Perineal Vaginoplasty

Last updated date: 16-Aug-2023

Originally Written in English

Perineal Vaginoplasty

A weakening of the vaginal canal, whether due to delivery or age, can have a negative impact on a woman's sexual life. The friction caused by penetration and movement on the vaginal walls contributes to the satisfaction both partners experience during sexual intercourse. Friction is reduced when the vaginal muscles are relaxed, which reduces sexual satisfaction. This can lead to a reduction in sexual pleasure, which can harm an intimate relationship.

The main reason for this lack of enjoyment, weaker vaginal muscles, can be addressed with a vaginoplasty. The diameter of the vagina can be lowered by repairing the soft tissues and strengthening the muscles along the canal. As a result, there may be more friction during intercourse, resulting in more sexual enjoyment for both partners.

A prolapsed uterus is not addressed by vaginoplasty. If you have a prolapsed uterus, depending on the severity of the prolapse, your specialist will be able to correct it during your vaginoplasty. Talk to him about it during your pre-surgery consultation.




Vaginoplasty is a vaginal rejuvenation operation that aims to improve, correct, tighten, or otherwise fix any defects or anomalies in a woman's genitalia. The technique can also be used to reconstruct the vaginal opening, correct congenital problems in the pelvic floor, excise growths or abscesses, modify the vulva, and enlarge or reduce the vaginal orifice to allow for enough friction. Any excess or unattractive outer skin can also be cut away for a more streamlined appearance.

Vaginoplasty can also help with more serious concerns like hysterectomy reconstruction, cancer treatments, and tumor or fibroid excision. In fact, vaginoplasty can reconstruct a urethra, rectum, or vagina that has never fully formed since birth or has been surgically removed owing to malignancy or other medical conditions.

Thousands of women undergo minor vaginal muscle tightening procedures each year to correct loose or flaccid vaginal muscles caused by heredity, aging, or, most commonly, delivery.


What Causes a Loose Vagina?

With aging, the skin loosens and becomes less flexible. The vaginal wall continues to expand and flexibility declines with each delivery when a woman gives birth, especially several times. Rough sex, being overweight, and rapid weight gain or loss are all possible causes. Even some drugs that cause hormonal changes, such as birth control, can inhibit tissue renewal and produce laxity. Because there is less sensation experienced during intercourse, both the lady and her partner experience unsatisfied sexual pleasure. Kegel exercises, no matter how carefully performed, only restore muscular strength to a limited extent. Stretching, flaccidity, heaviness, prolapse, ill-fitting tampons, and incontinence are all signs of pelvic floor trauma, which can result in a variety of functional issues for women.

Vaginoplasty addresses many of these problems by removing the excess vaginal lining and surgically tightening the various muscles and tissue within the vagina, as well as making other repairs and modifications to other pelvic organs as needed. This procedure restores the vagina to its pre-delivery state of youth and tone.


Reconstructive Vaginoplasty vs. Cosmetic Vaginoplasty

Cosmetic Vaginoplasty

It's crucial to understand the distinction between reconstructive surgery and cosmetic surgery before deciding if you should get vaginoplasty.

Cosmetic surgery alters the appearance of essentially normal anatomy, whereas reconstructive surgery enhances the function of a body part. It's similar to rhinoplasty in that a surgeon might rebuild the internal nasal cavities to improve breathing or reshape the nose for aesthetic reasons.

Because the American College of Obstetricians and Gynecologists (ACOG) evaluates surgeries and outcomes for functional concerns like urine incontinence, this difference is important. However, due to the hazards and lack of scientific evidence on the safety and effectiveness of cosmetic vaginal surgery, ACOG remains doubtful.

Some vaginoplasty procedures, for example, were first developed as reconstructive surgeries to correct birth anomalies in which the vagina was deformed, too short, or nonexistent (as in vaginal agenesis) so that a girl might grow up to have regular urination, period, and intercourse.


Benefits of Perineal Vaginoplasty

Benefits of Perineal Vaginoplasty

Thousands of women have benefited from vaginoplasty on both a physical and psychological level. Physically, it allows people to attain climax more quickly, restoring the increased sensation and friction required for satisfying sexual pleasure that may have been lost over time. Any extra improve repairs the health of previously damaged genitalia.

Women who have had vaginoplasty experience improved levels of confidence and self-esteem, enjoy sex without pain, and love their newly improved reaction to the more enjoyable feelings acquired from close intimacy. They are no longer embarrassed by the lack of friction prior to surgery. They prefer to provide a tighter, snugger vagina to both themselves and their partners, allowing them to experience the friction required to sustain a penile erection and reach climax.

Many couples have been capable of overcoming sexual dysfunction produced by anatomical genital defects thanks to vaginoplasty repair.


Perineal Vaginoplasty Indications

Perineal Vaginoplasty Indications

The operation is recommended for a variety of reasons:

  • Absence of malformation present from birth. Symptoms include no history of menstrual flow beyond adolescence and difficulty or pain in sexual activity.
  • Injuries sustained during childbirth. Symptoms of injuries sustained during childbirth include a loose vagina and a sense of mass in the vaginal area owing to compression from the urinary bladder or rectum, which can cause problems with urination and stool passing.
  • The vaginal entrance itself is bulging (the condition is known as vaginal prolapse).
  • Tumor causing bleeding and foul-smelling discharge as symptoms.
  • Trauma from sexual assault.
  • A transgender person requests gender-affirming operations (sex reassignment surgeries).

People with the following conditions should avoid surgery:

  • Other disorders that are not controlled or treated.
  • Vaginal infection that has been present for some time.
  • If the tumor has progressed to other areas of the pelvis or abdomen, surgery will be more difficult and life expectancy will be reduced.


Perineal Vaginoplasty Preparation

Perineal Vaginoplasty Preparation

Your doctor will give you a treatment plan and goals during your appointment. The treatment plan outlines the steps you must follow to prepare medically for surgery. To meet these objectives, we recommend that you work with your primary care physician. The following are typical steps:

  • Letters of referral or support. Two mental health letters of support that fulfill good standards of service will be required. These letters must be no older than 12 months. Before surgery can be scheduled and submitted to your insurance for prior authorization, the care team will need these letters.
  • Hair removal. The hair follicles are not cut during the procedure. Hair removal with electrolysis or laser is required. Vulvoplasty does not necessitate this.
  • Pelvic floor therapy. Prior to surgery, you will be referred to a physiotherapist who specializes in Pelvic Floor Therapy. If you require more appointments prior to surgery, they will inform you.
  • Nicotine use. At least 3 months before surgery, you must cease smoking, vaping, or using any sort of nicotine. The sooner you quit smoking, the easier it will be for your body to recover following surgery. A urine test may be needed months or even days before surgery.
  • Weight loss. Doctors want to support everyone, including people of different sizes and forms. They hope to have an open and respectful discussion about weight and BMI (BMI). Healing, post-surgical wounds, surgical complications, cosmetic outcomes (how nice you appear), and the necessity for future revision procedures are all factors to consider. For vaginoplasty, a BMI of 30 is ideal. During the surgical consultation and pre-surgery phase, your surgeon will review this with you. Weight control referrals are available to help you with a healthy weight decrease.
  • Diabetes. People with diabetes mellitus must have an A1C blood test of 7 or less within three months after surgery.
  • Hormones. Two weeks before and two weeks after vaginoplasty, your hormones must be stopped.
  • Bowel preparation. One to two days before surgery, you will need to do a bowel preparation, which involves clearing out your colon. The instructions will be given to you by the care team.


Perineal Vaginoplasty Procedure

Perineal Vaginoplasty Procedure

Vaginoplasty is a treatment that is used to heal the damage caused by the delivery and includes:

  • Extra skin is removed.
  • Stitches are used to bind loose tissue in the vaginal canal, either partially or completely.
  • reducing the size of the vaginal opening

Vaginoplasty to correct congenital abnormalities (birth malformations) may include:

  • Making a functional vagina.
  • Excess tissue or aberrant abnormalities are removed.
  • During menstruation, preventing blood from pooling.

When vaginoplasty is used as a part of gender-affirming surgery it includes:

The male external genitalia are partially removed and reconstructed during a vaginoplasty as part of gender affirmation surgery. A vaginal canal and labia are made of the skin of the penis and scrotum.


Perineal Vaginoplasty Complications

Perineal Vaginoplasty Complications

Wound Separation

Wound separation at the inferior introitus is the most prevalent postoperative complication. Dry dressings and expectant management are usually used to treat it. A complete wound rinse and delayed primary closure with nylon sutures may be required, and minimal bedside debridement may be required.


Vaginal Stenosis

The vaginal canal can become stenotic and constricted, causing a loss of depth and width. Although repeated dilations are the best way to control vaginal stenosis, a significant minority of patients can still develop vaginal stenosis despite meticulous dilation. In cases when only the introitus is restricted, y-v plasty can be used to incise the scar ring and bring in perineal skin. Skin grafts may be put into incisions formed into the neovagina in circumstances where a revision vaginoplasty is required. Revision peritoneal vaginoplasty or visceral interposition vaginoplasty may be required in more severe situations. In some patients, despite all dilation attempts, vaginal canal damage occurs due to inexorable healing of the vaginal cavity over time, which doctors believe is more likely in patients who have a history of exuberant scar formation, superspeed healing, or other scarring-related diseases like urethral stricture.



Despite meticulous surgical technique, the cut borders of the corpora cavernosa, bulbar urethra, vaginal canal, and spermatic cord may bleed during the vaginoplasty procedure. Small postoperative hematomas are rather common and can be seen in many cases. Large hematomas are uncommon, but if they produce swelling that endangers the flaps' health, they may require surgical exploration and drain.


Rectovaginal Fistula

A rectovaginal fistula is the most serious consequence of transfeminine genital surgery, and it can happen even with meticulous procedures. Fistulas that appear without evident rectal damage or repair could be the result of a hidden vascular injury to the rectum. Disturbed healing of a known intraoperatively repaired rectal injury or an undetected rectal injury are two other possibilities. Rectovaginal fistulas can develop at any time. Although many fistulas are tiny and heal on their own, repairs may be required. Fecal diversion, fistula removal, and vaginoplasty revision are all part of the reparative surgery.


Perineal Vaginoplasty Recovery

Perineal Vaginoplasty Recovery

  • Activity. For the next six weeks, avoid heavy activities. For three months, avoid either swimming or cycling.
  • Sitting. You will be advised to avoid extended sitting on the anterior pelvic for the first 6 weeks after surgery. To reduce pressure at the surgery site, we recommend employing a donut ring.
  • Bathing. Following the first postoperative visit, resume showering while patting incisional regions dry. For the first eight weeks after surgery, avoid taking baths or submerging yourself in water.
  • Swelling. Labial swelling is common and will subside 6-8 weeks after surgery. Long periods of sitting or standing might worsen swelling.
  • Sexual intercourse. Unless otherwise directed, you may restart sexual intercourse 3 months after the surgery.
  • Hand hygiene. Before and after any touch with the genital area, wash your hands. Every day, shower or wash. To prevent contamination from microorganisms from the anal region, wipe from front to back when washing. Avoid wearing tight clothing since friction might help bacteria spread.
  • Vaginal discharge. Brownish-yellow vaginal discharge should be predicted during the first 4-6 weeks after surgery. This is to be considered in the first eight weeks after surgery. Vaginal rinses should be able to help with this.
  • Smoking. Nicotine and smoking should be avoided for the first month after surgery because they can slow the healing process by restricting blood flow to the surgical site.
  • Diet, nausea, and constipation. As tolerable, increase your regular diet. Anti-nausea medicine could be recommended. Constipation is a side effect of narcotic pain relievers. If you have constipation, take Miralax (over-the-counter) once or twice daily as needed.
  • Pain medication. Pain following surgery is common, and painkillers will be administered. Pain medication must be taken exactly as directed. If you're using a narcotic pain reliever, don't drive. When you can react quickly, you can continue driving.
  • Dilation. Dilation is a major element of the rehabilitation process. For the first three months (or until instructed), the smallest size should be used.


Dilation after Perineal Vaginoplasty

After vaginoplasty, vaginal dilatation is a lifelong procedure. When and how to dilate will be explained by your physicians. Before and after surgery, you will have the opportunity to work with pelvic floor physiotherapists to assist with the dilation process. During your hospital stay, you will be given dilators.

Self-lubrication is not a goal or an expectation following this procedure. However, some patients report having achieved self-lubrication. For the dilation process, you'll need a high-quality water-based lubricant.

The vaginal walls of all women are exposed to one another when they are at rest. For transwomen who lack the regular sloughing and lubrication that a natal vagina provides, dilation is a vital procedure that keeps the vagina flexible. The new vaginal graft also has a tendency to shrink. The depth and diameter of the new vagina can be preserved with dilation.




The muscles of the perineum (the space between the vagina and the anus) can become overly stretched or divided, and the skin can even be scarred, as a product of tearing or poorly done episiotomies during childbirth.

This can cause irritation and the inability to enjoy sexual arousal, among other issues. Worse, it may prevent the contraction of the vaginal muscles during intercourse, which is required for an orgasm to ensue. Apart from these issues, some women may be self-conscious about bulging scars or extra skin in this area. All of these problems can be resolved through perineoplasty.

The surgeon will remove the scarred tissue, excise any excess skin if appropriate, and stitch the area closed in a way that ensures proper healing. Perineoplasty and vaginoplasty can both be done at the same time. If this is an issue for you, talk to your doctor about it during your pre-surgical appointment.



A stretched vaginal canal can occur for a variety of factors, resulting in a range of difficulties and low self-esteem. A vaginoplasty may be the best option for patients who have failed to improve with other treatments. Many women report greater bladder control, tampons that stay in place, and a substantially better experience during sexual activity after a successful surgery.