Robert L. Harris, MD

With your history of large babies delivered vaginally and your complaints of poor sensation, and after reviewing your photos, you very likely would do best with surgical vaginal tightening, i.e. Vaginoplasty and perineoplasty. Tie off of work depends on your response to surgery as well as what type job you do. This could be 2 week or 406 6 weeks, again, depending on your job type. Be sure to seek out a provider with significant experience in vaginal reconstruction.

Childbirth causes damage to the nerves and muscles in the pelvis and this may result in support loss and laxity of the vagina, sometimes accompanied by difficulty controlling bladder and bowel. Your complaints are very common and many times, your issues can be corrected surgically, although non-surgical rehab of the muscles is sometimes helpful. Your first step is to get a full evaluation by a provider specifically trained in female pelvic medicine and reconstructive surgery, and one that has special interest and experience with vaginal cosmetic surgery also. Do not be embarrassed to ask for help. 

If you have had children and this problem of sensation has worsened since then, it's likely you have some support loss that can be corrected surgically.  ThermiVa is a non-invasive treatment that might be of some help but you will need an exam by an experienced vaginal reconstructive surgeon first and then she/he can guide you in the right direction.

Labiaplasty is a cosmetic procedure to reduce the size and enhance the appearance of your labia. That surgery is not covered by insurance and will not have any effect on urinary incontinence. Surgery and other treatments for urinary incontinence are covered by insurance and sometimes can be combined with labiaplasty surgery. Be sure you go to an expert in both cosmetic genital surgery and Urogynecology so you will get the best advice and improve your chances for a good result.

Discomfort in jeans and other tight fitting clothing is a common complaint with enlarged labia. Cosmetic labiaplasty can relieve these symptoms. Be sure to choose an experienced surgeon for best results.

While this could be an issue with your painful intercourse, there are many causes so I'd see a specialist for further evaluation.

That's a hematoma and it's not normal and may require further surgery so go and see your surgeon as soon as you can.

While there are lasers (MonaLisa Touch, Core2Intima, etc.) to improve vaginal function and moisture and there are radiofrequency devices  (Thermiva and others) to improve vaginal and vulvar tone, none of these non-surgical options will tighten and restore vaginal function like surgery will.  So, it matters what you mean when you say "vaginal rejuvenation".  I would suggest that you visit a specialist who performs these non-surgical treatments as well as vaginal rejuvenation surgery and get an opinion on what is best for you, as every women is unique and her needs are different.

ThermiVa is not an issue with mesh but there is some theoretical risk to using CO2 laser, like MonaLisa Touch but this can be avoided by treating only the areas of your vagina where mesh does not come in direct contact with the laser energy.  We've done hundreds of these procedures and many of these women have had prior mesh repairs and are glad to discuss with you.

Laser for vaginal atrophy yields excellent results. The addition of systemic hormones may potentiate this positive effect but most women get significant improvement in dryness and irritation symptoms with the laser alone.