Perineoplasty/Labiaplasty

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 odor
  • Leaking urine and feces (these are rare complications)
  • Unsatisfactory results

What is a labiaplasty?

The term labiaplasty refers to a procedure that reduces the length of the labia minora. It is the most commonly performed vaginal rejuvenation procedure and it can relieve symptoms women experience from twisting and tugging of the labia.

Reasons patients want a labiaplasty

Women opt for surgery for a variety of reasons, including pain from twisting and tugging of the labia when riding a bike or during intercourse, itching, irritation and self-consciousness.

What does a labiaplasty do?

The goal of the procedure is to reduce the labia minora so that they don’t hang below the hair-bearing labia majora. A labiaplasty may be performed to reduce asymmetry when one is longer than the other, or, more commonly, to reduce the length of both labia so that the labia no longer twist, tug or fall out of a bathing suit.

Anesthesia for a labiaplasty

Labiaplasty is a procedure that can be done under either local anesthesia with oral sedation or under general anesthesia.

Labiaplasty procedure

The most common type of labiaplasty is the trim procedure, in which the extra tissue is removed and sewn up directly. Next in popularity is the wedge procedure, which maintains a natural border after a pie-shaped piece of tissue has been removed. Extra folds of the clitoral hood can also be reduced at the same time. Closure is usually done with absorbable sutures.

What are the risks of a labiaplasty?

The risks associated with labiaplasty include those of most surgical procedures, including bleeding, hematoma and infection. The most common complication is over-resection. While some women desire an aggressive reduction, this can result in chronic dryness, scarring at or near the vaginal opening and pain with intercourse. Healing problems are more likely to occur with a wedge procedure, particularly if the patient is exposed to substances that cause blood vessels to shrink.

Recovering from a labiaplasty

Most patients take a week off from work, during which they can reduce swelling and pain by icing with a cold pack sandwiched between the patient’s underpants and an elastic garment, like Spanx. This can be done “twenty minutes on, twenty minutes off.” The patient can also lie with her bottom elevated to reduce swelling.

Patients can resume wearing tampons or having intercourse after four to six weeks. Trim labiaplasty generally allows for a quicker recovery.

While the most distorting swelling is gone by 6 weeks, residual swelling may take six months to disappear.

What are the results of a labiaplasty?

Labiaplasty typically results in shorter labia that no longer hang down below the level of the hair-bearing labia majora. Most patients who experienced symptoms from twisting and tugging of their labia generally find relief after surgery. According to multiple studies, labiaplasty surgery is associated with a high satisfaction rate of over 90 percent.

Written by Joe Franzese

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