Definition and overview

The area between the vagina and the rectum is called the perineum. Perineoplasty is a procedure of reconstructing the vaginal opening in order to repair damage to the perineum and/or damage to the vulva which can be caused by child birth, intercourse, obesity, or inadequate innervation. Perineoplasty can be performed for medical or cosmetic reasons.

Reasons patients want a perineoplasty

A perineoplasty (or perineorrhaphy) aims to make this region more appealing by excising excess skin, removing skin tags, and reapproximating the underlying muscles or the perineal to provide a reduction in the introitus or vaginal opening. Women may report a feeling of physical looseness which may also be associated with decreased sexual satisfaction when compared to satisfaction prior to damage to the perineum.This procedure almost always accompanies vaginoplasty.

Anesthesia for perineoplasty

Perineoplasties are done in the office under local anesthesia.

Procedure

The surgeon makes a V-shaped incision starting from the top of the vaginal floor, cutting through the vaginal mucosa and the perineum. The incision is continued laterally on both sides of the hymenal ring and vaginal opening and ends just above the anal area. The skin within this diamond-shaped incision is then carefully peeled back and removed, as needed.

For the reconstruction process, the muscles are carefully put back together along the vaginal floor. The fascia is also moved to cover the reconstructed muscles, cutting away any excess skin and other tissues. Once the desired tightness or looseness is achieved, the surgeon sutures shut the surgical site neatly and precisely.

Risks

  • Bleeding
  • Infection at the surgical site that would necessitate antibiotic therapy
  • Inflammation and swelling of the affected tissues
  • Constipation after the procedure
  • Pain
  • Abnormal vaginal discharge that may have an unpleasant odour
  • Leaking urine and faeces (these are rare complications)
  • Unsatisfactory results