Vaginal Rejuvenation Surgery
One of the fastest growing segments of cosmetic surgery is female genital surgery. Many phrases are used to describe what is surgically done and the catch-all phrase lay people have seen with increasing regularity is vaginal rejuvenation. The branded name Laser Vaginal Rejuvenation has even gained national attention in print and television. In reality, vaginal rejuvenation is a marketing term referring to vaginoplasty, or the surgical tightening of the vaginal canal. Birth trauma, tissue stretching, and improper surgical healing are the usual reasons for requesting vaginal rejuvenation. Surgery usually entails a modification of a standard gynecologic procedure called anteroposterior repaire along with rebuilding of the perineum (the space between the vagina and rectum). This procedure was traditionally performed for a fallen or prolapsed rectum, or rectocele. A rectocele is a bulge of rectum going into the vagina. A similar appearing vaginal bulge is an enterocele. It is a bulge of small bowel going into the vagina. Lasers, scissors, cautery units, knives are used in surgery. Excellent results have been achieved by all these methods.
There is great controversy whether or not vaginal rejuvenation can improve the pleasure of intercourse or increase sexual desire. There are no randomized controlled studies showing that narrowing the vaginal canal improves orgasms or dramatically alters a woman's sex life. Reports of improved sexual sensation from increased friction are by anecdotal experience and less scientific surveys. However, many couples do report more satisfying lovemaking, more tightness, and a belief that surgery has helped their sex lives.
There are only a handful of surgeons who perform these surgeries in adequate volumes to be proficient and adept. Technical skill is of paramount importance but having an artist’s eye is of equal value. Some women even have their tummy tucks and breast augmentations done concomitantly as part of their extreme makeover.
Labiaplasty Minora (Labial Reduction)
This surgery is for the removal of excess, floppy, or uneven labia minora (smaller interior vaginal lips) that often causes chronic irritation, rubbing, or discomfort during sexual intercourse. Many request this surgery to eliminate the appearance of a bulge with certain clothing such as wet swimsuits or leotards. The term “Labiaplasty†can also relate to the cosmetic surgery of the labia majora (larger outer lips) to make it less prominent and saggy. Labias can grow large with estrogen stimulation at puberty and pregnancy and with the effects of gravity with aging. Labiaplasty is done in the operating room and in the office under local anesthesia at dramatically decreased costs. The Ellman Surgitron is also the tool of choice. It is dramatically less destructive than lasers often advertised. This procedure takes 60 minutes to perform.
What is Aesthetic Vaginal Surgery?
The term Aesthetic Vaginal Surgery is also known by other names such as Vaginal Rejuvenation, Laser Vaginal Rejuvenation, Labiaplasty, Vaginoplasty, Designer Laser Vaginoplasty, Perineoplasty, and Hymenoplasty. Aesthetic Vaginal Surgery is a broad term that includes the individual procedures. Since it is a rather new field dealing with the appearance and function of a woman'ss private parts the terminology has not been standardized. In simple terms, Aesthetic Vaginal Surgery and its many names deal with cosmetic surgery of the vulvar and vaginal region. It is cosmetic surgery of the Private Parts.
Why is vaginal correction important
Surgery to improve the appearance and function of a woman's vaginal tissues is important for both personal esteem and physiologic function. Childbirth is often traumatic resulting in lacerations and healing process that is not personally satisfying. The use of forceps or vacuum assisted delivery and the increasing weight of babies today result in more prolepses of pelvic organs, more incontinence, and more looseness of vaginal tissues or unappealing appearance of labial tissue. Many who have finished their childbearing years are now concerned about their personal appearance and are looking for ways to deal with this problem. Some feel that they have lost a great deal of sexual sensation due to loss of tone of the vagina.
Is the use of Lasers important
The laser is an important surgical tool that has many advantages. Certain lasers are very precise and are used as scalpels. Some lasers are ablative (destructive) and used more to destroy abnormal tissue or to resurface the skin. Many dermatologist and plastic surgeons use this type of laser. However, there is no magic in the use of lasers. In fact, other modalities such as radiofrequency cautery units can give more precise cuts and less tissue destruction by a factor of ten or more. Other surgeons will avoid electrical units altogether and use highl precise scissors or scalpel units. Another way to look at lasers is to realize that it is a tool in the doctor's bag but that it is not ultimately any better than a cold knife. However, it is undeniable that using the term Aesthetic Laser adds glamour and a sense of prestige to a procedure.
The procedure of vaginal rejuvenation surgery
Almost all of the cosmetic surgeries are outpatient. Labiaplasty and vaginoplasty cases are typically finished within an hour. If a repair of the bladder, rectum or bowel is needed then a 23 hour overnight stay may be needed. If a hysterectomy is needed than it is typical to stay one to two days. Placement of a sling to help with incontinence does not prolong the hospital stay. Many patients feel the pain involved is similar to the discomfort AFTER a baby has been born. They are somewhat sore but not in agony. Pain control is excellent in the large majority of cases.
The actual procedures
Labiaplasty is the cosmetic reshaping of the inner folds of tissue, called the labia minora, or smaller inner lips of the vagina. Various instruments are used such as pinpoint cautery, Yag lasers, fine scissors, or a knife. The edges are then sewn together with delicate absorbable sutures. A vaginoplasty (commonly referred to as vaginal rejuvenation) is when a diamond shaped section of tissue is excised from the inside of the vagina and brought down to the outside of the vagina. Often times a small triangular area is also excised from the perineum (the area right below the vaginal opening). This is called a perineoplasty or perineorrhaphy. The size of the tissues removed rarely are larger than a domino block. If needed, sutures that bundle loose muscles together are used to narrow the vaginal opening.
Surgery can trim excessively large labia minora, it can also reduce a labia majora. We can also trim the excess bulge of skin in the vagina and tighten the entrance to the vagina. We can make the whole vagina tighter by excising this loose vaginal skin. Surgery alone will not improve the tone of your vaginal muscles. You need pelvic floor exercising for that similar to Kegels exercises. Surgery can also add support to your fallen bladder, rectum, bowel, or vagina. Many women tell us that they are happy to be able to wear jeans, bathing suits, and form-fitting outfits again because the rubbing and irritation have disappeared.
Where is the procedure done
The procedure is usually done in the operating room or surgery center. If a simple labiaplasty or vaginoplasty is performed then the option of performing the surgery in the office under local anesthesia and oral and injectible medication can be considered. We tailor the surgery to the patient,s projected pain tolerance, anxiety level, and health status.
What type of anesthesia is used
You can have a short nap or be fully awake. General anesthesia is also common anesthetic used because of the patientes desire not to know or feel anything. Then there is the spinal or epidural anesthetic that allows you to be awake. This is ideal for those who have a fear of going to sleep or have other major medical problems. Sedation and use of local anesthetics is the least invasive of anesthetic options. Many choose this so that recovery is almost immediate and the down time is minimal. If the case involves bladder, rectum, or bowel repair of if a hysterectomy is performed then general anesthesia is the standard.
What are the logistics involved
A patient interested in aesthetic vaginal surgery usually calls or emails us to set up an initial appointment for evaluation. If at the time of evaluation the patient and physician agree that surgery is the correct choice then a surgical date is finalized. If the individual is an established patient then I will usually see her within a week of surgery to perform a pre-op evaluation. They may also have this pre-op evaluation with their primary care physician for surgical clearance. This is where blood work, X-rays, EKGs are done if needed. The majority of the time a simple blood count is all that is needed.
Anesthesia is a risk factor because of the very rare possibility of a reaction to either the injected medication or inhaled agents. High temperatures and fevers from Malignant Hypertension can occur. I have personally never seen this in 19 years of clinical practice. You can also aspirate food or fluid that can obstruct your breathing tube or even cause a pneumonia. There is risk of infection of the surgical site, there is a possibility of bleeding and hemorrhage and a need to have a transfusion. With transfusions there is risk of HIV, Hepatitis, and perhaps
other unknown viruses. There is even the risk of death. If tissue or mesh augmentation is needed then there is the risk of rejection of these grafts. Again, these complications are exceptionally rare and the huge majority of cases go quite smoothly. A risk you should also consider is one similar to remorse when one is not fully happy with the result of surgery. The risk of having the surgery redone or amended is present but fortunately is very rare.
What are the risks of Vaginal surgery?
We will fully review the risks of surgery before the case is even scheduled and give you every opportunity to have your questions answered.
Restrictions after Vaginal rejuvenation surgery
We advise Pelvic Rest for six to eight weeks. This means nothing goes inside the vagina, such as tampons or vibrators, and no sexual intercourse for the length of time. The only thing allowed in the vagina is the applicator full of estrogen cream we give you to aid in the healing process. We also recommend loose clothing and no tight underwear, thongs, or jeans that may cause rubbing and discomfort. We advice against lifting of objects or activities that can cause you to strain or bear down. We do not want tension on our suture line nor do we want to stretch tissues we have just tightened. Basically, treat yourself like a princess during this healing phase.
How soon can I go back to work?
If you had a labiaplasty or vaginoplasty you can return to work or normal activity within 4 days. If you had both a labiaplasty and vaginoplasty then it may take you a whole week before you feel comfortable to go back to work. Much depends on the type of work you do. For example, a woman who has a desk job will return to work sooner than one who has to walk or run and carry objects from place to place. We will need to individualize your return to work date. In any event, you are usually healed by six weeks although complete healing takes up to three months.
When can I resume sexual activities after surgery?
We recommend that you wait four to six weeks before resuming sexual intercourse. If you had a vaginoplasty it is also recommended that some stretching exercises of the surgical site start at six weeks to soften any scarring that may occur and to make the sexual experience more comfortable after surgery. This stretching exercise is not needed if you had a labiaplasty alone.
Can you talk about how surgery will affect my sex life?
There are many sites on the Internet that address the topic of sexual gratification and surgeries that may enhance this experience. In summary, there is an opinion that aging and the trauma of childbirth results in looseness of vaginal tissue, weakening of vaginal muscles, and resultant decrease in friction, hence, decreased sexual gratification for both men and women. Unfortunately, this topic is much more complex than simply tightening a vagina to increase frictional forces for both sexes. Surgery can indeed result in tightening of the vagina but there is no guarantee that your sex life will be better or that your orgasms will be more pronounced. You must weigh carefully the claims of an improved sexual experience. Sexual response is multifactorial and it is often the case that a persons personal relationship with his or her partner is the primary determining factor in the happiness of an intimate relationship. Surgery is no panacea but it certainly can improve appearances and increase friction involved. A positive body image is priceless. One more thing, surgery does not affect a woman’s ability to become aroused or her ability to become moist prior to having intercourse.
Will my partner feel any changes when we have sex ?
If you had a labiaplasty there will probably be a dramatic decrease in the interference of tissue that will be felt by both you and your partner. The same goes for vaginoplasty or vaginal rejuvenation since frictional forces are increased. You may need to perform some stretching exercises of your vagina after surgery to allow comfortable intercourse. This is even more important if your partner is large in size.