The Surgeon Minute

Perineoplasty and Vaginoplasty Explained

Perineoplasty and Vaginoplasty Explained

Childbirth can adversely affect more than just the appearance of your breasts and your stomach. It can also do a number on the vagina itself. While there are a plethora of non-invasive tightening procedures on the market, many patients have issues that are beyond the scope of what a non-surgical technique can deliver. Dr. Christine Hamori of Boston is an advocate for any procedure that helps women. She discusses the benefits of a perineoplasty and a vaginoplasty, two surgical procedures that help can help restore your sex life, relieve stress incontinence and improve your self esteem.

Who is a Candidate for Perineoplasty?

Any women who has had a vaginal delivery is a candidate for a perineoplasty and/or vaginoplasty. These are the same women who come in for a mommy makeover. They are worried about:

  • breast deflation
  • sagging skin in the abdominal area
  • muscle laxity

They also have sexual complaints.“They really feel that intercourse isn’t like it used to be” explains Dr. Hamori. Things just feel loose. They also often suffer from stress incontinence where they sneeze or jump around at the gym and wet themselves. Wearing a pad is uncomfortable, cumbersome and embarrassing.

Non-Invasive Vaginal Tightening Not Enough

Many of these women come into the office requesting a non-invasive tightening procedure. They have heard so much about them in the media without realizing their limitations. A woman who has delivered twins, for example, is probably not going to see an improvement with a non-surgical procedure. When Dr. Hamori examines such a patient, she typically finds that the vagina has stretched down towards the anus so that it’s literally gaping.

The patient feels self-conscious about the appearance of her vagina. In addition, this kind of looseness can make it nearly impossible to reach orgasm with vaginal penetration, so sex is less enjoyable. Severe vaginal laxity can only be addressed with either a perineoplasty and/or a vaginoplasty.

What is a Perineoplasty or Vaginoplasty?

A perineoplasty is when the outer vagina is tightened to give it a better appearance and function. A vaginoplasty addresses more of the interior of the vagina. When a woman delivers a child vaginally, the muscles of the vagina can separate. It’s similar to diastasis or a separation of the abdominal muscles that occurs during childbirth. The same thing occurs with your pelvic floor so that you no longer have any grip or strength.

Perineoplasty overview.

While kegels can help, these muscles “really need to be reapproximated or sutured together,” explains Dr. Hamori. Performed in the operating room, the procedure takes about two hours. In the perineoplasty, the surgeon excises a triangle of tissue — a little bit of the vaginal tissue and a little bit of the tissue between the anus and the vagina. In the vaginoplasty, he or she will remove any scar tissue that resulted from your deliveries and suture the muscles that have separated back together. This establishes both a better shape and function to your vagina.

Risks & Recovery

There are a few risks associated with a perineoplasty and vaginoplasty. It is a relatively large operation so bleeding is a potential problem. You also have to worry about a rectovaginal fistula. This is where there would be a small connection between the anal canal or rectum and the vagina. It usually heals on it’s own, but in less than 1% of the cases, it does not.

In terms of the recovery, Dr. Hamori uses Exparel, a long lasting analgesic, during surgery to help manage post op pain. This provides patients with about 48 – 72 hours of total comfort. She advises that patients ice the area and stay off their feet. The more that you stand, the more discomfort that you’ll feel. Otherwise, you need to avoid sex for 6 weeks, and exercise for 3 weeks. Dr. Hamori prescribes a regimen of estrogen cream inserted vaginally and kegels to improve muscle tone. Most patients feel great at about 2-3 months. Furthermore, this surgery delivers a permanent correction.

Perineoplasty results.

Gynecologist vs. Plastic Surgeon

Traditionally, gynecologists have not really been interested in doing these surgeries that enhance sexual function. In fact, they tend to discourage patients from receiving procedures such as a labiaplasty or a perineoplasty unless there is a medical need. The response has simply been to ‘live with it.’ But things are slowly changing. Now, there are even cosmetic gynecologists who are embracing these procedures. Should you then see a gynecologist or a plastic surgeon?

It depends; both are qualified to deliver great results. It’s really going to come down to your comfort level. When Dr. Hamori meets with a potential patient, she asks her very specific questions such as:

  • are you having trouble with orgasm?
  • does a bit of pee seem to sneak out when you stand up?
  • what does it feel like when you move your bowels?

For many patients who have felt dismissed by their gynecologist, this is revelatory and welcome. It’s important to women that the vagina look, feel and function at its best. This could help explain why on RealSelf, the perineoplasty and vaginoplasty procedures have a 100% patient satisfaction rating. That’s a number that really speaks for itself.

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