Keywords
Anterior colporrhaphyVaginal tighteningAesthetic vaginal plastic surgeryVaginal rejuvenation
Improve vaginal tone plus, a bonus
Many women feel like having an improvement of their sexual gratification ; they feel their vaginas loose, they can’t tighten them like before, but they also refer stress urinary incontinence. It is for these patients that anterior vaginoplasty can be a good option.
Often times, however, a patient answers negative when asked about stress urinary incontinence, but once you examine the internal vagina, you can feel a loose anterior vaginal wall. These are also good candidates for vaginal rejuvenation with an anterior vaginoplasty procedure.
Anatomy
The vagina is a canal, or tubelike structure, communicating to the outside through uterine cervix. It measures 6–12 cm long, shorter on its anterior portion (6–9 cm in length).
Vaginal walls are 2–4 mm long, and although very thin, they have several distinctive histological layers: mucosa, lamina propria (loose connective tissue), fascia, vaginalis muscularis (smooth muscle), and adventitia (located behind muscularis, is an extension of endopelvic fascia). Anteriorly, fascia is known as pubo-cervical fascia while posteriorly is known as rectovaginal fascia.
Relation between the vagina and its nearby structures
Assessment: Anterior Vaginoplasty
Important Fact
If your patient’s main concern is incontinence, you should refer her to another specialist.
Once talking to your patient , ask her about stress urinary incontinence; if she refers more than only drops during stress, and after you’ve examine her concluding that she really has an anterior prolapse, she is not a good candidate for vaginal rejuvenation procedure alone, and you need to refer her to another specialist.
If she only has stress urinary incontinence , remind her that this procedure is not intended to fix that situation, but it can help reduce her symptoms.
What Will the Patient Tell Me?
“I do not like my vagina, it looks wide open!”
“The skin of my vagina seems to get thinner and thinner.”
“My vagina skin keeps getting dryer.”
“When check at myself down there I find some pinkish tissue showing through and I do not like it!”
“I do not like seeing 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.”
“Some urine drops off when I jump or cough and I hate it!”
“After having kids, intimacy just doesn’t feel the same.”
“Sometimes pee myself and its becoming more frequent.”
“I love going to the gym, but I hate getting wet down there during weight lifting!”
“I love the gym, but I hate getting wet down there during Zumba/Aerobics , can you fix me?”
“I just wish I could go back to feeling the way I used to.”
“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!”
“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!”
“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 woman’s primary concern is that she is the one “not feeling” during intercourse, in the presence of stress urinary incontinence , it is very possible that she is a good candidate for an anterior vaginoplasty.
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.
Ask if she suffers from stress incontinence, and if so, be alert for it during internal vaginal examination, having the patient push once in lithotomy position.
How to Ask for Stress Incontinence
When you jump or sneeze, do you feel you wet your underwear, even a little bit?
Does it happen frequently or eventually?
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 stress urinary incontinence is found, she has a small anterior prolapse. If prolapse is big, or she has symptomatic incontinence , she is not your patient! You must refer her to another specialist, either a urologist or gynecologist for the right treatment.
Important Fact
If the patient has symptomatic incontinence , you must refer her to another specialist to treat this condition.
Third
Loose muscle tone inside anterior vaginal walls
Good anterior vaginoplasty candidate
What Can Be Achieved with Anterior Vaginoplasty?
Advantages
Ideal when there is looseness of anterior vaginal wall during internal vaginal exam
Can be done together with labiaplasty to enhance the whole vaginal area
Helps with stress urinary incontinence
Helps bring labia minora together on midline
Reduces evidence of inner vaginal mucosa
Improves female sexual gratification
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