WARNING: The following text contains explicit information and imagery about female genitalia and related surgical procedures. Do not continue if you do not wish to see these images. These pages should also not be viewed by those persons under the age of 18.
- Vaginoplasty (Tightening and rejuvenation of the vagina for vaginal laxity)
- Perineoplasty (Aesthetic repair of vaginal opening with tightening and elevation)
- Posterior Colporrhaphy (A/K/A posterior repair)
These three procedures are performed in our office in combination, and are together often called a vaginal tightening operation, vaginal rejuvenation, or simply vaginoplasty. A procedure involving only a perineoplasty may be done, at a reduced fee, for women who seek a modest tightening of the opening alone.
An enlarged vagina is a problem that is frequently experienced after childbirth, and especially after multiple children, a vaginal delivery of a large baby, or a difficult delivery. The specialized surgical tightening and rejuvenation of the vagina, perineum (vaginal opening) and supporting muscles is called vaginoplasty. Many women with grown children seek renewal of vaginal tissues to increase their sensation and sexual satisfaction, to improve orgasm, and to enhance the sexual experience they have with their partner.
The procedure that Dr. Goodman performs is similar to Laser Vaginal Rejuvenation™. A vaginoplasty, usually combined with a perineoplasty and posterior repair, involves repairing and strengthening the pelvic floor (bottom of the vagina,) and re-approximating the levator muscles, the bastion of the vaginal floor. Surgery can remove all scar tissue, re-approximate muscular support and fascial layers, and reconstruct the opening to appear more as it looked pre-children, but it takes committed post-surgical exercises to strengthen these newly re-approximated muscles. A surgeon who operates without teaching and instructing their patient regarding how to strengthen these muscles is leaving half the work undone. In our office, a specialized pelvic floor exerciser (the APEX™ pelvic floor stimulator or Peri-Coach™ biofeedback device) is included as part of the surgical fee, and patients are personally instructed in its post-operative use by Dr. Goodman.
Dr. Goodman incorporates a classic 3-layer closure — the gold standard for a vagino/perineoplasty — in addition to a classic posterior colporrhaphy. Here, after any existing scar tissue has been removed, one to two sutures are placed into the fibrous covering of each of the 3 levator muscles. This rebuilds the floor and decompresses the bulge from thinned-out recto-vaginal support tissue. The attenuated fibrous layer (recto-vaginal fascia) is strengthened and re-approximated as a covering over the muscles, further thickening and strengthening the floor and essentially holding it all together. The vaginal skin and opening is closed as a third, covering layer, and is repaired with smaller, less irritating sutures that cover the strengthening work below. Make sure your surgeon utilizes a 3-layer approach!
A difficult childbirth or a vaginal/perineal tear from childbirth can create an unusually open vaginal orifice that can lead to irritation from tight clothing, self-consciousness and diminished sexual enjoyment. A procedure to remove the scarred or lax opening and repair and elevate the perineum by re-approximating the muscles of the perineal body is called perineoplasty.
Perineoplasty produces a normal approximation of the lax vaginal opening and elevates and tightens the thin muscles of the opening for visual pleasure as well as to diminish the situation where the penis or toy simply slips out. Adding a vaginoplasty, which is a functional and cosmetic modification of the old posterior repair operation, further approximates the levator muscles and rebuilds the pelvic floor (see description of vaginoplasty in this section). These surgeries will also get rid of or diminish what is known as vaginal flatus, or passing air from the vagina. Additionally, surgery will diminish the risk of squirting or loss of urine during the joys and rigors of lovemaking.
The pictures below can only provide you with an external view, but should give you an idea of the benefits that this surgery provides. Many of the women shown below elected to have their generous-sized labia reduced (labiaplasty) at the same time as their vaginoplasty procedures. In these cases, our office discounts the additional labiaplasty procedure by 50%, which is significantly more than the industry standard. Dr. Goodman has performed well over 200 complicated vaginal tightening procedures, with excellent subjective and objective tightening, cosmesis, and functional improvement. Presently, most of the surgeries that he performs take place in his office procedure room under comfortable, safe, and less-expensive local anesthesia, although a hospital setting using general anesthesia may always be chosen.
A Personal Note from Dr. Goodman
How should you decide who to consult, and who should do your surgery? It is important that you do your homework! Look for either a trained plastic or cosmetic Gyn surgeon. You can find them by carefully reviewing websites, looking specifically for genital plastic/cosmetic surgeons who SPECIALIZE and who are very experienced in labiaplasty, vaginal rejuvenation, perineoplasty & vaginoplasty. BE CAREFUL with doctors who tout “minimally invasive” laser or radiofrequency but who are not skilled with surgical options. Look for labiaplasty surgeons who can either PROVE to you that they’ve taken a specialized course with either myself, Dr. Matlock, Dr. Alinsod, Dr. Halperin, Dr. Ostrzenski, or a surgeon who has performed AT LEAST 50 to 100 cases and can prove this to you by providing you with before and after photos on their site. If they have performed fewer than 20 of these procedures, don’t let them operate on you.
Who should you STAY AWAY FROM?
While even the best trained female genital cosmetic surgeon can achieve a poor result, virtually all of the “botch jobs” come from Ob-Gyns who have not been properly trained and who do not have the needed experience for this procedure. Fine and meticulous plastic technique is not taught in Ob-Gyn residency training programs, and neither is aesthetic labiaplasty or vaginal tightening for sexual improvement reasons. The only thing that an untrained Ob-Gyn is likely to know about labial surgery is “cutting them off.” They have virtually no idea how to aesthetically trim and sculpt the clitoral hood. Additionally, while general Ob-Gyns know how to repair the vagina for defecation difficulties (called a “posterior repair”), this procedure WILL NOT tighten the vagina for any length of time, nor will it produce the “before-I-had-babies look” of the opening that many women are looking for with vaginal rejuvenation. I participate in a large number of medical legal reviews of malpractice cases involving labiaplasties. Every one of these mutilations has been performed by general Ob-Gyns.
THE FIRST SURGERY IS THE ONLY CHANCE YOU HAVE TO GET IT RIGHT. While revisions of “botched” or “mutilated” labiaplasties can be performed by premier genital plastic surgeons such as myself, revisions frequently cost much more than would have been the case had the original surgery been performed by the right surgeon in the first place.
Please do not hesitate to contact our office for any questions. Dr. Goodman offers free consultations about these procedures, generally lasting 5-10 minutes. For information specific to you and your wishes and anatomy, a personal in-person or telephone consultation (with photos) should be booked.