Vaginoplasty

The Vaginoplasty or Vaginal Rejuvenation or Vaginal Tightening or Posterior Vaginal Repair is a surgical procedure performed to fix Vaginal Relaxation. Women with vaginal relaxation often complain they no longer feel the same amount of friction during intercourse. They will often describe vaginal looseness as a decrease in a woman’s ability to attain vaginal orgasms.

The main component of the lack of friction is the relaxation of the posterior inner vaginal wall. This is usually a component of relaxation at the vaginal opening. The cause of vaginal wall relaxation is a weakening of the pelvic support structures and thinning of the recto-vaginal septum in the posterior vaginal wall.

The underlying causes of thinning of the Recto-Vaginal Septum are:

• Multiple or prolonged deliveries.
• The use of forceps, vacuum, or other assisted methods of delivery.
• A history of constipation and straining with bowel movements.
• Perineum tears or an episiotomy into the rectum or anal sphincter muscles.
• Aging, occasionally likely in younger women or in those that have not delivered children

There are 4 methods of correcting relaxation of the vagina:

1) The Kegel Exercise is safe but would have to take 6 months until results would show, and does not guarantee full effectiveness.    

2) The Incisionless Laser Vaginal Tightening is a new trend of innovation to the Cosmetic Gynecology for mild to moderate vaginal relaxation; this procedure has limitations and cannot guarantee the results and satisfaction.

3) The Vaginoplasty or Posterior Vaginal Repair is the surgery to narrow the diameter of the vagina which results to a smaller, and tighter vaginal canal and vaginal opening. Vaginal muscle will be tighter and stronger by muscle plication. However, this surgery also has its limitations to the women with multiple deliveries.    

4) The Anterior and Posterior Vaginal Repair (A-P Vaginal Repair) is the surgical repair of pelvic prolapse by entailing the surgical removal of the excessive anterior and posterior vaginal tissues as well as bladder and rectum prolapse, thereby correcting the pelvic organ prolapse, at the same time tightening the vagina.

Recently, Laser has been applicable to the Vaginoplasty/Posterior Vaginal Repair. Benefits of Laser Vaginal Rejuvenation include: More precision and accuracy as a result of the surgical wound control, less blood loss, less risk of vessel and tissue damage, and quicker recovery time. However, surgical method brings much better results than the laser one and needs only one-time treatment.

Additional Surgery

Hymenoplasty : At one time, it was believed that the hymen is the “symbol” of a woman’s virginity. However, in reality, the hymen is a very thin piece of tissue that could be torn apart in many non-sexual ways, which are attributed to, in addition to the first sexual intercourse, strenuous and demanding activities such as gymnastics, horse riding, cycling, or even tampon use. Some women particularly from Latin America and Middle Eastern cultures are greatly concerned about their virginity and often times seek to restore their “hymen” for the some reasons. 

This surgery is a very delicate and meticulous surgical procedure that places the hymenal ring and tissues in close proximity to each other. The sections (usually the upper-layer of tissues) that have been torn are removed. After the torn tissues are removed, the remaining edges are stitched together. Doing so recreates a star-shaped hymenal ring’. This ring imitates the original hymen structure before it was broken. The newly formed small ‘ring’ will continue to fuse together over time. Eventually, it will very closely resemble your original hymen. The hole will be quite small, therefore, after marriage or whatever the occasion may be, the tissue will tear and bleed as it did once before. In certain cases, vaginal lip lining may be used to develop a new hymen. This lining contains a network of veins making it a suitable hymen replacement as it has the ability to bleed when torn. Like any other surgeries, the surgery has limitations and cannot absolutely ensure results and satisfaction, as there are many other factors affecting the surgery’s success. In case of unsatisfactory results or complications, correction surgery may be performed as appropriate and possible.

Before the Vaginoplasty/Posterior Vaginal Repair

• The patients are instructed not to eat or drink anything 6 hours before the operation.
• Prior to the surgery, a nursing staff will make inquiries regarding your previous medical history as well as arrange for your vital signs such as temperature, respiration, blood pressure, and pulse. In case of existing diseases or drug allergies, please inform the medical staff before the consultation. You should prepare and take with you any pills or treatment medications, you are currently taking.
• After the examination and assessment, you will discuss with Dr. Prinya about your expectations and concerns. He will then explain to you about the methods (or techniques), processes of the surgery, some potential post-operative risks and complications prior to decision-making. 

Post-operative care instructions 

• ​​After the Vaginoplasty/Posterior Vaginal Repair, a urinary catheter might be inserted for 1-2 days after the surgery. Nausea and vomiting may be experienced, as a side effect of the Intravenous sedation, which is noted to be relieved as soon as its effect wears off.
• You will be given an antibiotic to prevent post-operative infection, a laxative drug to prevent constipation, an anti-inflammatory drug, and an acetaminophen to lessen the wound pain.
• In a few days after the surgery, you may experience an urge to pass stool (straining) and a sense of incomplete emptying (tenesmus). This is caused by the sutured posterior vaginal wall between rectum and vagina. Taking a rest is recommended to reduce this symptom. Laxatives will be given to prevent constipation.
• Within the first 1-2 days after the surgery, you should not take a shower, which may potentially cause infection–perhaps rub the body dry. Cleaning the perineum area after urinary excretion may be done with sanitary wipes and after fecal excretion done using water and toweling gently. Do not put anything to clean inside of the vagina.
• Within the first 2-3 days after the surgery, you should take a rest (refrain from work) and be still to enable the wound to heal faster, and have little movement as possible to avoid wound disruption.
• You may experience light reddish bleeding out of the vagina in around 1-2 weeks after the surgery. A slim sanitary napkin should be used to monitor the post-operative bleeding. In case of a lot of bleeding or reddish blood clot, swollen reddish wound and high fever, please contact Dr. Prinya for suggestions or come to clinic for the surgical wound examination.
• After the surgery, you may have all kinds of food, especially vegetables and fruits, with the exceptions of alcoholic drinks, pickled food, and smoking for about 2 weeks. 
• You may have abnormal vaginal discharge, a green-yellowish discharge after the surgery, because the vagina is full of secretion fluid and various kinds of bacteria. This can cause reaction to the surgical wound and sutures. Complete absorption of the sutures will usually occur within 6 weeks. Green-yellowish discharge may also persist during this time. 
• You may experience itching or curd like discharge as a result of vaginal fungal, possibly following taking antibiotics to avoid post-operative infection. In case of smelly vaginal discharge or vaginal fungal infection, you have to take additional medications. For women who experience itching caused by the dissolving sutures and the process of healing, they will be prescribed antihistamine to control the itching.
• Recovery varies individually. You may return to work within 3-5 days after the surgery.
• After the first 2 weeks to 4 weeks after the surgery, the surgical wound is expected to heal appropriately, you may start your usual activities gradually, and strenuous physical activities should be limited.
• After 4 weeks of the surgery, you may do your usual activities. Relaxing exercises and lifting light weights are permitted. However, you should refrain from running, soaking in the bathtub, swimming, heavy lifting, cycling, other heavy activities, and sexual intercourse for 6-8 weeks after the surgery.

Potential side effects after Vaginoplasty

1. Urinary frequency or difficulty in urination may be noted a few days after the surgery due to the tightening of the vaginal muscles immediately after surgery, which is expected to gradually disappear after the vaginal muscles have started to loosen up a bit. After the surgery, some women less than 1%, may experience the difficulty in urination and may be catheterized for 2-3 days to prevent cystitis.

2. Inflammation or infection of the wound may occur because the surgical wound is in the vaginal opening area constantly being prone to contamination with fluid from the vagina, urinary tract, and alimentary (fecal) tract. During the inflammatory phase of healing, which last up to 2-4 weeks after the surgery, sloughing off of tissues or necrosis can be observed due to the retention of moisture in the surgical wound in the vulvovaginal area.

3. Leakage (Fistula) between or rectum and vagina is theoretically considered a rare complication. If you have some vaginal body fluid with feces-like smell, please inform Dr. Prinya immediately for prompt diagnosis and treatment.

4. Unsatisfactory results. This surgery has limitations and cannot absolutely ensure results and satisfaction. The surgery may result in incomplete tightening of your entire vagina depending on your former anatomical structure. In case of unsatisfactory results, correction surgery may be performed as appropriate and possible.