Vaginoplasty

Introduction

Over the past decade, we have witnessed an increase in intimate surgeries globally, including vaginoplasty. According to ISAPS data , more than 55,000 vaginoplasties were performed worldwide in 2016

Goals of vaginoplasty

Vaginoplasty is a female intimate surgery that aims to narrow or widen the vaginal canal , to improve the sexual life and self-esteem of women who suffer from intimate problems. However, when we refer to vaginoplasty, we tend to associate this surgery with the act of narrowing the vaginal canal, in this case, we can also refer to it as “vaginal closure” surgery.

Who can have a vaginoplasty?

The type of candidate differs according to the type of intervention ( narrowing or widening ). We can distinguish as potential candidates women who:

• Have the sensation of having a wide vaginal canal, making intercourse difficult with penetrations that “float” and vaginal gases.
• They suffer from an abnormally large vaginal canal opening, making it difficult to carry out simple daily activities (vagina that fills with water during bathing …).
• They suffer from an abnormally distended vagina, with vaginal laxity or hypermobility, with an elongated or too open vulva.
• Who have had an episiotomy.
• Who want to live a fuller sexuality.
• That they fear an evolution of their case towards a prolapse.
• With incontinence.
• They have a vaginal canal that is too narrow.
• They suffer from vaginismus, preventing them from living a normal sex life because of the pain.

What are the causes of vaginal laxity?

The vaginal laxity has many causes, whether due to natural factors or external factors , as explained by experts Aragon Medical Center. Among them we find:

External factors:

• vaginal deliveries: after the 3rd delivery, 40% of women suffer from some vaginal laxity
• A poorly closed episiotomy .

Natural factors:

• natural aging , which can lead to relaxation of the perineal muscles
• some women may naturally have a vaginal canal that is too wide.

What is vaginal hypermobility?

Not all women who are going to have a vaginoplasty, nor all women who have given birth suffer from vaginal hypermobility. However, all women with vaginal hypermobility are candidates for a vaginoplasty.

Vaginal hypermobility is the most extreme case of abnormal opening of the vagina. This phenomenon occurs most often after one or more deliveries.

According to the Teknon Medical Center, vaginal hypermobility is due to a deficit in the tonicity of the perineal muscles . Women who suffer from it complain of a multitude of symptoms, among which, vaginal gas during penetrations, a decrease in vulvovaginal sensations or the abundant loss of fluids after bathing.

Women who suffer from vaginal hypermobility also suffer reproaches from their partner who accuse them of the loss of sensitivity during intercourse, giving rise to great complexes that often lead them to avoid intimate relationships.

How to choose my surgeon?

As with any surgical procedure, it is important that you see a qualified and experienced surgeon . In Spain, surgeons must be part of the SECPRE (Spanish Society of Aesthetic and Reconstructive Plastic Surgery) to be able to practice. You can also go to a urogenital surgeon or a gynecologist. The most important thing is that you verify that your surgeon is a specialist in female intimate surgery. The  comments that “the most qualified professionals for this are usually gynecologists since they also perform genital aesthetics.”

Then, we invite you to look for opinions of former patients in forums. Read all the information you find, it will give you clues about the type of work your surgeon will do.

Take your time to research, visit different surgeons if necessary. It is important that you find someone who makes you feel confident.

It is worth mentioning that since it is an intimate surgery, you may feel more comfortable going to a doctor, since she will have to examine you in detail during your first consultation.

What happens during the first consultation?

During the first consultation, the surgeon will ask you a series of questions to find out what your symptoms, motivations and expectations are. It will also take the opportunity to write your complete medical history in order to rule out a possible contraindication. Afterwards, he will examine you and tell you what are the different alternatives that exist to solve your problem; He will talk to you in detail about the procedures, risks, results, how to prepare and how to live the postoperative period. Finally, they will give you a complete budget with the total price of the surgery.

Take advantage of this first contact to ask the surgeon questions . We recommend that you prepare a list with all your doubts before the consultation, to ensure that you do not forget any details.

If you decide to proceed with the intervention, the surgeon will give you an appointment for a second consultation, in order to better prepare the process.

We remind you that the physical examination that the surgeon will perform consists of a vaginal examination, so if you do not feel comfortable with a male doctor, it is better that you go to a surgeon beforehand

How to prepare for the intervention?

We leave you this list of tips to prepare for your intervention:

• stop smoking at least 1 month before surgery and 2 months after
• stop taking your oral contraceptive 1 month before surgery to reduce thromboembolic risk
• stop taking anti-inflammatory medications such as aspirin at least 15 days before surgery.
• you will have to consult your anesthetist at least 48 hours before the intervention
• the night before and the morning of surgery, you will need to shower with an antiseptic

Anesthesia and hospitalization

The type of anesthesia depends on the case of each patient, the experts at SECPRE explain that vaginoplasty can be performed under local anesthesia with sedation, or general anesthesia if you prefer. You can also opt for an epidural.

Most likely, you will have to be hospitalized for about 24 hours , but depending on each case, the surgeon may also decide to perform outpatient surgery , so that you return home the same day.

Vaginoplasty procedure

• Narrowing vaginoplasty

The center explains how a complete vaginoplasty (colpoperineorraphy) is performed. It is a quick intervention that lasts approximately 1 hour. At first, the surgeon proceeds to tighten the muscles so that the structure is more solid. Then, join the edges of the skin of the vaginal canal to shrink and narrow it. This also allows you to correct a possible episiotomy scar.

• Enlargement vaginoplasty

It is again a simple intervention, in which the surgeon is responsible for weakening the muscles of the perineum and performing a skin plasty whose purpose is to enlarge the vulva.

Postoperative

The experts at the Teknon Medical Center inform us that pain after a vaginoplasty is very easy to manage and bearable with pain relievers. Bruises may appear, but will disappear on their own in a few days.

It is important that you have impeccable intimate hygiene : bathe with an antiseptic and gently dry the area 2 times a day for 3 days. We also advise you to wear loose clothing and a hygienic protector during the first days to avoid rubbing.

The stitches are absorbable and will disappear on their own after 10 days. You can resume a professional activity after 5 or 6 days as long as you do not have a physical job, as well as a progressive sexual activity after about 6 weeks.

They also recommend that we wait 1 to 2 months before doing activities such as horseback riding or cycling.

Results

It is an intervention with a high degree of satisfaction . We can classify the results into two types:

• at a functional level: sexual relations are much more pleasant, the couple rediscovers forgotten sensations
• aesthetically : laxity is corrected, the vulva is more aesthetic.

Other vaginoplasty techniques

There are other less invasive and complete techniques for performing a vaginoplasty or treating the vaginal area. They can be applied in patients suffering from very weak vaginal laxity or in lighter cases of vaginismus.

• Vaginoplasty with lipofilling

If the muscle laxity is moderate, the surgeon can perform a lipofilling from the fat of the pubic area, the buttocks (or any area of the donor). The fat will be treated and purified (Coleman method) before being injected into the lateral walls of the vaginal mucosa. This method makes it possible to narrow the diameter of the vagina, increase the G-spot and improve the quality of the vaginal mucosa. This technique is performed on an outpatient basis, under local, general or epidural anesthesia, depending on the patient’s preferences.

• Hyaluronic Acid Vaginoplasty

This type of vaginoplasty is also much gentler than other techniques. Hyaluronic acid injections are done very quickly, in the doctor’s office and under local anesthesia. However, hyaluronic acid is naturally reabsorbed by the body and its effects last between 15 and 20 months, after which time it will be necessary to repeat the operation. Bruising is likely after the injection.

• Botulinum toxin injections (Botox)

Tabien can treat some cases of vaginismus with injections of Botox , because this product is known to inhibit muscle activity. (Vaginismus is due to a large muscle contraction that prevents penetration.) As with hyaluronic acid injections, it is done in the doctor’s office under local anesthesia.

Complications and risks

Like any cosmetic procedure, there are risks and complications linked to the intervention. SECPRE experts inform us that there are 2 types of risks ; the former are associated with anesthesia and the latter with the surgical procedure, so it is always recommended to go to an experienced and qualified surgeon.

We have the following risks related to vaginoplasty:

• hematoma
• infections
• imperfect scar
• necrosis
• sensitivity disorder
• recurrence of vaginal laxity
• fistula between the anus and the vagina (very rare complication)

frequently asked questions

• It is painful? No, it is not a painful procedure. However, your doctor will prescribe an analgesic to facilitate the postoperative period.
• How can I prevent the need for a vaginoplasty? In some countries women choose to give birth by caesarean to preserve the integrity of the vagina.
• What are the other complementary operations? To achieve a rejuvenation of the intimate area, you can also perform a labiaplasty (reduction of the vaginal lips), treat vaginal dryness, as well as increase the G-spot, using techniques such as lasers, or even injections.
• What are the other female intimate surgery procedures? You can perform interventions like hymenoplasty, labiaplasty, clitoral surgery, pubic lift, or Mount Venus liposuction, to name just a few.
• What happens if I get pregnant after my surgery? It is advisable to perform this surgery once all the desired pregnancies have passed, because delivery can alter the results of vaginoplasty.