Perineoplasty is the surgical procedure of reconstructing the vaginal opening and the perineum for cosmetic and medical purposes. It is primarily considered a type of functional and/or aesthetic surgery. It is intended to tighten the external genital area though there are some instances where the procedure is performed to treat certain diseases and medical conditions. In our practice, many women with recurrent bothersome urinary tract infections have a large gaping episiotomy opening that extends close to the anus which leads to fecal contamination on regular basis and subsequently colonization of vagina with fecal bacteria and recurrent urinary tract infections.
The procedure is also known as perinealplasty or vaginal rejuvenation.
Perineoplasty can be recommended for:
- Women who had an episiotomy during childbirth – Episiotomy is the surgical cut made in the perineum to widen the vaginal opening and facilitate delivery. This procedure can lead to the loosening of the skin and the sensation of a wide vagina. This can result in decreased sexual satisfaction for both patients and their partners. Some women can request to undergo this procedure to remedy this intimacy problem.
- Women diagnosed with dyspareunia or painful sexual intercourse due to vaginismus or bacterial infection. Vaginismus is manifested by involuntary contraction of the vaginal muscles, leading to pain during sexual penetration. The bacteria, known as lichen sclerosus, can also cause scarring and itching in the genital area. In some cases, patients also find it painful to urinate and defecate. Another condition that causes pain during sexual intercourse is the vulvar vestibulitis syndrome. Its symptoms include burning pain sensation and tenderness in the vagina even hours after sex. Women with this condition also find it painful to insert tampons when they have their menstruation.
- Women with a congenital condition called small vaginal introitus – The introitus is located at the entrance to the vagina. It can adversely affect the patient’s quality of life if it is too small or narrow. In some cases, the narrowed opening leads to urinary problems like urinary tract infections. It can also contribute to painful sexual intercourse. Women with this condition can opt to have the tissues at the vaginal opening and perineum surgically loosened to achieve desired elasticity.
- Women with rigid muscles in the perineum – This condition complicates the process of giving birth. In some cases, rigid perineum develops after an episiotomy wherein the muscles stiffen after surgical incision. These patients may opt to under perineoplasty to relieve the tightened sensation and to avoid labour complications should they choose to have another baby.
- Women with a hymenal ring – This disorder is characterised by a thick hymen that causes pain and possible injury during sexual intercourse. It is also a contributing factor for tightness in the vaginal introitus.
- Women suffering from injury or trauma involving the vaginal opening, perineum, and even the adjacent anus.
Perineoplasty is considered a safe procedure with a high success rate. It is typically done in an outpatient setting that allows patients to go home afterwards. It results in enhanced sexual satisfaction among women who experience looseness in the vagina and perineum. If done to address a medical condition by tightening the tissues, perineoplasty also provides relief from pain and discomfort associated with the condition.
Patients are advised to rest for several days and avoid sexual contact until the surgical site has completely healed. Vaginal contact with irritants or other chemical substances as well as strenuous physical activities should also be avoided. Most patients are also advised to undergo physical therapy consisting of pelvic floor exercises following the procedure.