The term “Genital Plastic Surgery” is a bit vague. What are the specific procedures? At this point, it is best if we divide “genital plastics” into two categories:

1. External – procedures on the labia minora, the labia majora and the clitoral hood
2. Internal– procedures including hymenoplasty, as well as vaginal tightening therapies, surgical and otherwise, performed inside the vagina for the purpose of enhancing friction, “feeling” and orgasm during intercourse, and at times improving comfort and urinary continence

For this post, we’ll be focusing on internal procedures.

Hymenoplasty (HP)

HP can be looked at as either an “external” or “internal” procedure, as the hymenal ring could be considered the gates of the vagina. Although occasionally performed “to be a virgin again” for one’s sexual partner, HP is usually performed as a cultural imperative in order to assure the vaginal tightness and bleeding upon consummation of marriage that is mandatory in many Islamic cultures. It is not uncommon for Islamic women who have previously been sexually active to seek repair/tightening upon facing the reality of arranged marriage and the necessity of feeling “tight” and experiencing the hymenal tearing, with resultant bleeding, that is expected of a “virgin.”

Hymenal ring repairs are performed differently by different surgeons, and no specific surgical technique or outcome success has ever been reported, as patient confidentiality significantly limits questionnaire contact and “repaired” women rarely return to their surgeons for followup.

In this procedure, several mini-incisions are made around the hymenal ring, removing wedges of tissue, re-approximating and tightening, and staying as inside as possible.

Vaginal Tightening Procedures

Vaginal Rejuvenation… Colpoperineoplasty… Vaginoplasty… Perineoplasty… These are all names used to describe surgical procedures aimed at tightening the vaginal barrel for the purpose of increasing sexual pleasure.

Additional procedures are presently in the research pipeline, in both the US and abroad, involving radiofrequency wave (RF)- based non-surgical procedures aimed at “shrinking” the vaginal mucosal skin by contracting underlying collagen so as to provide a modicum of tightening. There are theoretical advantages and disadvantage to this technology.

Advantages certainly include a minimal, safe and pain-free procedure, but RF only lasts around a year (it needs to be regularly redone), and it certainly would not produce the permanent elevation of the pelvic floor and re-approximation of the musculature and perineal body that has proven effective in 85-90% of patients.

Some surgeons only tighten the opening and the underlying musculature. Some add tightening of the upper vagina by surgically removing stretched and redundant vaginal skin, and sometimes underlying fibrous tissue. If incontinence is an issue and the bladder pushes down into the vagina, this also may be surgically repaired along with tightening by removing excess upper vaginal skin and re-approximating the tough under-the-skin fibrous tissue (if it can be found). If incontinence or vaginal relaxation is significant, the surgery may be augmented by suspending the bladder and surrounding tissue to other fixed fibrous structures, through either the laparoscope or with the use of suspension slings attached to the undersurface of the lower abdominal muscles (“TVT” and “TOT”).

Make no mistake: this is major surgery, taking 1 ½ to 3 hours to complete. It also carries real risks including infection, excessive blood loss, poor or delayed healing, and under- or over-tightening. The surgical technique basically consists of removing stretched vaginal skin and any underlying scar tissue from obstetrical tears or repairs. The closure is made in layers, first re-connecting the muscle bundles, then the tissue under the skin, and finally the vaginal tissue and the skin outside and, if the incision continues onto the perineal surface, strengthening and elevating the vaginal opening. The point of this is to re-establish the downward tilt of the vagina that existed before childbirth and to tighten the barrel against the pubic bone with the stroke of the penis or other inserted object.

Vaginal tightening procedures should be performed only by gynecologists or urogynecologists, who are experts at, and have received extensive training in working within, the vagina.

Anesthesia, Surgical Venue & Surgical Time

Now is a good time to discuss options for both anesthesia and where your surgery should be performed. Major vaginal tightening procedures must be performed in a place (i.e. a hospital or surgical center) that has all the equipment necessary for emergencies and unexpected occurrences, as well as the equipment for the deeper anesthesia required when working inside the vagina.

External procedures, as well as more superficial perineal tightening (perineoplasty), lend themselves to less formal venues such as an in-office surgical suite, and may be performed under nerve block or local administration of anesthetic along the incision lines, frequently with the aid of minor sedation.

After mild sedation to aid in relaxation, a long, slender needle may be utilized to block the pudendal nerve which courses deeply inside the pelvis or, more commonly, long-acting local anesthesia is injected just under the skin with a fine needle, providing immediate numbing of the areas to be modified. Savvy surgeons “buffer” the acidic local anesthetic with bicarbonate of soda to minimize the initial stinging with the injection.

Full-on vaginal tightening operations take 1 ½ to 3 hours to perform. Although a quick (and, I would argue, shoddy) labiaplasty can be preformed in 20 minutes, the more careful and meticulous surgeon usually takes 45 minutes to 2 hours to do a Labiaplasty (LP), especially if hood reduction is also involved. If labia majoraplasty is added, plan on an additional hour of surgery. Some local anesthetic agents can last a good 4-5 hours.


Excerpted from Dr. Goodman’s Ebook Everything You Ever Wanted to Know About Women’s Genital Plastic & Cosmetic Surgery.