A recent development in pelvic floor surgery is the advent of Vaginal Rejuvenation Surgery. This may mean different things to different people. As a pelvic floor surgeon it is part of the treatment for pelvic floor dysfunction. When the pelvic floor is damaged by childbirth and further affected by hormone changes and gravity, it may become necessary to perform reconstructive surgery of the vagina. As part of the correction of prolapse and incontinence the overall health of the vaginal support structures must be assessed and corrected. This often results in a return to a more normal vaginal anatomy, a narrowing of the vaginal opening, and a reconstruction of the space between the vaginal and rectal openings. This treats the gaping vaginal opening caused by childbirth.
The wall of the vagina between the rectum and vagina (recto-vaginal septum) is reinforced (rectocele repair) as is the vaginal wall between the bladder and vagina (cystocele repair). A perineorrhaphy or reconstruction of the episiotomy tissues is the final piece of the puzzle. Reconstructing this area results in more sensation during sexual intercourse for the woman and her partner as well as enhanced muscle control in many cases.
Although these procedures result in better anatomy, better sexual function and better physiologic function (better urination and sensation), they may also result in better appearance because when our anatomy is more normal, we feel more normal. All the procedures described above are indicated surgeries although they may be scheduled electively, at a time that suits the patient. These procedures are covered by most insurance policies as they are for real diagnoses.
This should not be confused with “vaginal plastic surgery” which is often described as vaginal rejuvenation. These procedures are frequently not covered by insurance and are not related to the anatomy or function of the vagina but only appearance. Whereas reconstructive surgery can result in better appearance, rejuvenation surgery does not necessarily result in better function.
Labioplasty or surgical adjustment of the lips of the vagina is rarely necessary. I have performed labial surgery in cases where the two lips of the vulva are uneven or exceptionally elongated. Otherwise, normal variations are just that, normal variations and should be left as is. Tampering too much with the labia can lead to scarring, areas of numbness, prolonged swelling, pain, and sometimes no improvement in sexual function.
Vaginal reconstruction is an effective tool in restoring normal sexual function and anatomy as well as improved appearance. Consulting with a urogynecologist will result in the best possible outcome. I recommend discussing your concerns with your gynecologist or requesting referral to a specialist.