Vaginoplasty

Introduction

Vaginoplasty is a surgical operation that involves the reconstruction of the vagina or the construction of a new vagina. Vaginoplasty surgery is performed to tighten the vagina and/or reshape its opening. It is a type of genitoplasty that surgically tightens or repairs vaginal musculature and the loose and/or redundant mucosa on the posterior wall of the vagina is removed. The excess external skin may also be removed during the process to give the vagina a cosmetically appealing appearance. An alternative to vaginoplasty surgery is using radiofrequency or laser therapy to induce thermal tightening of the internal vaginal lining.  These procedures offer an excellent non-surgical, no downtime solution to vaginal laxity. However, patients suffering from severe vaginal laxity may not significantly benefit from this technique and will realize more effective results with a surgical vaginoplasty.

Vaginoplasty surgery was initially created as a reconstructive procedure for the repair of congenital genital abnormalities to enable the child to have normal urination, menstruation, and sexual function. Over time, vaginoplasty surgery has evolved to cover a variety of conditions ranging from functional problems to cosmetic enhancements. More recently it is being advertised as a vaginal rejuvenation process by many plastic surgeons as a way to achieve a youthful-looking vagina for those suffering from age-related and child-bearing effects on their genitals. 

Vaginoplasty surgery is offered by surgeons of varied specialties, depending on the individual need such as those in plastic surgery, gynecology, urology, and pelvic reconstructive surgery. 

Labiaplasty is another type of genitoplasty that involves surgery of the skin folds, labia majora, and labia minora, surrounding the vaginal introitus. This surgery may be performed alone but is often performed in addition to a vaginoplasty to achieve an aesthetically appealing genital area.

What is the purpose of Vaginoplasty?

The purpose of a Vaginoplasty can be divided into physical and psychological depending on the results desired by you.

Physical:

The main requirement of most patients coming for vaginoplasty surgery is for enhancement, increment, or restoration of sexual function and pleasure. However, vaginoplasty is also a very useful procedure for those complaining of urinary incontinence or dribbling due to a weakened pelvic floor. A vaginoplasty in such patients, when combined with Kegel exercise, helps restore the strength and elasticity of the pelvic floor muscles and often times leads to the reversal of urinary incontinence.

Psychological:

A healthy sexual life and satisfaction with the appearance of one’s vaginal area are closely associated with emotional health and confidence in women. Therefore, along with the physical enhancements, the psychological benefits of a vaginoplasty can not be overlooked. When one is unsatisfied or embarrassed about the appearance of their genital areas, such as an enlarged labia or sagging skin, they may find it difficult to maintain a healthy intimate relationship with their partner. Vaginoplasty surgery thus helps women feel confident and empowered in their sexual life.

What causes the need for Vaginoplasty?

The need for vaginoplasty mostly arises when women feel a loosening or sagging of vaginal skin with age or childbirth and are unable to comfortably wear a tampon are dissatisfied with their sexual experience. Women may also experience urinary incontinence and pelvic organ prolapse due to weakened musculature in that area. This procedure can address both the problem of excess and lose vaginal tissue as well as improve the physical appearance of the vagina by bringing it back to its natural shape and size. It may also be combined with other rejuvenation procedures such as perineoplasty, labiaplasty, clitoral hood reduction, as well as generalized regional skin tightening with Morpheus8 and tone and texture improvement with Fraxel Laser.

 

Vaginoplasty is an extremely beneficial procedure for women suffering from intersex conditions that result in infants being born with ambiguous or abnormal external genitalia. Such conditions include gonadal dysgenesis, androgen insensitivity syndrome, and congenital adrenal hyperplasia. Such conditions can greatly affect sexual relationships and the emotional health of the individual in addition to the medical problems associated with them. Vaginoplasty helps improve both the aesthetic appearance and the sexual, reproductive, and urinary function of the vagina.

Am I a Candidate for Vaginoplasty?

An ideal candidate for vaginoplasty is an otherwise healthy individual usually presenting with a complaint of sagging vaginal structures, reduced sensation following multiple childbirths, lack of sexual satisfaction, loss of vaginal or urinary sphincter tone leading to incontinence or unsightly protrusions of tissue from the vaginal opening. The patient may also present without any such troubling symptoms and only request the surgery for rejuvenation purposes to achieve a youthful genital appearance and experince. However, vaginoplasty is not recommended for those seeking help for psychosexual dysfunctions such as the inability to achieve orgasm or low sex drive.

When is Vaginoplasty medically necessary?

In some conditions, a vaginoplasty becomes a medical necessity in the treatment of different acquired medical conditions and can be used alone or in combination with other pelvic reconstruction surgeries. Some of these conditions are described below:

  • Gynecologic malignancies: A vaginoplasty may be performed to create a new vagina and achieve a normal anatomical appearance if you have had a vaginectomy for vaginal cancer. Extensive surgeries to treat pelvic floor abscesses and tumors can also cause weakness of the vaginal wall and therefore benefit from vaginoplasty.
  • Vaginoplasty may be performed in addition to the treatment for a congenitally fused urethra and vagina to counter the resulting weakness of vaginal walls after surgical separation.
  • Cystocele and rectocele, which is prolapse of the urinary bladder and rectum respectively, require surgical correction to reposition these organs in their normal anatomic locations. The cause of these conditions may be due to multiple childbirths and aging and is associated with a weakened vaginal wall.
  • Female cloacal exstrophy, a rare condition in which the child is born with the bladder and some of the intestines outside the abdominal cavity. It may also be associated with a split in the bony pelvis and spinal abnormalities. The treatment for this includes correction of spinal abnormalities, the closure of the exposed bladder and intestines, and may include vaginoplasty surgery to correct the external appearance/function of the vagina. 
  • Other medical conditions that may benefit from a vaginoplasty include vaginal suspension and fixation, and hymenorrhaphy, among others. 

Benefits of Vaginoplasty

 

Promotes Self Esteem

The vagina can take on multiple normal appearances depending on age but these changes may be unwanted by you due to unsightly appearance and they may leave you feeling self-conscious about it. A vaginoplasty, therefore, helps in boosting your self-confidence if you suffer from loss of vaginal tone and tightness. It can promote self-esteem and help you feel more feminine, youthful, and confident in your sexuality.

Discomfort and pain

Many women opt for vaginoplasty when they feel pain or discomfort during intercourse. This may be due to damage to the vaginal wall or sagging skin and loss of muscle tone in the vagina. Vaginoplasty can relieve this pain by repair of the vaginal wall and restoring the normal tone of the vagina.

Improved Sexual Gratification

Another benefit of vaginoplasty surgery is to achieve enhanced sexual gratification if you are suffering from some kind of sexual dysfunction. This may present as a loss of interest or joy during sexual activity and both partners can benefit greatly from this procedure as it will make the act of intercourse enjoyable for you both.

Enhanced Appearance

Vaginoplasty is offered by many plastic surgeons and is undertaken as an elective procedure for those who want to improve the function and appearance of their genital area. This cosmetic procedure can restore a youthful and tightened vagina, and when combined with external skin tightening and texture improving procedures such as Morpheus8 and Fraxel, the surrounding vaginal skin is left  truly rejuvenated and refreshed.

Increased Vaginal Firmness and Strength

Labour and childbirth can significantly damage the muscles of the vagina and pelvic floor and mothers with multiple childbirths can greatly benefit from vaginoplasty. Vaginoplasty helps restore the normal anatomy of the vaginal structures and prevents many complications such as urinary incontinence, and prolapse of tissue from the vaginal orifice.

Side Effects of Vaginoplasty

The side effects of vaginoplasty can be divided into general risks that accompany any surgical procedure as well as some specific complications.

General Risks

The general risk factors of vaginoplasty are similar to other surgical procedures and include hemorrhage, infection, and anesthetic complications. Excessive scar formation may also occur after surgery.  Scarring can also make the vaginal area unsightly and leave you sensitive and uncomfortable, although this is exceedingly rare with vaginoplasty surgery, as this area of the body tends to heal very well.  Additionally, blood clots may form in the nearby deep veins after surgery, known as deep vein thrombosis, and can lead to ischemia and pulmonary embolism. However, such general complications are not common in people who are otherwise healthy before the surgery. 

Specific Risks

The specific risks of vaginoplasty although rare include the following:

  • Necrosis of the clitoral region (1-3%) or the surgically created neovagina (3.7-4.2%), as well as shrinkage of the vagina, can occur in 2-10% of patients.
  • 12-15% of the cases resulted in stricture or stenosis of the vaginal opening and require expert and timely correction so that proper intercourse and menstruation can occur.
  • Damage to the local sensory nerves may occur post-surgery leading to a decreased or abnormal sensation of the vagina. 
  • Intestinal vaginoplasty uses sigmoid tissue to create a new vagina and is beneficial in those with insufficient skin for penile inversion technique. This method however may be followed by paralytic ileus, peritonitis, constipation, and dysuria, and excess mucus production in some patients and can increase the long-term risk of colon carcinoma.
  • Some cases of vaginoplasty may rarely result in fistula formation, which is an abnormal connection, between the vagina and the urethra or rectum and this may require a second surgery for correction. 
  • The final risk of such a surgery is dissatisfaction with the outcome of vaginoplasty which is principally due to dissatisfaction with the external appearance of the newly created vagina.

Most of these complications are rare and can be easily avoided by an open and honest consultation with your surgeon about the expected outcomes and possible risks.

The Surgery Walkthrough

There are several techniques for reconstructive vaginoplasty surgery, which are used in different clinical conditions. 

These include:

  • Active or passive stretching by using dilators, Vecchietti traction devices, or balloon vaginoplasty
  • Procedures that involve the formation of neo-vaginas from the labial and perineal tissues
  • Forming a neovagina in the rectovesical space by using different tissues such as amnion, split or full-thickness skin graft, intestine, peritoneum, or buccal mucosa.

In aesthetic vaginoplasty surgery, the procedure is performed under a general anesthetic but it can also be performed using local anesthesia with a sedative. You will lie comfortably on the operating table with your legs spread apart. Next, according to the preoperative discussions you had with your surgeon, the likely initial steps will be for excess skin to be removed at the vaginal opening. The vaginal mucosa is carefully separated from the vaginal muscles. Excess vaginal mucosa within the vaginal canal is then carefully excised and the cut edges are sewn together. This effectively narrows the diameter of the vaginal canal. Next, the vaginal muscles are approximated or sewn together using a technique similar to that used during a tummy tuck which tightens the vaginal introitus or entrance. 

With this technique a relaxed vaginal opening is tightened and made smaller. The incisions are closed by using dissolvable internal and external sutures. Vaginoplasty gives visible results immediately after the surgery although you will have to wait at least 8 weeks before engaging in sexual intercourse. Most aesthetic vaginoplasty surgeries take approximately 1- 2 hours and can vary depending on the skill of the surgeon.  

Preparing for Vaginoplasty

Upon arriving to the surgery center, you are taken first to a preoperative room to change into your hospital gown and wait comfortably. A nurse will take your vitals and place a peripheral IV through which fluids, anesthetics, and antibiotics can be administered during surgery. 

While in the preoperative room you will also:

  • Meet your surgeon and other doctors and nurses who are assisting in the surgery.
  • Sign consent forms for surgery and anesthesia which will inform you about the potential risk factors associated with the surgery.

Some surgeons advise their patients to begin a clear-liquid diet which may include, water, apple, white grape or white cranberry juice, black tea or coffee, and clear broth, two days before surgery.

Along with an appointment with the surgeon, you will also have an appointment with an anesthesia nurse who will review your medications and give specific instructions about whether any medicine needs to be stopped before the surgery. For example, 2 weeks before the operation you may be advised to stop taking estrogen supplements to reduce the risk for blood clots.  Similarly, to decrease the risk of bleeding you may be asked to stop taking any blood thinners or NSAIDs. Additionally, alcohol consumption is discouraged in the 24 hours prior to surgery. 

It is also advised to stop smoking, chewing tobacco, vaping, or using any nicotine products at least 4 weeks prior to surgery date as nicotine reduces blood flow to the genital region thereby reducing wound healing and increasing the risk of other complications during surgery.

Excess fatty tissue can negatively influence the result of the operation and can have safety implications. Therefore, depending on the case, you may be asked to lose a certain amount of weight prior to surgery. Three to six months before the surgical procedure you may be asked to go through permanent hair removal either by laser hair removal or electrolysis. This is done to prevent hair growth inside the new vagina which can lead to problems like ingrown hairs, abscesses, increased vaginal discharge, foul odor, and discomfort during intercourse or dilation.

Vaginoplasty Recovery Time 

You can expect to take 1-2 weeks to recover completely from surgery, and for a more in depth description of the vaginoplasty recovery process, check out the article linked. For the first few days, you may experience mild to moderate pain in the vaginal area. Intercourse and use of tampons should be avoided for 8 weeks post-operatively. General symptoms include swelling, soreness, and slight bruising following the surgery which usually subsides in 1-2 weeks. You should be up and walking the day after surgery.

Vaginoplasty Results

Visible results of vaginoplasty are noted almost immediately after surgery and the final results will be fully noticeable a couple of months after surgery. You can usually resume sexual activity within 8 weeks after surgery. The results are permanent but can be influenced by pregnancy and childbirth. Carefully following the post-operative instructions is the main factor which dictates the long term success of the vaginoplasty surgery.

Cost for Vaginoplasty

In addition to the cost of vaginoplasty surgery itself, other considerations are necessary before and after the procedure and the cost of these should be noted. These additional factors include:

  • Anesthesia charges
  • Operating room charges
  • Consultation fees
  • Lab fees
  • Post-surgery garments and aftercare
  • Prescriptions for medication

The average cost for vaginoplasty surgery is approximately $10,000 which includes the OR and anesthesia charges. However additional charges may be incurred for additional concurrent procedures including labiaplasty, breast augmentation, feminization surgery, etc. The final cost can vary depending on your insurance plan, residence, and choice of surgeon. Most health insurance plans do not cover the cost of aesthetic vaginoplasty procedures or its complications as they consider it an elective procedure rather than a medical necessity. Some insurance carriers may cover vaginoplasty procedures, but this needs to be pre-authorized beforehand.

Summary

The vagina is a muscular tube in a woman’s body that connects the uterus and cervix to the external genitalia and is necessary for childbirth and menstruation. Ageing, pregnancy, labor, and other hormonal changes can lead to a change in the anatomy of the vagina which may or may not affect its function. These changes can lead to sagging, stretching and deformation of the vagina, decreased sexual satisfaction, and loss of tone and strength of pelvic musculature. 

 

Fortunately, you can opt for a vaginoplasty if you are interested in restoring the youthful appearance of the vagina and for treatment of any of the negative effects of reduced vaginal tone, strength, and stretching as a consequence of childbirth.

 

Vaginoplasty surgery is an innovative aesthetic procedure that has become popular for women who are unhappy with the way their vaginal area looks and feels or are having troublesome symptoms secondary to stretching and laxity secondary to childbirth.  Vaginoplasty not only improves the physical appearance of your vagina but also helps in boosting self-confidence by tightening the vagina to its pre-childbirth state.  

 

Vaginoplasty can also be performed as an adjunct to other corrective surgeries such as those done for trauma, rectocele, cystocele, and malignancy.

 

If you’d like to find out more about vaginoplasty surgery or Doctor Vallecillos, a world leading specialist in the procedure, please reach out to us directly through the consultation request form.

References

  1. Magagi IA, Adamou H, Garba SO, Halidou M, Adakal O, Habou O, Abdoulaye MB, Nayama M, Sani R. Sigmoid Vaginoplasty in Mayer-Rokitansky-Kuster-Hauser syndrome. Gynecological Surgery. 2020 Dec;17(1):1-6.
  2. Schnatz P, Boardman LA, Committee on Gynecologic Practice. ACOG Committee Opinion Number 795: Elective Female Genital Cosmetic Surgery. Obstetrics and Gynecology. 2020;135(1):e36.
  3. Vilanova-Sánchez A, Hewitt GD, Levitt MA. Vaginoplasty and Vaginal Replacement. InOperative Dictations in Pediatric Surgery 2019 (pp. 179-181). Springer, Cham.
  4. Grimstad F, Gatti J, Strickland J. 44. Impact of Postoperative Care Tools and Techniques on Vaginal Reconstructive Procedure Outcomes. Journal of Pediatric and Adolescent Gynecology. 2020 Apr 1;33(2):196-7.

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