In my last post (“Do Sex Researchers Really Have This Much Fun?”), I described the physiology and biomechanics of a woman’s orgasm experience, differentiating between “clitoral” and “vaginally activated” orgasms. While avoiding any labeling of one or the other as “best,” I described the differences in the two experiences and the innervation responsible for each. (At least, I hope I did!) For those of you who missed that post, or for those who wish to “refresh,” you can see it here.

Today’s post will carry this biological information forward one step, discussing the technical (surgical) procedure designed specifically to promote vaginal tightening for the specific purpose of producing additional pressure, friction, and “stretch” on the sensual nerve receptors in a woman’s anterior (upper) vaginal wall, in the depths of her vagina and cervix, and in the pelvic floor (above her rectum and anus).

This is in absolutely no way meant to denigrate the clitoral orgasmic experience, which stands very fine on its own. It’s just that, especially if vaginal laxity has developed over the years (such as after childbirth(s) and with aging), the friction and vaginal distension necessary for vaginally activated orgasm may be less robust. Additionally, with age, your lover’s penile girth and rigidity may slacken, and more friction may be necessary for his orgasm, as well.

Which leads me to the particulars, rationale, and outcomes of so-called “vaginal tightening operations,” which is also called “vaginoplasty,” perineoplasty,” “colpoperineoplasty,” and “vaginal rejuvenation.” Whatever name you give it, in skilled, trained hands (which, unfortunately, does not necessarily include your average general Ob-Gyn), these operations serve to tighten the vaginal barrel to produce greater friction. This results in greater swelling and stretching of the vaginal canal to provide greater pressure on the erectile tissue of the inner areas of the clitoral complex, the bulbs and crurae, buried deep in the anterior vaginal wall in the area of the so-called “G-spot,” as well as expansion and sensual pleasure derived from the autonomic fibers in the cervix, posterior vaginal wall, and especially in the G-spot area, along with the clitoral complex.

In addition to bulking and strengthening the pelvic floor, these operations are designed to anatomically change the “angle” of the vaginal canal from its frequently lax, more horizontal post-childbirth position and re-establish the “downward tilt” that nature gave it prior to the terrific forces of childbirth breaking it down (in some women more than others). By tightening the “barrel” and elevating the perineal body, additional “bulk” is in essence provided to a penis that in reality may be a bit smaller than it once was. This allows the penis to “push” more firmly against the G-spot and allows both the dorsum of the penis and your lover’s pubic bone to better “massage” the outer clitoral structures.

How is this done surgically? Surgery is performed in the hospital, in a surgicenter (usually under spinal or general anesthesia), or in an office surgical suite under a local (awake) anesthetic by those few well-experienced specialists who are masters in this operation. (This includes myself here in Davis, CA; Dr. Red Alinsod in Laguna Beach, CA; Drs. Miklos and Moore in Atlanta, GA; and perhaps one or two others in the U.S.) While the technique is reproducible from patient to patient and has a basic surgical structure, I cannot emphasize enough the importance of seeking a surgeon experienced in the performance of these procedures specifically for reasons of enhancement of sexual pleasure, and not simply for correction of incontinence or “pelvic relaxation” (although these goals may also be accomplished with a “tightening” operation).

After suitable anesthesia, and after adequate exposure of the outer half of the vagina and perineum has been established via a special retractor system designed specifically for this purpose, a “kite-shaped” incision is made with a special radiofrequency (“RF”) needle, laser fiber, or scalpel, with the top of the “kite” in the midline (approx. 1 ½ – 2 ½ inches within the vagina), the “wings” of the “kite” at the vaginal opening/old hymenal ring area (at approx. the four o’clock and eight o’clock positions), and the “tail” of the incision in the midline (around ½ to 1 inch above the anal verge). After the (frequently attenuated) fibrous sub-vaginal support tissue has been taken down from the vaginal skin, the superficial vaginal, vestibular, and perineal skin, as well as all of the underlying scar tissue from obstetrical episiotomies/lacerations and subsequent repairs, is removed, exposing the supportive but stretched muscle bundles.

The whole area is repaired with a “three-layer” closure, first re-approximating the pelvic floor (“levator”) muscle bundles with large-caliber absorbable sutures, then covering these by re-approximating the fibrous fascia, gathering and strengthening it in the process, placing two or three “crown sutures, firmly building up and re-approximating the muscular wall of the vaginal opening, and finally effecting an aesthetic, cosmetic re-construction of the vaginal opening, to a degree re-creating the vaginal opening that existed “pre-babies…”

Savvy reconstructive vaginal surgeons will augment the surgical repair with at least a three- to six-month series of pelvic floor exercises to further strengthen the newly re-approximated musculature. This may be done by incorporating specific vaginal muscle training devices (In-Tone™, Apex™, or other specially designed pelvic floor trainers, and/or the use of Luna Beads™ or “benwa balls”) and frequently adding the services of a pelvic floor physical therapist to further improve post-surgical results. Our office specifically includes an Apex™ device and/or Luna Beads™ and, in women with very poor “Kegel’s” strength, incorporates physical therapy as part of a post-operative strengthening program.

It does make a difference who you choose to perform your pelvic floor tightening procedure. While most general Ob-Gyns have adequate training in general vaginal pelvic floor operations, only a few are specifically trained in surgery designed for the purpose of vaginal tightening for the purpose of enhancement of sexual pleasure.