Keywords
PerineoplastyVaginal tighteningAesthetic vaginal plastic surgeryVaginal rejuvenation
Tightening the entry doesn’t necessarily mean increasing sexual gratification.
During vaginal delivery, many women endure tearing of perineal area, while for others, in order to avoid tearing, an episiotomy is performed. In either scenario, the patient will need stitches on her perineal area, which oftentimes can cause dehiscence leaving her with visible scars and/or muscle diastasis, both with consequences for her future sexual life.
During intercourse, secondary sexual gratification is achieved by friction, but there are differences between male and female regarding this topic; to men, a tight vaginal entrance could be enough, while to women friction at the entry (her anterior vaginal wall) would do.
It is important to remember that if we want to enhance sexual gratification for our female patients merely through a perineoplasty, which is basically tightening the vaginal opening, we won’t have a happy ending. A mere perineoplasty on a patient with wide entrance and wide inner vagina as well will only contribute to male’s satisfaction, and not particularly to female’s.
Important Fact
Tightening the entrance (perineoplasty) doesn’t necessarily increase a female’s sexual gratification.
Anatomy
The perineum is an area between vaginal opening and anus.
It has a diamond shape and can be anatomically divided into two triangles when drawing an imaginary line joining both ischial spines. The anterior triangle (towards pubic bone) is the urogenital triangle, where the urethra is located. On the most posterior border of anterior triangle, we find the vaginal opening. The posterior triangle (pointing towards the coccyx) also known as anal triangle is where the anus is located.
Perineal anatomy
Assessment: Perineoplasty
Important Fact
Perineoplasty can be a very good complement to labiaplasty and/or vaginoplasty .
The first thing you need to address when a patient comes in to your office is not the possible ways to improve or tighten her vagina but, rather, asking for her reasons to seek them. If you don’t know for sure why she is there, before physical examination , you could get lost with later findings and come up with treatment options that won’t fix the situation she came to you for advice in the first place.
What Will the Patient Tell Me?
“I do not like the fact that I can see the inside of my vagina.”
“My labia were trimmed way too much during labiaplasty, so I can see the inside of my vagina.”
“My labia were trimmed way too much during labiaplasty years ago, and now I’m experiencing dryness.”
“After vaginal delivery I teared down there, and I’m afraid they didn’t suture correctly.”
“I have a terrible scar down there.”
“I have an awful lot of excess tissue in the area.”
“Would you be able to remove these sort of ‘skin folds’ that stretch from my perineum toward my anus?”
“It tears with every penetration.”
“I just do not want to have sex anymore, it really hurts every time.”
“I love my kids . . . but they ruined my sex life!”
“I feel pain when my scar gets tense during intercourse.”
“What is the point of having sex if I just do not enjoy it anymore?”
“Could you please examine me and see if I am a good candidate for perineoplasty?”
“I just want an enhancement down there.”
“I’m running out of excuses, I just do not want to have sex with my husband anymore!”
“It’s just embarrassing! sometimes, while having sex, there’s this sound as though air enters my vagina during intercourse.”
“I am afraid my husband will leave me and find another woman, I just do not want to have sex with him anymore, cause, neither of us enjoys sex like we used to!”
“I know I don’t please him as before, but he won’t tell me, I want to surprise him!”
“Our marriage is not doing well, so maybe if sex improves we may still have a chance!”
“We just don’t feel the same after our kids were born. Sex was very important for us, but now we’re less interested in it every day!”
“We have discussed the situation and are willing to try getting our sex life back, by trying some kind of vaginal tightening procedure!”
“It feels terrible being in the middle of sex and have him tell me: ‘Tighten your vagina,’ nothing like that ever happened before the children!”
“My husband says it doesn’t feel the same anymore after the kids. I want this fixed!”
“My husband suggested this surgery, he was the one who got me the appointment.”
“Could you please fix my wife.”
What to Look for in My Patient?
Important Fact
Very few women are good candidates for perineoplasty only. If the idea is to enhance sexual gratification for both man and woman, performing a mere perineoplasty will only serve the male’s satisfaction, not the female’s.
After listening to your patient, you will have a clearer understanding of why she’s there. If her medical records show her sexual gratification is ok, but her primary concern is her partner’s, she will be a good candidate for perineoplasty only.
First
Ask again what bothers her, and if possible, have her show you, and then take a good look again.
Second
Perineal area
Excess mucosa, mucosa/skin folds.
Visible scarring tissue: feel it; check if it hurts when touched.
Small lacerations on the perineum.
Small lacerations in the vaginal introitus.
Exposed inner vagina mucosa.
Vaginal internal exam
Hard inelastic tissue on scarring area.
Loose muscle tone at entry—perineoplasty candidate.
Loose muscle tone not only at the vaginal entry—patient will need more than only perineoplasty.
What Can Be Achieved with a Perineoplasty ?
Important Fact
Never overcorrect it; if you end up with a smaller inner than outer introitus, your patient will be in pain when having sex, as it will make her prone to lacerations during intercourse.
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