Hadn't looked at the early/mid game in a while but it seems vaginoplasty is now unavoidable and irreversible unless you disable the "forced bottom surgery" fetish flag.
Bergmeister talks as if the MC has had their dick enhanced, but the full body shop hasn't even become available yet (neither has Twig's potions) so nothing has changed in the trouser department before this event.
Used to be you could just leave all fetish flags enabled and avoid the more extreme ones through normal play, but now you have to go through them and toggle the ones you'd rather avoid, it seems. I liked that the MC could avoid some of their changes through being smart and decisive; now it's just the player removing difficulties for them, which doesn't feel earned.
I think someone else already mentioned this upstream, just hadn't noticed it for myself before.
Edit: According to the wiki, this should only happen if the MC has visited the body shop and said they wanted it. If that's accurate there's a bug: