No medical procedure is without risk. Although Labiaplasty, Clitoral Hood Revision and Hymenoplasty are generally low-risk surgeries, since they are virtually entirely elective procedures, the bar is set higher when it comes to the responsibility of your surgeon to fully explain the risks.
Risks of external vulvar procedures include a wound opening or partial opening(s); requiring longer than expected time to “fill in” and heal; infection requiring antibiotic treatment or drainage; excessive swelling with prolonged healing; delayed post-operative bleeding that may require re-opening of the incision to tie off the bleeder; healing taking longer than expected; removal of too much or too little tissue; post-operative sexual pain and cosmetic results not being up to your expectations.
Risks of Hymenoplasty include the above, plus the inability to guarantee that the goal (tightness and bleeding with subsequent coitus) will be accomplished. The biggest “risk” is actually that the cosmetic outcome does not keep up with expectations. Although you and your surgeon should carefully communicate regarding your outcome desires, no plastic or cosmetic surgeon can guarantee that it will look “perfect.”
Vaginal Tightening Procedures: The Basics
With the exception of minor and more superficial reconstruction of the opening, these are major surgical procedures, not to be taken lightly. The surgery is performed in a tight space, surrounded by vital organs containing a rich blood supply. Muscles must be re-approximated without placing sutures too deep into muscle bundles.
Without a doubt, these are procedures to be tackled only by experienced gynecological or urogynecological surgeons. These surgeries must be performed under anesthesia sufficient to provide the visibility necessary for a safe repair. Less extensive repairs involving the opening and into the vagina a short ways (1- 1 ½ inches) can be performed under local anesthesia in the office, if your surgeon is skilled and has the proper equipment in the office setting.
Similar to external procedures, recovery is sequential. Again, the first week is the roughest, usually requiring several doses of narcotic medications the first several days, frequently aided by the addition of Ibuprofen or Naprosyn to whatever narcotic analgesic is supplied. The discomfort tends to be more “deep” and “achy” than the more superficial pain from Labiaplasty. Little analgesia other than occasional Ibuprofen or its equivalent is usually required thereafter.
One problem you may encounter can be difficulty emptying your bladder, especially if you are anxious or in pain. For this reason, it is imperative that you “get on top” of the pain by starting early on your pain meds (and also taking a mild tranquilizer if you are anxious) for the first couple of days. This is no time to try to “tough it out.” You don’t want to be in too much pain early after surgery. It’s much harder to get pain under control if you wait until you’re in significant distress before you take meds. So start early!
As with Labiaplasty, I recommend resting around the house during the first week post-op. Beginning the second week, patients are more ambulatory, usually returning to sedentary work in 2-3 weeks and vigorous work activities in about 3 weeks. However, it’s important that you do no heavy lifting or strenuous activities or have intercourse for at least 4-6 weeks post-op. In one-third of cases, lovemaking may be resumed 4-6 weeks post-op, for one-third it takes 6-8 weeks, and the remaining one-third require 8 weeks or longer. Your surgeon will guide you in this regard.
At times (maybe one-quarter of the time) the vagina may be a little too tight, and a period of time (weeks to months) is required utilizing progressively larger rounded-tip plastic dilators, possibly along with some estrogen cream, to get the vaginal diameter large enough for comfortable lovemaking. Because of the more invasive nature of intra-vaginal surgery, the potential for serious complication is greater than for external vulvar procedures. The risks can be divided into intra-operative and postoperative.
Vaginal Tightening Procedures: The Risks
During surgery, risks include excessive blood loss, possibly even requiring transfusion; injury to adjacent organs (the bladder, rectum and peritoneal cavity containing intestines lie adjacent to the areas in the vagina undergoing surgery)’ and anesthetic risks (these surgeries are frequently performed under a general or spinal anesthetic, although less major repairs involving only the opening and a little into the vagina may be performed under a local or regional nerve block.)
Post-op risks include infection; blood collections under the skin (“hematoma”) that can enlarge and/or become infected; prolonged healing; over-healing with irregular tightening in the vagina (sometimes referred to as “stricture”); separation of incision(s); post-op pain with sex; and cosmetic outcome not in keeping with expectations.
Just how often do complications occur? My personal experience parallels that of the medical literature. In several peer-reviewed studies, significant complication rates are approximately 5% (1 out of 20 cases). These complications include wound separations, poor cosmetic outcome requiring re-operation, excessive blood loss, serious infection, prolonged healing, return to the operating room, pain or poor healing far outside of the normal range. However, a study I conducted of 258 patients undergoing 341 separate procedures found that 15-20% of patients and their physicians noted some sort of initial problem (more swelling, pain or bleeding than anticipated, slower healing than anticipated, problem with the anesthetic, etc.) that promptly resolved, causing no long-term distress and have no long-term effect on outcome.
There is a very important caveat here. The above statistics come only from experienced, high-quality surgeons who report complications. Complication rates for the average general gynecologist who performs genital plastics only occasionally are very likely to be significantly higher, and usually goes unreported.
Your Take-Home Message
Choose only a well-experienced surgeon, or someone who can prove they have taken a specialized instruction course in genital plastics, and make your cosmetic requests clear to your provider.
Unfortunately, in this area as in many other facets of society, charlatans and shysters exist. Do your “due diligence” before you let any surgeon touch you in such a sensitive, personal, sexual and private area. This is not a time to be “penny wise and pound foolish”!
1. A Large Multicenter Outcome Study of Female Genital Plastic Surgery, Journal of Sexual Medicine, 2009.,Michael P. Goodman, MD,* Otto J. Placik, MD, Royal H. Benson III, MD, John R. Miklos, MD, Robert D. Moore, MD, Robert A. Jason, MD,
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