This blog is a brief, concise overview of the methods available for tightening the human vagina for reasons of increased sexual pleasure. These procedures are frequently referred to as “vaginal rejuvenation” or “vaginoplasty,” and can encompass other procedures including perineoplasty and posterior colporrhaphy (aka “posterior repair.”)

Definitions:

1. Posterior colporrhaphy (aka “posterior repair” or “PC”) is surgery to repair herniation of a rectal wall bulge through the vaginal floor. Its specific purpose is to improve defecatory function. By itself it has no effect on vaginal tightness or improvement of vaginal friction.
2. Perineoplasty (aka “perineorrhaphy” or “PP”) is the aesthetic surgical reconstruction of the perineum (the area between the vaginal opening and anus), vulvar vestibule, and outermost portion of vagina) to both “bulk” the opening for better pressure against the inner and outer parts of the clitoris and to aesthetically reconstruct the vaginal opening and minimize the size and any gaping of the introitus.
3. Vaginoplasty (“VP”) is not truly a medical term, but has come to mean a surgical procedure performed on the mid/inner to mid/outer portion of the vaginal floor to re-approximate the stretched-out levator muscles, strengthen fibrous fascial planes, excise all non-stretchable/non-viable scar tissue from old childbirth lacerations and episiotomies, and bring the muscles of the vaginal opening together in an effort to diminish the diameter of the vaginal canal and tighten the musculature in the mid-vagina, the area of muscular support. [**There are no muscles in the far upper vagina: all musculature begins at the border of the upper and mid vagina, continuing in crisscrossing layers to the vaginal opening.] The purpose is to produce greater friction and stretch of the anterior vaginal wall and internal and external clitoral pleasure receptors, leading to improved clitoral and vaginally-activated orgasmic pleasure.
4. Vaginal Rejuvenation (“VRJ”). This is a difficult term to define, as it means different things to the lay public and to medical practitioners. As used correctly in a surgical context, VRJ refers to a combination of PC, PP, and VP.

Who is a candidate for vaginal tightening surgery?

These procedures were originally designed to improve defecatory function; as modified, they may now make improved intra-vaginal muscular strength possible for women. Any woman, and most especially one who has borne a child(ren) and has issues involving muscular and tissue strength and self-esteem/appearance, is a potential candidate for vaginal tightening. If urinary incontinence is an accompanying complaint, either a surgical decompression of a prolapsed bladder (aka “anterior colporrhaphy/anterior repair”) or a urethral/bladder sling (“TVT” or “TOT”—the gold standards) are appropriate. If the incontinence is mild and the patient is able to return for ongoing treatments, non-surgical (aka minimally invasive) vaginal tightening at the base of the bladder in the upper vagina via fractional CO2 laser (FemiLift™) or radiofrequency (“RF”) is certainly effective.

The TRUTH about each method.

If you have child(ren) and you are experiencing a sensation of a wide vagina with less friction, or experiencing more difficulty with orgasm, loss of muscular strength, vaginal “wind,” a bulge inside, tampons and/or penises falling out, or a sagging, redundant vaginal opening, your best bet is a carefully-performed surgical repair performed by a Gyn or Urogyn specifically trained in surgical vaginal tightening. A minimally invasive procedure just won’t do it, PERIOD! While FemiLift™ or Mona Lisa™, ThermiVa™ and the other laser and RF machines may be helpful as add-on procedures for incontinence, using them for vaginal tightening is a little like peeing in the ocean. Docs who tout these so-called minimally invasive procedures as a first-line therapy for childbirth-induced vaginal relaxation are not trained to do the necessary work. They have purchased an expensive machine and are incorrectly marketing it to pay the lease. You will be disappointed and will have thrown away >$2000- $3000.00! The best practitioner to see is one who has both expert surgical skills and minimally invasive tools at his/her disposal. Only a surgeon with these requirements can choose the method(s) best for your individual situation!

When to use “minimally invasive” laser or RF energy?

1. Potential use for women who have not yet had children and have a new, smaller sexual partner.
2. As an add-on for incontinence performed along with a surgical tightening repair.
3. Potential use for post-partum women (> 6 months post-partum) who plan on having another vaginal childbirth(s) and wish modest temporary tightening to tide them over until they can get a definitive repair after their last childbirth.

Whichever method you choose, the muscles, although re-approximated with surgery, are not strengthened! You will still need to embark on an ongoing course of pelvic floor P.T. (physical therapy) to strengthen the newly re-built musculature of your vaginal floor.

How to choose your practitioner/surgeon

Whom to see:

1. A Gynecologist or uro-gynecologist (+ occasionally a plastic surgeon or cosmetic surgeon, but only if this individual is practiced and comfortable working deep within the vagina, working with the “bulge” and muscles deeply inside. You do not want a surgeon who is only comfortable working with “the opening” and a bit inside) — make sure they can PROVE it!
2. Training: Gynecologists and especially urogynecologists are well-trained working within the vagina and doing a site-specific repair of the rectal bulge to improve defecatory function, but usually ARE NOT PREPARED to perform the caliber of intra-vaginal excavation and re-bonding that a proper vaginoplasty entails. You will have to do your due diligence in your search, seeking a cosmetic gyn or urogyn who can prove to you either via a separate certificate from a bona fide training course (such as the one I hold several times a year called The Labiaplasty and Vaginoplasty training Institute of America™, or LaVaTI™,) or via evidence of being well-experienced in the art and science of a proper vaginal tightening operation and having performed many provable surgical cases.

Who NOT to see:

1. Someone who cannot prove that they are an experienced (deeply inside) vaginal surgeon.
2. Any doctor who only does laser or RF work and who is not also a bona fide and respected intra-vaginal “rejuvenation“ surgeon.