Oseka Onuma, MBBS, FRCOG

Hi Sammy. Hope you've having a great festive season.
From the pictures it appear that the vaginal entrance is open. Part of the problem will be detachment of the perineal body muscles. Although not visible it is highly likely that you also have damage to the supports of the front and back walls of the vagina. Non-surgical treatment will not fix either of these if you suffer from symptoms such as reduced sensation during sexual intercourse. Non-surgical laser vaginal treatment does have some other benefits but if you want a tighter vagina and tighter vaginal entrance, there is no substitute for surgery.
I would suggest that clitoral hood reduction should be avoided because of the risk of over-exposure of the clitoris resulting in irritation. If the size of the clitoris reduces in the future then you could then consider clitoral hood reduction only if you feel that it interferes with access to the clitoris or you are bothered by it's aesthetics.
Best wishes on your journey.

Hi Nicolex26

There are numerous techniques for repairing the posterior vaginal wall, perineal body and perineum. This usually suggests that one size does not fit all.

There are a number of significant factors including your clinical presentation (what you and your surgeon felt/saw during examination), what your indicated desire was, what your surgeon 'heard' you say, what your surgeon was trained in doing.. and the list goes on.

A sexual function approach to pelvic reconstructive surgery is best done by a surgeon who has training in this specific area and they might not confine their advice to repeat surgery alone but, depending on the quality of your tissue, may be able to give you advice about the pros/cons of other treatments such as Platelet Rich Plasma (PRP) treatment and laser vaginal treatments.

Best wishes

O

The 'gold standard' surgery for uncomplicated stress incontinence currently recognised by medical professionals around the world is the 'mid-urethral sling,' or a 'TVT' procedure. These usually use a small piece of mesh and thus have been implicated in the current 'mesh controversies.' Nevertheless, it still has one of the highest success rates with low complication rates of any of the accepted stress incontinence surgeries.

You will need to take into account your personal circumstances. If you have completed your family then the decision is easier than if your family is not yet complete. In either case, discuss with your gynaecologist, as long as they have a specific interest in female continence medicine and surgery.

In a nutshell, you plan to have an elective procedure to improve your quality of life, then jump on a flight 1.5hrs later. I could write a list of the possible things that could go wrong with that strategy but suffice to say, take a breath, plan to stay local to your area of surgery for at least 24hrs and enjoy the fruits of your endeavours with reduced risk. Good luck.

The main indication for having any treatment is the presence of a symptom or problem that you wish to make better. Laser or thermal energy devices can be used to improve the quality of the vaginal epithelium with a variety of positive effects. Age is not a limit to treatment, it is the willingness to be treated and needs to be an individual decision aided by your doctor.