Andrea S. Wang, MD, FPMRS

Thank you for your question!  The crinkled dark tissue between the vaginal opening and the anus is the perineum, and a perineoplasty will help with the appearance in this area.  

The photo showing your desired results also includes a labiaplasty and some refinement around the clitoral hood.  The labia would not change with perineoplasty alone.  For the neat, tucked in look you describe the trim method may be a good approach.

Thank you for this excellent question, I think most women are concerned about clitoral sensation.  The nerve branch that travels to the clitoris does not travel within the labia minora and should not be affected by a labiaplasty.

There is incredible variety in the area where labia minora approach the clitoral hood. It is not uncommon to see a difference when the right side is compared to the left, as you have noticed.  It takes an artful surgical approach to address this as beautifully as possible.

Hello there in Florida!  The vagina and the lower part of the rectum share a wall that is supported by strong connective tissue.  It's not unusual to be able to feel the stool through the vaginal wall, and it doesn't always mean that a rectocele is present.

However, your symptoms may be much more noticeable if the vaginal opening is tightened without having repair of the tissues that are further inside or higher in the vaginal canal.  You are very correct in that it could affect your results and satisfaction.  

Since this is a repeat surgery, you may wish to consult a surgeon who specializes in prolapse repair as well as labiaplasty.   

Best of luck and stay safe!

Thank you for your question!  If you are happy with the appearance of the right labium, then let her be.  Let your surgeon know that your goals are for the procedure - many women with this appearance are looking for symmetry.

Thank you for your question, I know many women have similar concerns.  You have normal and beautiful anatomy for an adult woman, but it sounds like you would like to have the loose tissue reduced.  From the pictures, I do see redundant tissue in the area covering the clitoris.

I think of the procedure more as a hood reduction, not a clitoropexy.  The procedure would smooth out the redundancy of the skin covering the clitoris, but the clitoris itself would not be affected.  

There are different surgical approaches that can accomplish this.  I personally would suggest careful removal of the excess folds to the sides of the clitoris, in a very thin layer.  This would be in addition to a labiaplasty.  Reducing the hood would make it easier to stimulate during sexual activity.

Congratulations on your babies, and thank you for your question.  Your diagnosis is correct - you appear to have both anterior (front) and posterior (back)  compartment prolapse, as well as a widened opening.  In many cases the uterus descends as well.

For women with posterior compartment prolapse, it's not unusual to need to press on the perineum or inside the vagina to help the stool come out.  Needless to say this can be distressing!

Most surgeons recommend 6-8 weeks for full recovery.  Nothing inside the vagina and minimize strenuous activities during this time.  Prolapse surgery is considered medically necessary and is generally covered by insurance.

Thank you for your question!  Although a vaginoplasty would not alter the rectum itself, the connective tissue between the rectum and vagina will be more supportive.  This helps with the sensation of snugness during vaginal intercourse, and you might expect the same result during anal intercourse.

Regarding your question about your partner "feel[ing] heat" - sometimes it's the man!  Perhaps he would consider an evaluation by a urologist for this.

Thank you for your question.  If you did not experience improvement with CO2 laser, it's reasonable to consider surgical revision of your labia majora.  The scar is typically placed in the area between the labia majora and labia minora, just as you described.  It's an area that heals very well, and relatively quickly.  Good luck!

Thank you for sharing your photo.  There does appear to be inflammation not just around the urethra, but also involving the vaginal opening. This can be caused by infection or chronic skin conditions.  The dramatic hormonal changes after delivery can also cause skin changes.

I don't see prolapse on the photo, but if you are feeling a vaginal bulge I would definitely recommend an evaluation by a urogynecologist.  S/he would be able to address the prolapse, as well as the inflammation around your urethra and vaginal opening.

I think you would benefit from an exam by a urogynecologist, who would be comfortable counseling and operating on both vaginal and urethral support.  The tissue under the urethra can more prominent for different reasons, and figuring this out will help determine the best approach.  A cystocele can be due to lateral or central defects, and again an exam would be necessary to determine which is happening in your case.  Best of luck!