What kind of vaginal reconstruction do I need? (photos)

I'm in my 30's and had a stage 3 prolapse Rectocele, cystele with bladder leakage and I had a surgery done by a urogyn 9 months ago. I think the Rectocele has come back but higher up. I'm not sure what grade it would be because of so much scar tissue and the new lumps are there from having the surgery. I can't remember what it looked like post surgery. It just looks horrible now. What procedures would you recommend? Is it better to see a plastic surgeon or a urogyn again? What would the cost be?

Doctor Answers 6

Question on vaginal reconstruction: perineoplasty & vaginoplasty...

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Your "introitus" (the vaginal opening) is "gaping" (stretched open,) and hymenal tags and lower vaginal mucosa (vaginal skin) is "prolapsed" (sticking out.)  This is not unusual after childbirth(s.) No need  to do anything if it doesn't bug you. There is nothing you "NEED." However, you may "WANT" elective surgery to repair, bulk, strengthen and re-position the vaginal opening. This surgery is termed a "PERINEOPLASTY."  Additionally, if the inner vagina and vaginal muscles are stretched, weak & slack, you also may request a "VAGINOPLASTY," a tightening repair ot the inner vagina/pelvic floor.  If this is the case, seek out a specialized gynecologic or urogynecologic surgeon, a "Cosmetic Gynecologist," who can accomplish what you want. You MAY find someone in Nevada, but you may need to travel a bit to find just the right, experienced surgeon. You'll need to find a surgeon who is experienced at both the plastic, aesthetic work necessary for the outside repair, and the knowledge & experience necessary to correctly re-approximate the pelvic floor/vaginal muscles. I would recommend that you "choose experience." I have performed > 125 of this type of operation., You should choose a surgeon who has performed at least 50 surgeries specifically for the exact reasons that you have.

The attached weblink and other areas, especially the Blog on this site will help you.

Best wishes,

\Michael P Goodman, MD

Davis, CA, USA

You need Reconstructive and Cosmetic Vaginal surgery

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Thank you for your post with photo which demonstrates a gaping vaginal opening with remnant hymenal tags and recurrent posterior vaginal prolapse. Unfortunately, recurrence of prolapse following reconstructive vaginal surgery is a risk. Since you have a recurrence and have both, functional and aesthetic concerns, you need to seek out the expertise of an experienced reconstructive and cosmetic vaginal surgeon. A plastic surgeon or a general urogynecologist will not provide you with all the options (and experience) you may be looking for. Please link below for more information on finding the best surgeon for you as well as hundreds of before and after photos and patient testimonials.  We'd be happy to see you; be sure to ask about our travel credit program we offer to patients who come in from out of state. 

Best of luck,

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 38 reviews

What kind of vaginal reconstruction do I need?

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First off it sounds like you have already been through quite a bit.   Based on your description, I would first recommend a re evaluation either by the same urogyn or a new one but a proper evaluation is in order.

If there is no need to address any pelvic dysfunction or prolapse then I would consider a cosmetic gynecologist for the repair.   In your particular instance, I would not consider a plastic surgeon given the prior surgeries and or issues that may arise while performing a proper vaginoplasty.

Best of luck

You need a thorough exam to determine what type of vaginal reconstruction will improve you

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It seems that you are concerned with both appearance on the outside and recurrent pelvic organ prolapse on the inside. Surgery changes and distorts your anatomy. The only way to determine what you need is to conduct a thorough pelvic exam in consultation. Expertise in both pelvic reconstruction and cosmetic gyn surgery is necessary to address your concerns. Plastic surgeons are not trained in the former.

What Vaginal Procedures are best for me?

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Dear 933767b,

Thank you for your question and photo. Your question encompasses a variety of topics as they relate to the vagina, repair/restoration options, functionality and cosmetic appearance. These questions would need to be addressed with a gynecologic/urogynecologic surgeon well versed and experienced in both vaginal reconstruction ;restoration of the anatomy and repair of pelvic floor defects leading to prolapse, incontinence etc., or vaginal rejuvenation (tightening) to help with "vaginal function" as it would pertain to more satisfying sexual encounters. Please understand these are not mutually inclusive or exclusive. Not all pelvic surgeons are created equally thus as stated earlier researching the surgeon who is versed in both reconstruction and rejuvenation is important. It is always best when this person is someone whom you can have an open and honest conversation as to what your concerns are and your desired outcome. This coupled with an in person thorough evaluation of the many factors that would play into the final decision can an appropriate plan be implemented that will address your findings and desired outcome. Best wishes. 

Paul Pietro, MD
Greenville Physician

Vaginal rejuvenation vs reconstruction

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Ihave been performing reconstructive vaginal surgery for 25 years and rejuvenation surgery for 16 years and without an exam it is very difficult to say what surgery you need. Reconstruction and rejuvenation are very similar but it is the art of the surgery which define rejuvenation.  Rejuvenation and reconstruction defined below: So lets first define reconstruction --- this is what urogynecologist, gynecologists and pelvic floor reconstructive surgeons do.  We treat vaginal prolapse.  Vaginal prolapse means a lack of support of the vagina and the vagina supports the bladder, rectum, urethra.  The uterus can also prolapse as the ligaments which supportive uterus often break and results in uterine prolapse Define rejuvenation - it means to make new again.   Well actually reconstruction means - to make new again too.  The difference in reconstruction is the surgeon is just putting it anatomically back to where it belongs.  Sort of like making a suit with all the basics.  Where as a rejuvenation specialist is not as worried about putting it back to where it belongs but instead they focus on making things tighter for intercourse.  They are often done through the exact same size incision at the same spot of the vagina. So a reconstructive surgeon can make you a suit which has two sleeves, a pocket in the front, a neck hole/yoke and shoulders and a it comes just below the buttocks. This is great for women who have advanced prolapse and doesn't care about tightening.   A rejuvenation specialist can give you a tube top which is tight around the torso but you don't have any armholes/sleeves or a pocket.  This is great for someone who has mild prolapse and just wants to be tighter during sex.  If you have advanced prolapse or prolapse which is moderate or severe and are sexually active you want to ATTEMPT to have it all.  You want a tailored made suit which has the sleeves, pockets and looks good and feels good when you go out.   If your uterus is falling down or you have had a hysterectomy  and the vaginal apex or vault is falling down, you really need to have this area suspended first and then the surgeon can advance to the tightening aspect at the same surgery.  

The surgeons with the most experience in reconstruction are urogynecologists.  The problem with most urogynecologists is they do NOT believe in vaginal tightening as they have yet to learn how to think outside of the box. Most urogynecologist have 2-3-4 years of extra training.  A good urogynecologist can treat uterine prolapse and cysotcele with laparoscopy and should have performed 100s if not 1000's of procedures. To get the right surgeon to tighten the vaigna is not based upon a plastic surgeons skill but instead a surgeon who is trained in both reconstruction ( usually a gyn, urogynecologist) and rejuvenation (which was developed here in the USA by a gynecologist)        You need to find a surgeon with experience, expertise and a proven track record of results.   Go to their website looks before and after pictures read their reviews.  Understand their complication rate especially for the reconstructive aspect as this is the most invasive of procedures. DOES YOUR SURGEON SPECIALIZE IN BOTH??>==   The average plastic surgeon does NOT tighten the vagina this is not their specialty nor do they understand vaginal anatomy.   A gynecologist unless they were specifically trained in rejuvenation do not tighten vaginas either.   Choose a surgeon who has trained in BOTH and who has the reputation, experience, expertise and results you are hoping to achieve.   Do not choose a surgeon based on location or board certification as neither guarantees expertise in vaginal rejuvenation.  Best of luck in your endeavors! 

Question for you----  What do YOU hope to achieve?  A better looking vaginal opening?  More friction during intercoure?  Do you still leak urine?  Do you feel pressure in the vagina and want this to go away?  Knowing exactly what you hope to achieve will help the urogynecologist ( who specializes in cosmetic vaginal surgery) attain your goals!!! He / She must know what you are hoping to achieve with the surgery.  I don't think your last surgeon was aware that cosmetics was important to you.  That is just my opinion.

John R  Miklos MD 
Urogynecology & Cosmetic Vaginal Surgery 
Atlanta ~ Beverly Hills ~ Dubai

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.