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Perineoplasty

Perineoplasty, also referred to as perineorrhaphy, is plastic surgery that focuses on the deformities, imperfections, damages and defects of a woman’s anus and vagina. The surgery specifically removes scar tissue, unsightly bulges and unwanted skin, and then tightening or loosening the perineal muscles and vagina. An added benefit of perineoplasty is that, by making these adjustments, the surgery also serves to restore a woman’s confidence, and physically increase her levels of sexual pleasure.

What is the Perineum?
The perineum is the area located between the anus and the vagina. Small as it is, the perineum has the important job of being a structural support for several surrounding organs, and it encapsulates muscles that play a large part in vaginal tightening and loosening.

What Can Cause Damage to the Perineum?
Childbirth: Giving birth vaginally, especially during a difficult delivery, is the most common cause of perineal damage. Even an uncomplicated delivery can cause physical trauma to the vaginal and perineal muscles. Sometimes, an incision is made (episiotomy) in the perineum to ease baby out more easily. Sloppy stitching by a less experienced physician to mend either the natural tearing or planned cut may result in improper healing of the tissue, muscles and perineum. This may leave heavy scarring, pain and discomfort. Multiple births, of course, may worsen these problems. Perineoplasty can rectify them by opening the stitched area again and re-suturing it correctly, enabling proper healing.

Obesity: Excess weight can put strain on the entire body, including the perineum and the structures that it supports. It can also stretch the muscles, causing them to lose elasticity, much the way a mattress becomes concave in places as it conforms to the weight of your body sleeping on it night after night, providing less support as time goes on.

Extreme weight loss: We’ve all seen the ravages of sagging, flaccid, excess skin on someone who has thinned rapidly due to illness or binge dieting. Just as these unsightly effects are visible outside of the body, they can also happen internally, causing the perineal and other muscles to droop permanently even though the pressure of weight is gone. Think of that mattress again. It may regain its shape again during the day for a while, but eventually, after several years, the indentations and depressions become permanent.

What Other Conditions Does Perineoplasty Treat?

  • Vaginal itching
  • Vaginal laxity: (looseness of the vaginal opening that can cause decreased sexual sensation)
  • Vaginismus: (involuntary contractions of the vagina during attempted intercourse)
  • Vulvar vestibulitis: (severe pain during attempted penile or tampon entry)
  • Genital wart removal
  • Incontinence: (involuntary loss of urine)
  • Intraoital vaginal stenosis: (narrowing of the vagina, often caused by cancer treatment)
  • Dyspareunia: (painful intercourse due to a small vaginal opening)
  • Cystocele: (protrusion of the bladder into the vagina)
  • Rectocele: (protrusion of the rectum into the bowel)
  • Aesthetic enhancement: (tightening of loose or flaccid tissue or bulges to give the area a more attractive visual appearance).

What to Expect
Perineoplasty is an out-patient procedure that usually takes about an hour under general or local anesthetic. Rarely is hospitalization required.

A ‘V’ shaped incision is made to the posterior vaginal wall. Scar tissue, bulges and other damages are removed. Depending on the reason for the surgery, the muscles are then either tightened or loosened to correct the problem, then stitched carefully. After a brief recovery time, the patient is permitted to go home.

Recovery
Patients are cautioned to refrain from having sex for six weeks. It is recommended that any strenuous activity such a bicycling, horseback riding, heavy lifting, or stretching be avoided during this time as well. Tampons should not be used. Most patients should be able to return to work after several days.

Pain and discomfort is usually minimal to moderate and can be treated with over the counter pain medication, or a prescription supplied by the doctor. Minor bleeding and some discharge can occur, and this is normal.

There may be some dizziness or nausea for a day or two as a result of the anesthesia, but this should disappear after forty-eight hours.
The incision must be kept clean and dry. Stitches will dissolve by themselves in about two weeks. It is important to drink lots of water and increase fiber intake during this time to avoid constipation.

Complications
Generally, there are few risks associated with perineoplasty. However, the doctor should be contacted if any of the following occur:

  • Excessive bleeding
  • Signs of infection
  • Constipation not relieved through fiber intake
  • Vaginal discharge accompanied by a foul odor.

Childbirth can cause a great deal of trauma and physical change to the body, and women have accepted this as part of the reproductive process since the beginning of time. Today, however, there are procedures that can virtually restore your body to its pre-pregnancy state.

There is no need to suffer quietly and resign yourself into assuming that nothing can be done to ease the pain or embarrassment associated with any of the conditions mentioned above, or to dread intimacy because of possible discomfort or lack of sensation. We can help you. To make an appointment with one of our specialists, please call 770.720.7733.

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