Perineoplasty

A perineoplasty is vaginal surgery to correct a damage, defect, or deformity on the perineum, in between the vagina and anus.

Common issues resolved by a perineoplasty are:

• Untoned vaginal tissue (loose vagina)
• Vaginal itching
• Damaged perineum (possibly from childbirth)
• Incontinence
• Genital warts
• Painful sex (dyspareunia)
• Introital stenosis
• Vaginismus
• Vulvar vestibulitis
• Decreased sexual sensation

The perineoplasty procedure

There are two types of perineoplasty – the first tightens the perineal muscles and the vagina, while the other loosens the perineal muscles. Naturally which one is chosen depends on the problem.

Reasons why we would tighten the perineal muscles and vagina

• Childbirth: If a woman has given birth and stretched or torn the tissue or had an episiotomy (a cut), the tissue may fuse and heal together before stitches dissolve, and this can cause them to heal incorrectly.
• Obesity: obese women have overstretch and damage the perineum, along with stressed perineal muscles that can eventually separate.
• Poor nerve function: either there are too many nerves or not enough in the area to cause tension.
• Sexual penetration: sex can cause damage to the perineum, particularly if a woman has an anatomical abnormality.

Issues can include detachment of the anal sphincter muscles and perhaps the collapse of the rectum (rectocele).

The perineal tightening procedure

The perineoplasty procedure involves a V-shaped incision on the back wall of the vagina, with the angle dependent on the degree of tightening required. Any damaged tissue or excess scar tissue is removed. Muscles may be stitched together or detached  from the perineal attachments.

The perineoplasty for painful sex (dyspareunia) caused by vaginismus

Vaginismus (the involuntary contraction of the pubococcygeus muscles) can be treated in some women using a perineoplasty to loosen the vaginal entrance (introitus). This could include a simple incision at the posterior fourchette (the fork at the bottom of the vaginal opening). This surgery is considered effective for dyspareunia caused by lichen sclerosus and vaginismus, and possibly vulvar vestibulitis, though nonsurgical methods should all be tried first.

The loosening perineoplasty

A triangle of skin is removed from underneath the vulvar vestibule. The  aim is to leave as much vaginal mucosa as possible. Recovery times are about four to six weeks.

Cosmetics, ‘vaginal rejuvenation’

Some women have elected to have vaginal tightening surgery for cosmetic reasons.