Perineoplasty is the surgical procedure of reconstructing the vaginal opening and the perineum for cosmetic and medical purposes. It is primarily considered a type of plastic surgery to tighten the external genital area though there are some instances where the procedure is performed to treat certain diseases and medical conditions. The procedure is also known as perinealplasty or vaginal rejuvenation. A variant of this procedure is also performed to loosen the muscles of the perineum.
The vagina is a tubular structure in the female reproductive system that connects the vulva to the cervix. During sexual intercourse, it stretches to accommodate the penis and stretches even further during childbirth. It also serves as a passageway for blood during menstruation. The perineum is the area located between the vagina and the anus. It provides support to the pelvic floor and also contributes to enhanced pleasure during sexual intercourse.
Perineoplasty can be recommended for:
Women who had an episiotomy during childbirth - Episiotomy is the surgical cut made in the perineum to widen the vaginal opening and facilitate delivery. This procedure can lead to the loosening of the skin and the sensation of a wide vagina. This can result in decreased sexual satisfaction for both patients and their partners. Some women can request to undergo this procedure to remedy this intimacy problem.
Women diagnosed with dyspareunia or painful sexual intercourse due to vaginismus or bacterial infection. Vaginismus is manifested by involuntary contraction of the vaginal muscles, leading to pain during sexual penetration. The bacteria, known as lichen sclerosus, can also cause scarring and itching in the genital area. In some cases, patients also find it painful to urinate and defecate. Another condition that causes pain during sexual intercourse is the vulvar vestibulitis syndrome. Its symptoms include burning pain sensation and tenderness in the vagina even hours after sex. Women with this condition also find it painful to insert tampons when they have their menstruation.
Women with a congenital condition called small vaginal introitus - The introitus is located at the entrance to the vagina. It can adversely affect the patient’s quality of life if it is too small or narrow. In some cases, the narrowed opening leads to urinary problems like urinary tract infections. It can also contribute to painful sexual intercourse. Women with this condition can opt to have the tissues at the vaginal opening and perineum surgically loosened to achieve desired elasticity.
Women with rigid muscles in the perineum – This condition complicates the process of giving birth. In some cases, rigid perineum develops after an episiotomy wherein the muscles stiffen after surgical incision. These patients may opt to under perineoplasty to relieve the tightened sensation and to avoid labour complications should they choose to have another baby.
Women with a hymenal ring - This disorder is characterised by a thick hymen that causes pain and possible injury during sexual intercourse. It is also a contributing factor for tightness in the vaginal introitus.
Women suffering from injury or trauma involving the vaginal opening, perineum, and even the adjacent anus.
Perineoplasty is considered a safe procedure with a high success rate. It is typically done in an outpatient setting that allows patients to go home afterwards. It results in enhanced sexual satisfaction among women who experience looseness in the vagina and perineum. If done to address a medical condition by tightening the tissues, perineoplasty also provides relief from pain and discomfort associated with the condition.
Patients are advised to rest for several days and avoid sexual contact until the surgical site has completely healed. Vaginal contact with irritants or other chemical substances as well as strenuous physical activities should also be avoided. Most patients are also advised to undergo physical therapy consisting of pelvic floor exercises following the procedure.
The patient is placed under local anaesthesia and positioned properly to allow access to the vagina and the perineum area. The surgeon makes a V-shaped incision starting from the top of the vaginal floor, cutting through the vaginal mucosa and the perineum. The incision is continued laterally on both sides of the hymenal ring and vaginal opening and ends just above the anal area. The skin within this diamond-shaped incision is then carefully peeled back and removed, as needed.
For the reconstruction process, the muscles are carefully put back together along the vaginal floor. The fascia is also moved to cover the reconstructed muscles, cutting away any excess skin and other tissues. A catheter may be inserted to facilitate urination during the first few days after surgery. Once the desired tightness or looseness is achieved, the surgeon sutures shut the surgical site neatly and precisely. The goal is to make the surgical site appear as normal as possible.
Some surgeons opt to use laser technology instead of a scalpel for improved precision. They have the option of using a carbon dioxide laser in making the V-shaped incision, which is closed with absorbable sutures after the procedure.
Patients who undergo perineoplasty are at risk of:
Gilbert DA. (1999) Female Aesthetic Genital Surgery. Reconstructive and Plastic Surgery of the External Genitalia. Ehrich R, and G. Alter, Editors.
Woodruff JD, Genadry R, Poliakoff S. (1981) Treatment of Dyspareunia and Vaginal Outlet Distortions by Perineoplasty. Obstetrics and Gynecology. 57:750–754.