Vaginoplasty

(1)

Plastic Surgery, Universidad del Valle Plastic Surgery, Cali, Valle del Cauca, Colombia

Keywords

Posterior colporrhaphyVaginal tighteningAesthetic vaginal plastic surgeryVaginal rejuvenation

Improve vaginal tone with an “easier to do” procedure

We usually think that women seeking a vaginal tightening procedure must’ve had children, but this isn’t necessarily true. Remember: The vagina is elastic; so the more it is used, the looser its walls become. That’s how we have some women, even young girls who feel their vaginas are loose, wanting to enhance their sexual gratification.

For such women, a posterior vaginoplasty could be a good option, obviously, after a thorough vaginal examination to make sure her vaginal walls can be tightened. I’ve had young patients seeking surgery just because it is “trendy,” but after examining them there’s a good vaginal tone, so for these women, the author simply does not recommend any surgical approach.

Anatomy

The vagina is a tubelike structure that communicates to the outside through the uterus cervix. Measuring 6–12 cm long, it’s longer on the anterior portion (8–12 cm long). On its posterior portion, the vagina is called posterior sac, Douglas cul-de-sac, which is where the penis lays during intercourse.

Vagina’s posterior wall is anterior to the rectum wall. There’s an extra embryological layer between vaginal and rectal walls called rectovaginal septum.

Assessment: Posterior Vaginoplasty

Important Fact

If the patient has no stress urinary incontinence but is asking for a vaginal tightening, she may be a good candidate for posterior vaginoplasty.

When a patient seeks vaginal tightening, always ask her if she suffers from stress urinary incontinence. If the answer is no, but when you examine her you find looseness—mostly felt at the posterior vaginal wall—she may only be a good candidate for posterior vaginoplasty.

What Will the Patient Tell Me?

What she sees:

“I do not like my vagina, it looks way too open!”
“I noticed my vaginal skin is getting thinner and thinner.”
“I’ve noticed my vaginal skin dryer and dryer.”
“When checking myself down there I see some pinkish tissue showing through my vagina and I don’t like it!”
“I don’t like being able to 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.”

How she feels:

“Sex doesn’t feel the same after having my kids.”
“I just wish I could feel the way I used.”
“Sex just isn’t appealing anymore.”
“I do not know what’s wrong with me . . . I’m frigid!”
“I used to feel more with my vagina, but now it is totally numb, I feel nothing down there!”
“What is the point of sex if I just don’t feel anything!?
“Trying to get an orgasm has been really difficult to me for some time now, I’ve had to find other ways to help myself, with other sorts of stimulation to achieve it.”
“Could you examine me to see if I am a good candidate for vaginal tightening.”
“I just want an improvement down there!”

Her sexual life concerns related to her partner:

“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!”
“I think my husband is less interested in me.”
“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!”

What her partner tells her:

“My husband says it doesn’t feel the same anymore after the kids. I want this fixed!”
“I know my vagina is not as tight as it used to, I confirmed it when he asked me to tighten more during the sex.”
“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

When the main concern is female sexual gratification, she may be a good candidate for only posterior perineoplasty.

After listening to your patient, you will have a clearer understanding of why she’s there. If her medical records show she wants an enhancement of her sexual satisfaction or that she needs to improve her sexual gratification, plus a history of stress urinary incontinence , she is a good candidate for anterior vaginoplasty.

First

Ask again what bothers her, and, if possible, have her show you; then take a good look again.

Second

Have her push and take a look at her vaginal introitus ; if there is posterior prolapse, you will notice it.

Third

Examine.

Internal vaginal exam, look for:

Loose muscle tone: inside vaginal walls posteriorly

A good candidate for posterior vaginoplasty

What Can Be Achieved with Posterior Vaginoplasty?

Important Fact

It is rare to only perform posterior vaginoplasty, as it’s usually accompanied by perineoplasty.

Advantages

Ideal when there is looseness of posterior vaginal wall only during internal vaginal exam
Can be done together with labiaplasty to enhance the whole vaginal area
Does not help with stress urinary incontinence
Helps bring labia minora together on midline
Reduces evidence of inner vaginal mucosa
Has an easier learning curve
Improves female sexual gratification