Aesthetic vaginaplasty is a surgical procedure used to reduce excessive width in a woman's vaginal canal. This sometimes happens after natural childbirth, and is usually a cosmetic concern. The procedure is made specific to a patient's desires expressed at her initial consultation.

Women who desire this type of surgery will often complain of a vaginal sensation of being "stretched out". They notice it mostly with vaginal sexual intercourse. Many of these women feel that it often takes longer to have orgasms since they feel less friction. Some of these women can't have orgasms at all.

Most patients who complain of diminished sensation or friction during intercourse can have a one to three hour surgical procedure designed to enhance friction during intercourse. Aesthetic vaginaplasty will effectively enhance the tautness and tightness of the vaginal walls by decreasing the vaginal diameter. The surgical technique required for each individual patient varies depending upon the amount and type of vaginal relaxation found.

The Procedure

There are several surgical techniques used to obtain the desired outcome. The proper method for each patient is decided at the consultation and is unique to each patient. After childbirth patients may have one of a few conditions:

Rectoceles happen when the rectum bulges into or out of the vagina. Rectoceles may occur as a result of injuries sustained during childbirth. With a weakened or bulging rectum, bowel movements become more difficult. The rectocele also causes the vagina to feel larger, reducing the sensation during intercourse.

Cystoceles occur when the bladder falls or descends from its normal position. The most common symptom associated with cystocele is difficulty in completely emptying the bladder. This can be associated with bladder infections. Large cystoceles can cause the bladder to overfill and allow small amounts of urine to leak. Leakage is most common during activity such as walking or bouts of coughing. Cystoceles can also occur due to trauma from childbirth.

Urethroceles usually occurs in conjunction with a cystocele. Both of these conditions result in, among other things, involuntary loss of urine, particularly when there is increased pressure in the abdomen, caused by walking, jumping, coughing, and sneezing, laughing, or sudden movements.

Enteroceles are the bulging of small intestines into the back wall of the vagina.

The goal of the surgery is primarily to repair any defects that may be found. After repair of the defects the cosmetic portion of the surgery is performed. For a proper vaginal tightening, not only is the vaginal tissue dissected and trimmed, but the underlying supporting structures and muscles are repaired. This results in a more uniform, sturdy repair. The degree of tightness created in the vagina will depend on the patient's wishes.

At the end of the procedure the entrance of the vagina is also surgically corrected to enhance the tightness. Defects in this area are typically also from childbirth or poorly healed episiotomies. The skin over the area is dissected away, the underlying tissue and muscle is gently brought together and then both layers are repaired.

Surgical repair of the inside of the vagina, as well as the opening, generally results in uniform tightness of the entire vaginal canal, not simply the opening.

Possible Complications

In any surgical procedure no matter how competent the surgeon, there is the possibility for complications. The complication rate for this procedure is low.

Bleeding: Blood clots can collect beneath the skin and must be removed through a small opening or via the use of a needle. Bleeding can be made less likely by avoiding aspirin and aspirin-like compounds (like ibuprofen and motrin) for 7-10 days prior to surgery. This will be explained to you before the surgery.

Infection: The infection rate in patients following labioplasty is very low. Infection can cause poor wound healing and increase scarring. Infections may require drainage through a small opening. Antibiotics are given in most cases to reduce the possibility of infection.

Skin Loss: Very rarely a portion of skin will not survive and will be replaced by scar tissue. This is usually due to loss of the blood supply to the flap or infection.

Asymmetry or Undesirable Shape: The defect in a vagina is never completely symmetrical. Sometimes there may be more of a defect to repair on the top of the vagina than on the bottom of the vagina. Patients start out with varying degrees of asymmetry to start with. Some are greater than others.

During the procedure we make every effort to make them match closely, but sometimes we do not completely succeed. This is sometimes due to healing or the pre-operative condition of the vagina. The overall goal is improvement in appearance and a decrease in the vaginal size and diameter. Your operation is designed after discussing your desires but the ultimate results is dependent upon healing. Healing can never be predicted 100%. We make all reasonable efforts to deliver a result with which you will be pleased but we cannot and do not offer any form of guarantee or warranty.

Pain Sensation: Very rarely there is pain in the operated area that is permanent. This usually improves over weeks to months. It is possible that sensation in the operated area could become unusual or annoying. The problem is directly related to the amount of tissue removed. In other words, the more tissue that we remove (tighter repair) to repair your vagina, the greater likelihood of having more post-operative pain.

Post-Operative Care

Following the procedure, the wounds will be dressed with petroleum jelly gauze. The sutures will dissolve over a few weeks. You will return to the office the morning after the surgery to have the gauze removed. You should have light activity in the early post-operative period to minimize the potential to damage the healing wound or cause bleeding. Vaginal sexual intercourse should be avoided for at least six weeks. In some cases you can receive oral sex in as little as 3 weeks. Avoiding trauma to the area allows for the best possible would healing. A small amount of patience during the post-operative period will pay off dramatically in the long run.
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