Perineoplasty

Overview

Perineoplasty is a surgical procedure designed to repair the perineum and external vaginal organs, collectively known as the vulva. The perineum, the area between the anus and vagina, plays a crucial role in supporting reproductive organs and pelvic floor muscles. Various factors such as childbirth, weight loss, and trauma can cause damage to this area, leading to loose and overstretched skin around the vaginal opening.

The primary aim of perineoplasty is to strengthen and tighten the perineum, narrow the vaginal opening, and repair any loose, scarred, or damaged skin around the vagina. By addressing these issues, the procedure helps restore the function and comfort of the perineal area, which is vital for overall pelvic health and well-being.

In addition to functional benefits, perineoplasty can also enhance the appearance of the perineal area, contributing to improved self-esteem and body image. This surgical intervention offers a comprehensive solution for those experiencing discomfort or dissatisfaction due to changes in the perineum, ultimately promoting both physical and emotional well-being.

Reasons for undergoing the procedure

Many individuals opt for perineoplasty to address loose skin at their vaginal opening, which can lead to reduced sexual satisfaction or feelings of self-consciousness. In more severe cases, muscle damage may even result in incontinence.

Some common reasons for choosing perineoplasty include:

• Low self-esteem.
• Low libido, or the desire for no sex.
• Incontinence of the bowels or urine.
• Pain, discomfort, or irritation in the vagina.
• Skin surrounding their vagina that is loose, protruding, or gaping.
• Excessive scarring following a vaginal delivery or an episiotomy.
• Sensory loss during sexual activity.

Childbirth is the primary cause of damage to the perineal area. During vaginal deliveries, the vaginal opening stretches to allow the baby to pass through. Multiple vaginal deliveries heighten the likelihood of a loose and overstretched vaginal opening.

Experiencing a significant perineal tear during delivery or undergoing an episiotomy increases the risk of scar tissue formation or improper healing of the vaginal muscles. Scar tissue can lead to discomfort and a loss of sensation.

Other factors that can stretch or widen the vaginal opening or damage the perineum include:

• Age.
• Heredity.
• A damage or trauma.
• Drastic weight increase or loss.
• Constant straining or hitting (as in riding a horse).
• Exercise or sports with a lot of impact.
• Additional gynecological conditions.

Your vaginal opening can potentially be made tighter with a perineoplasty. It has no effect on your interior vaginal region or vaginal canal, though.

Risks

Like any surgical procedure, perineoplasty carries potential risks and complications. Common issues include:

• Infection
• Constipation
• Bleeding at the surgical site
• Failure to achieve the desired level of strength or tightness
• Dyspareunia, or painful sexual intercourse

Before the procedure

Perineoplasties are performed by gynecologists. Talk to your gynecologist about your surgical preferences and symptoms. They can help you comprehend the benefits and hazards of the operation and respond to any questions you may have. Asking them about the healing process and what needs to be done in advance of surgery is a good idea.

During the procedure

Perineoplasty can be performed under either local or general anesthesia, depending on your condition and the complexity of the procedure. During the surgery, the gynecologist makes an incision at the vaginal opening, removes excess skin or scar tissue, and repairs the deeper muscle layers around the vagina. The incision is then closed with stitches.

The procedure usually lasts about an hour. After a short recovery period at the surgical center or outpatient facility, you can typically return home the same day. Hospital stays are generally not needed.

After the procedure

As with any surgical procedure, your body will need time to heal after a perineoplasty. During the first few days, you may experience swelling and discomfort. Most doctors recommend using ice packs and pain relievers to manage the pain. Additionally, sitz baths and soaking your perineal area in warm water can provide soothing relief during the initial weeks of recovery.

Your doctor may provide the following post-operative instructions:

• Wear a sanitary pad in the event that you bleed vaginally.
• Maintain the space dry and clean. The stitches ought to fall out on their own in a few weeks.
• Give your vagina a break from any objects for at least six weeks. Tampons and abstaining from sexual activity are part of this.
• Set activity limits for a minimum of four weeks. Avoid doing any intense workout or heavy lifting during this period.
• To prevent constipation, consume a lot of fiber-rich foods and drink lots of water. You might also try a stool softener.

Most doctors will advise pelvic floor exercises, also known as Kegel exercises, to assist strengthen the area once you’ve recovered from surgery. They might ask you to see a physical therapist for a few weeks, or they might give you a list of exercises to perform at home.

Outcome

Recovery from a perineoplasty generally takes six to eight weeks. It’s important to follow your doctor’s advice during this time. You should refrain from physical activities for four weeks and avoid sexual activity for six weeks.