Vaginoplasty/Perineoplasty. Is it better to use a urologist vs plastic surgeon vs ob/gyn?

After reviewing this site there seems to be different drs that perform this procedure. Is it better to use a urologist vs plastic surgeon vs obgyn? This is so confusing.

Doctor Answers 8

WHO shoud perform vaginal tightening procedure: plastic, gynecologic, or urogynecologic surgeon? Be careful whom you choose!

Thanks for the cogent question. Here is an honest answer from one who is very acquainted with this issue. The vast majority (>98%) of Plastic Surgeons are NOT TRAINED in intra-vaginal work (vaginal tightening/vaginoplasty), although they may be skilled in simple repair of the opening only. A urogynecologist is trained in pelvic floor repair for various prolapses, but unless they have been SPECIFICALLY TRAINED in vaginoplasty/perineoplasty oriented for vaginal tightening, improving sexual pleasure , specifically bulking up the perineum by removing all scar tissue and doing a plastic/cosmetic repair of the opening, that Dr. is not who you want.  Ditto fr a general Gynecologist. Ask if he or she is SPECIFICALLY TRAINED and experienced in perineoplasty/vaginoplasty for improving sexual pleasure, rebuilding the pelvic floor, bulking the perineum and very aesthetically re-building the vaginal opening to appear more like it was prior to children.
If you specifically write or call our office, I will be happy to send you a power point presentation that I have presented to various Aesthetic and gynecologic meetings that well-explains the performance, reasons and goals of vaginal tightening procedures..
Best wishes,
Michael P Goodman, MD
Davus, CA, USA

Who is the best surgeon for female surgery: vagina, labia

Who is the best surgeon for female surgery: vagina, labia
Who performs aesthetic vaginal treatments? Board Certified Plastic Surgeons may have experience and training in performing these surgeries. Training in reconstructive genital surgery and transgender surgery along with experience in aesthetic procedures, provide Plastic Surgeons with special skills to perform these operations. Some gynecologists and uro-gynecologists have special interest and training in this aspect of women’s care. Find someone board certified with experience

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

What kind of surgeon should I use to for vaginoplasty?

I agree with Dr. Miklos's answer.  He and his partner Dr. Robert Moore are leaders in this field of Cosmetic and reconstructive vaginal surgery.  On the west coast, Dr. Michael Goodman and Dr. David Matlock are similarly leaders.  Dr. Miklos and his partner Dr. Moore also see patient's in Beverly Hills.   All these doctors have gynecology backgrounds with a focus on cosmetics and female pelvic reconstruction.  I don't think its a good idea to use a plastic surgeon for vaginoplastic surgery although some plastic surgeons who specialize in female genital cosmetic surgery can do excellent work with labiaplasties - which is altering the cosmesis of the labia.  Experience and focus is what matters - that and availability and courtesy.  Don't have surgery unless you need to - and find a doctor that doesn't just push you into an operation or overstates his or her qualifications. 

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Urogynecologist vs gynecologist vs urologist

Thanks for the questions.  Part of the answer to your questions resides in the fact ---Do you need rejuvenation or reconstruction.   The only way you will know is to be assessed by a surgeon who is well versed in both reconstruction and vaginal rejuvenation.   Rejuvenation is really a cosmetic/function type problem and reconstruction is not.   What is vaginal rejuvenation?  Vaginal rejuvenation really means the internal tightening of the vagina and tightening of the vaginal opening usually to enhance friction for intercourse.   In experienced hands this surgery is approximately 85-90% successful as defined by the patient ( i.e. she is satisfied with the enhancement of friction during the act of intercourse 12 months after surgery).   There are only 4 papers written on this topic and my partner, Dr Moore and I are co-authors of two of these papers.    This surgery is usually accomplished by performing posterior vaginal wall surgery ( known as a posterior repair and coupling this with a levator muscle plication) + a vaginal opening repair known as a perineoplasty.   This requires experience, expertise, and good knowledge of  the pelvic floor.      Patients who have had multiple childbirths may need more than just tightening procedure they actually need vaginal reconstruction. 
What is vaginal reconstruction?  Vaginal reconstruction is what most urogynecologist have been trained to do...to reconstruct the vagina to give the support back and this does NOT focus on tightening the vagina. Reconstruction is for the restoration of the anatomy and also to fix things like urine and fecal leakage or retention.  The urogyencologist has extensive training and is the most experienced of all surgeons in operating on the relaxed vagina.  The second most experienced surgeon for vaginal reconstruction would be the gynecologist.  The urogyn  is trained by first spending  4 years in a residency in obstetrics and gynecologic surgery and instead of going out to practice they then tspend 3 more years of subspecialty training in vaginal reconstruction or the rebuilding of the vagina (when it falls down aka vaginal prolapse - see the next few paragraph for an explanation).  Plastic surgeons, dermatologists, an family practice doctors who have perform cosmetic vaginal surgery do little concept of vaginal reconstruction.  They are not trained in residency to do vaginal surgery nor have they spent 7 years learning vaginal reconstructive surgery like a urogynecologist.  In fact I do not know of any plastic surgical residency in the nation who dedicates more than a few months to training their resident on vaginal surgery.    Vaginal Prolapse is basically the same as the vagina falling down and each area of the vagina which falls has its own descriptive name" Uterine prolapse - the uterus is falling down into the hollow of the vagina and towards the opening of the vagina in severe conditions the uterus can actually fall  out of the vaginal opening and it hangs between a womans legs.  Cystocele - the deeper portion of the ceiling of the vagina gives way and the bladder which is being supported fall downward into the hollow of the vaginal canal. Often these patients will suffer from frequency and urgency of urination as well as vagina pressure.  If the condition is very severe the patient will have difficulty emptying her bladder. Urethrocele - the ceiling of the vagina near the opening of the vagina gives way and the urethra sags.  Often these patients will suffer from cough urine leakage ( aka stress urinary incontinence) Rectocele - the floor of the vagina gives way and the rectum pushes upward into the vaginal canal producing a bulge pushing towards or out of the the opening of the vagina.  Often patients will complain of difficulty emptying their rectum of stool. Urethrocele means there is a lack of support of the urethra and often (but not always) these patients will leak with coughing  and sneezing. Urogynecologist have been trained to treat the anatomy of the vagina to support each of these structure as well as consider the function of urination and defecation as they perform surgery. Often this surgery needs to be accomplished laparoscopically i.e. small incisions through the abdominal wall.   However most urogynecologist have not been trained in the concept of cosmetic vaginal surgery or  vaginal rejuvenation . You certainly would benefit from a thorough evaluation by a urogynecologist or a pelvic floor surgeon/gynecologist.  But you would probably want to choose someone who is also trained or has expertise in vaginal rejuvenation.  So I caution you to choose a surgeon wisely............choose a surgeon who can accomplish both of your needs: 1) restoring friction during intercourse and   2)  decreasing the pressure  inside of the vagina ( which maybe best accomplished by restoring the supportive anatomy of the vagina and NOT JUST TIGHTENING the vaginal opening.  Choose a surgeon who is specialized in urogynecology or vaginal floor reconstruction and cosmetic vaginal surgery.  Please see both sections of my website to get a full understanding and the different between cosmetic vaginal surgery and vaginal reconstruction.  Remember your choice of surgeon should be based upon: experience, expertise, reputation and results and do not solely focus on location, convenience and cost. John R Miklos MD Urogynecologist  & Cosmetic Vaginal Surgeon
Atlanta ~ Beverly Hills ~ Duba

The best surgeons for vaginoplasty are experts in both pelvic reconstruction and cosmetic gynecology

A vaginoplasty is a relatively straightforward procedure for tightening the vagina when the pelvic supports are intact. The problem is that most vaginas which require tightening have damaged pelvic supports. To put it simply, a vaginoplasty built upon damaged pelvic supports won't work. Therefore you need a surgeon who is skilled at repairing damaged vaginal supports at the time of the vaginoplasty. The experts in pelvic reconstruction are gynecologists, urogynecologists and a few urologists.

Surgeon Specialty of Choice

Thank you for a great question and one that many women have.  The short answer is to seek out either a Urogynecologist with a cosmetic practice or a gynecologist with a cosmetic practice - not a generalist Ob-Gyn (with no formal cosmetic training), not a general plastic surgeon (with no formal gyn surgical training), and not a generic "cosmetic surgeon" who also lacks this specialized training.The longer answer:  Most states will allow a doctor to practice medicine however he or she sees fit to do it.  Therefore, you will see Family Practice doctors, ER doctors, even Anesthesiologists and Radiologists calling themselves "cosmetic surgeons" and performing procedures in their offices, such as liposuction and others.  This is a misnomer.  Only a surgeon can call him or herself a "cosmetic surgeon."  Surgical specialists such as gynecologists, ENT, ophthalmologists, general surgeons, etc. can take additional training in Cosmetic Surgery and even become board certified by the American Board of Cosmetic Surgery (ABCS) by demonstrating education and training through a written and oral board examination.  Board certified Plastic Surgeons also must demonstrate competency through their board.  For any cosmetic surgical procedure, I would not recommend any surgeon who #1 is not actually a surgeon and #2 has not demonstrated competency and training through one of those two boards.  That's the first benchmark for you.  Secondly, since you are talking about a specific body part that many plastic and cosmetic surgeons do not routinely perform surgery on, you need to look hard to find one that has that experience.  Most likely, this will be a surgeon who has done an Ob-Gyn residency and then done additional training in cosmetic surgery and may or not be a fellowship trained Urogynecologist.  But any surgeon who is board certified by either of the two boards I mentioned above and also has the specific experience of performing many surgeries on the female genitalia would be acceptable in my book.  I hope that helped and good luck with everything.

THE best specialist for a Vaginoplasty is...

Hello Korenashel,Thanks for your important question which should help many women who also find themselves confused. The best specialist for a vaginoplasty and all the other vaginal rejuvenation procedures available to women are reconstructive and cosmetic vaginal surgeons who have primarily focused their practice and careers on these procedures. Urogynecologists are subspecialists who have had 2-4 years of additional training, beyond their ob/gyn or urology residencies, in pelvic floor reconstruction. These subspecialists have then had additional training in cosmetic procedures of the vulva/vagina/body to address the functional and cosmetic concerns that women have. The reason this is so critically important is that most women with complaints of vaginal looseness have had vaginal deliveries and have vaginal prolapse which NEEDS to be addressed at the time of a vaginoplasty. The BEST surgeon to do this is the urogynecologist who can then address both the looseness and prolapse as well as other cosmetic concerns in one surgery.The least qualified is the plastic surgeon who has zero formal training in vaginal reconstruction.  The next least qualified is the general ob/gyn or urologist who only completed their residency and did not do a fellowship in Female Pelvic Medicine and Reconstructive Vaginal Surgery. They typically do not have the volume and experience in addressing complex pelvic floor issues that coincide with a woman's complaint of vaginal looseness.  In my practice I perform over 300 surgeries a year addressing a multitude of complaints related to vaginal function and appearance. It is this volume of work that has led to the fine tuning of procedures and excellent anatomical results and patient satisfaction. This is likely the most important decision of your life so why would you settle for someone who doesn't have the training, experience, expertise and proven results? This is the reason why so many women travel from all over the US for their procedures.    See link below for additional information on finding the best surgeon for you.  Best of luck,

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 23 reviews

Which Doctor to use.

I am biased of course but I would recommend a cosmetic gynecologist for a vaginal tightening procedure.  We have been trained and are very comfortable with this area of the body.Also, there may be components of prolapse that need to be addressed which in my opinion a cosmetic gynecologist or uro gynecologist are best suited to diagnose and repair.Hope that helps.  In the long run, find someone you feel comfortable with and has lots of experience in doing vaginal reconstructive surgery.

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.