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When Maya Bernstein, 18, first became sexually active in high school, she was nervous. How would she know what to do? Especially, it seems, how things should look. The numbers shot up so quickly that the American College of Obstetricians and Gynecologists ACOG issued new guidelines this month for doctors who perform labial and breast surgery. Among the recommendations: physicians are now encouraged to screen girls for body dysmorphic disorder, an obsession with an imagined or slight defect in appearance. While the rise in requests for labiaplasty remains relatively small—with an increase from to girls overall—the data suggest more girls are becoming ashamed of the most intimate parts of their bodies. And the increase in this procedure is part of a larger boost in cosmetic surgery for teens. More than 8, teen girls received augmentation breast surgery in , nearly double the number from just four years earlier, according to the American Society of Plastic Surgeons, which officially recommend girls wait until they are 18 to go under the knife.