Vaginal tightening (vaginoplasty)

Vaginal tightening (vaginoplasty), as well as tightening of the perineum (perineoplasty), belong to plastic-aesthetic intimate surgery. Vaginal tightening serves to alleviate various complaints associated with vaginal dilatation. While perineoplasty tightens the area between the vaginal entrance and the anus. Both procedures can be performed together as a vaginal perineoplasty (colpoperineoplasty).

The intimate area (vagina and perineum) of the woman is subjected to great stress during childbirth. The stretching of the tissue causes the vagina to dilate and the adjacent muscles to separate. In addition, there are injuries to the birth canal due to tearing or cutting of the perineum (episiotomy). The pelvic floor training recommended after births is intended to help reverse these changes and strengthen the pelvic floor. Nevertheless, tissue weakening of the perineum and vagina due to childbirth or age can be the cause of permanent discomfort. For example, a widening of the vagina or a gaping of the perineum can result in reduced sensation with limited sexual satisfaction.

The organs of the small pelvis (bladder, uterus, bowel) are held in place by the pelvic floor. Weakness of the pelvic floor as a result of pregnancy, childbirth, but also overweight or heavy lifting can lead to a lowering of the vagina and the organs in the small pelvis. A distinction is made between:

• a lowering of the anterior vaginal wall with bladder and urethra (vesicocele),
• a prolapse of the uterus and
• a lowering of the posterior vaginal wall with the intestine (rectocele).

Typical symptoms of prolapse are a foreign body sensation in the vagina, incomplete bladder or bowel emptying, bladder infections, bladder weakness and incontinence up to pressure ulcers of the vagina. These functional complaints are usually treated by surgery, such as a vaginal tuck (colporraphy). Vaginal tightening is therefore not a new procedure, but in the past, it was mainly performed to treat functional complaints and was therefore medically indicated.

However, dilatation of the vagina and/or perineum can also result in problems during sexual intercourse or aesthetic impairments without the existence of vaginal prolapse with the typical functional complaints. Thus, the sexual life of women or couples can suffer considerably as a result of reduced mechanical stimulability during intercourse. Studies show that in these cases, correction of the anatomical changes in the form of vaginal tightening, perineal tightening or vaginal and perineal tightening helps improve sexual function. Age-related changes in the vaginal skin can sometimes be treated conservatively, e.g. with hormone ointments, or minimally invasively with laser procedures (CO2 laser, erbium laser) or radiofrequency technology.

Consideration

A tightening of the vagina, the perineum or both may be useful for you if you have had a dilatation of the vagina and/or the perineum after childbirth, or as a result of age or your constitution, and you suffer from the following complaints:

• Dilatation of the vagina and/or perineum results in decreased sensation during sexual intercourse.
• Your ability to achieve orgasm is made difficult or impossible by the dilatation of the vagina and/or perineum.
• Your sex life and/or that of your partner is affected by the dilation of the vagina and/or perineum.
• You feel aesthetically disturbed by the visual changes of the intimate zone.
• You feel inhibited by the optical changes of the intimate zone.

Vaginal tightening (vaginoplasty and/or perineoplasty)

A vaginal lift and/or perineal lift is performed to narrow the vagina and/or vaginal opening. This is done by removing excess skin and mucosa in the perineal and vaginal areas, removing scar tissue after pelvic floor injuries, and repairing the pelvic floor muscles with sutures. An isolated perineal lift only narrows the vaginal entrance and is recommended for women who do not suffer from vaginal dilation but are only interested in improving the appearance of the intimate area and sexual function.

In case of simultaneous vaginal dilatation, both surgeries are combined. In cases of isolated vaginal dilatation, minimally invasive techniques, such as laser vaginoplasty, can be used. In principle, these operations are possible at any age, as long as there are no serious underlying diseases that increase the risk of surgery too much.

Consultation

A prerequisite for successful surgery in the intimate area is careful planning. This begins with your personal consultation with your surgeon at the AARE KLINIK. It is important for him to find out your wishes, ideas and expectations of the vaginal lift in order to be able to give you a realistic idea of the possibilities and limits of this operation.

The physical findings include a vaginal and rectal examination in addition to an examination of the external genitalia. Depending on the findings, additional examinations by the gynecologist, endocrinologist and other specialists may be required. In particular, the physical examination assesses the appearance of the intimate area and the width of the vaginal opening and canal, as well as checking pelvic floor muscle function and sphincter function. During the physical examination, digital photographs are taken, which are then used for objective analysis and for planning the operation.

The recommendation of a suitable treatment procedure is derived from the results of the physical examination. Together with you, an individual treatment plan will be drawn up which, in addition to a tightening of the perineum and/or vagina, may also include a correction of the labia minora (labiaplasty), labia majora (labial augmentation) or mons pubis (mons pubis plastic surgery). All risks and possible complications of the procedure are discussed with you and the agreed operation is documented on a planning sheet.

To plan the operation, we need information from you about your medical history (previous illnesses and previous operations), current illnesses (such as high blood pressure, diabetes, thyroid dysfunction), allergies or intolerances as well as possible medication intake. These are used to assess the risk of surgery and anesthesia. Please bring all current and important medical findings to the consultation.

Procedure

Individual factors and personal preferences determine the choice of surgical procedure.

Isolated vaginal tightening causes narrowing of the vagina, either by careful removal of excess skin and mucosa or by stimulation of the vaginal skin and mucosa by laser treatment (CO2 laser or erbium laser), the radiofrequency technique or injection treatments with the body’s own fatty tissue (lipofilling) or platelet-rich blood plasma (PRP).

An isolated perineal lift causes narrowing of the vaginal entrance (introitus). It involves careful removal of excess skin and mucosa around the perineum and vaginal entrance, removal of scar tissue, and repair of the pelvic floor muscles with sutures. Tightening of the perineum alone only narrows the vaginal entrance and is therefore recommended only for women who do not suffer from vaginal dilatation. In case of concomitant vaginal dilatation, a combined vaginal and perineal tightening (vaginoplasty) is performed. In this case, a 3-layer closure is performed as the gold standard of vaginoplasty and perineoplasty.

This includes suturing the levator muscles (transversus perineus muscle and bulbocavernosus muscle) to restore a stable pelvic floor, suturing the weakened connective tissue (rectovaginal fascia) as the second layer to reinforce the repair, and suturing the vaginal skin as the third, covering layer.

Depending on the findings, vaginal and perineal tightening can be combined with corrections of the inner and/or outer labia (labiaplasty) and mons pubis (monsplasty).

Risks

Vaginal and perineal tightening are intimate surgical procedures on the female genitalia that, when correctly indicated and performed, rarely lead to serious complications, such as injury to the rectum and the development of rectovaginal fistulas. In individual cases, however, they may require prolonged follow-up treatment or repeat surgery. Therefore, you will be informed about all risks and possible complications during the consultation.

Mild complications that usually heal without consequences include bruising (hematomas) and swelling. However, pronounced bruising must sometimes be surgically removed in order not to jeopardize further wound healing. Pain during sexual intercourse, vaginal dryness and tightness occasionally occur, but are usually temporary and treatable by the use of lubricants (lubricators) or medical devices to dilate (dilators).

The risk of serious complications, such as infections, wound healing disorders or circulatory disorders of the tissue, is increased in smokers or patients with chronic diseases, such as diabetes.

In individual cases, a repeat operation may be necessary to treat severe complications, such as bowel injuries or rectovaginal fistulas.

General risks

• Haematoma (bruising), bleeding and swelling
• Seroma (accumulation of wound fluid)
• Healing problems or infection
• Wound breakdown/dehicence (separation of wound edges)
• Injury of nerves or vessels
• Numbness in area of operation (temporary or permanent)
• Circulatory problem
• Scars
• Slight asymmetry
• Unsatisfactory aesthetic result
• Secondary surgery
• Thrombosis or embolism

Overall, vaginal and perineal lifts in the hands of an experienced plastic surgeon are a safe procedure with few complications and high patient satisfaction. You can help minimize certain risks by following our recommendations before and after surgery.

Preparation

Our goal is to make the operation itself, as well as the time before and after it, as pleasant as possible for you. You can support us and yourself by following simple rules of conduct.

For example, it is advisable for smokers to stop smoking 2 weeks before and after the operation, as smoking can impair wound healing. Certain medications that increase the risk of bleeding, such as aspirin (ASS), non-steroidal anti-inflammatory drugs as well as some vitamin preparations and homeopathic remedies should also be discontinued 2 weeks before the operation. You will receive precise instructions on this from us before the operation.

Tightening of the perineum and vagina can usually be performed on an outpatient basis under local anesthesia at the AARE KLINIK. If the procedure is performed under twilight or general anesthesia, you should ensure that you can be picked up after the operation and cared for at home for the next 24 hours. In the case of certain pre-existing conditions or combination operations, inpatient treatment in a private hospital may be advisable.

Day of Surgery

The vaginal lift or perineal lift is performed on an outpatient basis at AARE KLINIK or otherwise as an inpatient at a private hospital.

During the operation you will receive various medications for your comfort. As a rule, the procedure is performed under local anesthesia or twilight anesthesia (sedation).

For surgery under local anesthesia, you will be allowed to go home immediately after the procedure. After an operation under twilight or general anesthesia, you will be taken to the recovery room and continue to be monitored there until you are fully awake and able to stand up. You will then be allowed to go home with an accompanying person.

After outpatient general anesthesia, you should be taken home by an accompanying person and continuously monitored there for the first 24 hours. This person will receive all necessary instructions from us for your aftercare as well as rules of conduct in case of complications or unexpected events.

If you are operated on as an inpatient in the hospital, you will be taken from the recovery room to the ward, where you will stay until the next day. Already on the day of the operation you should get up regularly to minimize the risk of thrombosis. The pain after a perineal or vaginal tightening is usually minor and can be treated well with mild decongestant painkillers, which you can continue to take at home for the first few days.

Day after Surgery

It is important to know that the recovery time after each operation varies individually. In the 2-3 weeks after the perineal or vaginal tightening, you should take it easy on yourself physically and, if necessary, slightly cool the genital region. In order to prevent the risk of thrombosis, you should regularly walk short distances, even if you still have discomfort when walking at first. Take only the painkillers prescribed for you and do not take any medications containing aspirin (ASS) or other anticoagulants.

In the first 2-5 days after the procedure, you may experience a feeling of tightness and slight soreness in the intimate area. Therefore, take the painkillers prescribed for you. Often there is still a feeling of numbness of the skin in the perineal area at the beginning. This is usually only temporary. However, it can take weeks to months, in some cases even longer, until the feeling returns to normal. Slight swelling and bruising in the perineal area usually disappear within 2-3 weeks. You will usually be able to perform most of your daily activities a few days after the operation. After only a few days, you will be able to shower normally again.

However, you should refrain from taking full baths or excessive heat (e.g. sauna) for several weeks until all swelling has subsided. Most skin sutures dissolve by themselves and do not need to be removed. Non-dissolvable sutures are removed after one week.

Activities that require prolonged sitting may still be uncomfortable at first. They are usually possible again after a few days. However, you should avoid physically strenuous and sporting activities for a total of 4-6 weeks. Heavy lifting and sexual intercourse should also be avoided for at least 6 weeks.

After the operation you will be examined at regular intervals in the AARE KLINIK. Here the healing progress will be assessed until the final surgical result is achieved. An important complement to the operation is consistent pelvic floor training over several months. This can be supported by special aids such as a pelvic floor stimulator with biofeedback application.

Outcome

Swelling and bruising may persist for some time after the operation. The healing process is gradual and it takes several months before the surgical result can be finally assessed. Scars may initially be red and swollen or appear darker pigmented. Minor superficial wound healing disorders usually heal spontaneously and without consequences under careful wound care. Scars are usually barely visible in the genital area over time.

A perineal or vaginal tightening serves to improve the genital shape and function. It can increase one’s well-being and self-esteem and eliminate inhibitions or sensation problems during sexual intercourse. Although better sensation during sexual intercourse is achieved in most cases, an improvement in sexuality cannot be guaranteed as a result of the procedure, as this depends on many factors.

The results of vaginal and/or perineal tightening are usually long-lasting. However, the aging process as well as weight fluctuations, pregnancy and lifestyle can affect the result.

Costs

Tightening of the vagina or perineum is usually an aesthetic procedure that is not covered by health insurance. In the case of an aesthetic indication, the treatment costs must be borne by the patient herself. The costs for an aesthetically indicated vaginal or perineal lift are variable and depend above all on the complexity of the operation and the institution in which the operation is performed (AARE CLINIC or hospital). An exact cost estimate can therefore only be provided after a personal consultation.

The costs are composed of:

• Surgical fee (incl. consultation and follow-up)
• Anaesthesia fee
• Technical costs (AARE KLINIK/hospital)
• Medication
• Diagnostics (laboratory, ECG, etc.)

Appointments for vagina tightening with Dr. Scheufler in Bern

Before any intimate surgery you should have a comprehensive consultation and additional examination. Only in this way can you be sure whether the type of surgery will lead to the result you expect. In addition, your consultation will give you a good impression of our experience in the field of genital surgery. Feel free to ask for before and after photos to get an idea of what the results look like.

PD Dr. Oliver Scheufler, board certified plastic, reconstructive and aesthetic surgeon and author of this website, is pleased to be at your service for a personal consultation. Besides his main occupation at the AARE KLINIK, Dr. Scheufler is also scientifically active and lectures at the University of Basel. He also was a visiting professor at Duke University (USA). Please do not hesitate to contact him if you wish a professional consultation!