Roberts reported that her passion had returned, and then some.
Just as she hoped, she could reach climax within a few minutes, and with little effort.
"Just like a man," she said.
E-mail Justin Berton at jberton@sf chronicle.com.
This article appeared on page F - 1 of the San Francisco Chronicle