Charles R. Hanes, MD

An episiotomy can be large and quite traumatic, or it can be small. The same may be said about a perineoplasty. It all depends on the goal of the surgery and the defect being corrected. Your doctor should be able to help you know how big the incision will be and how traumatic it will be.

Sitting on a donut after a perineoplasty may not be necessary at all. It totally depends on how much swelling, bruising and pain you have. Sometimes this is quite minimal. You can think of it like the swelling after a vaginal delivery. Sometimes there is very little swelling and sitting is not uncomfortable. On the other hand, there are deliveries that are more traumatic, resulting in more swelling. A perineooplasty can be very simple or it can involve a larger, more traumatic incision.

There is no clear answer since the term perineoplasty encompasses a wide range of incisional lengths. I recommend a minimum of two weeks of staying dry. If the incision is no longer tender and there has been no bleeding or drainage for at least a week, there would be no harm in swimming. You want to avoid any activity that is going to result in pulling the incision apart. 

I think it is unlikely that any itching or burning would be from recurrence of the atrophic vaginitis. I would recommend you see your doctor and determine if you might have a vaginal infection such as from yeast.

Usually there is not much pain after a perineoplasty - similar to episiotomy pain after a vaginal birth; however, everyone is different and there is always the possibility that there can be more swelling or even a hematoma that would cause more pain. For that reason, i do not think it would be wise to plan on activities the following day. If you were not having pain, there would be know reason that you could not be out, driving, and resuming many normal activities.