Sowing together muscles - vaginoplasty. Any suggestions?

Ive heard that they sow the muscels together only in the posterier wall during vaginoplasty. What if the muscels are divided mostly in the front? And how do you know where the damage is? During my childs birth I remember pressure and pain primerely in the anterior wall.

Doctor Answers 4

Any suggestions on how to know how much damage I have from childbirth?

Dear Annabelle111,

Thank you for writing in with your excellent questions.  Childbirth can affect bladder, bowel and sexual function, and can damage the front, back and/or sides of the vaginal canal and vaginal opening.  The damage is identified by your symptoms and by a physical exam.  Leakage of urine with coughing, sneezing, bending, jumping and lifting (or other increased abdominal pressure) is related to the stretch of the front vaginal wall support of the bladder neck.  Problems related to bowel function like constipation and hemorrhoids, or having to assist in moving one's bowels by applying pressure either inside the vagina or on the outside space between the vaginal opening and the rectum are due to the stretch on the back wall muscles and those at the vaginal opening.  Changes in sensation for one or both partners (reduced or none), air that moves in and out causing gas-like noises, and partner fall out during sex are due to damage at the vaginal opening.

An experienced ob/gyn, urogynecologist or pelvic reconstructive surgeon will be able to tell you after listening to your concerns and symptoms and performing a pelvic exam exactly what areas are damaged and what surgery or surgeries will help you. If you have mild damage and mild symptoms, you may be a candidate for the new non-surgical no downtime radiofrequency treatment called ThermiVa, which can be done in 25 minutes in the office and you can exercise and have sex the same day.  If the damage is moderate to severe, vaginal surgery is a better and longer lasting option for you to consider.

You can read more about vaginal rejuvenation surgeries at the link below.

I hope this information is helpful.


Troy Robbin Hailparn, MD, FACOG
Cosmetic Gynecology Center of San Antonio

San Antonio OB/GYN
5.0 out of 5 stars 33 reviews

Do I need from front fixed too when I have vaginoplasty?

Childbirth causes damage to the vaginal canal.  Most of laxity can be fixed by addressing the posterior wall of the vagina and the opening to the vagina.  But women commonly have damage to their anterior wall as well.  The damage here can result in pressure and leakage issues and urinary voiding issues. 

My recommendation is to seek evaluation from a specialist in Female Pelvic Medicine and Reconstructive surgery as this is the medical specialty that addresses pelvic organ prolapse.   A simple history and physical exam will answer your concerns.

Michael Litrel, MD, FPMRS, FACOG
Woodstock Urogynecologist
5.0 out of 5 stars 3 reviews


Dear Annabelle111;

The surgery which you receive is based upon the appropriate diagnosis made by an experienced surgeon.  Most plastic surgeons and cosmetic vaginal surgeons do not always address the whole vagina and sometimes they are correct that you do NOT need the whole vagina addressed or surgically corrected but other times a good examination with a comprehensive evaluation will give you the whole story of support.  

For most women they only need the posterior vaginal wall and the vaginal opening repaired and yes this is by pulling the muscles together to tighten the vagina i.e. vaginoplasty but in my practice I have women with the uterus falling to the opening of the vagina as well as the bladder.  If i don't correct all this vaginal prolapse i.e. falling the the patient will not get the best results.  So choose a surgeon wisely, choose a surgeon with experience, expertise and proven results.

If you think you have anterior vaignal wall proalspe i.e. bladder prolapse or uterine prolapse than get a surgeon who understands prolapse and most likely that will be a urogynecologist or a seasoned gynecologist and not a plastic surgeon.  Choose surgeon who has years of experience and get more than one opinion.

John R Miklos MD
Urogynecologist & Cosmetic Vaginal Surgeon
Atlanta ~ Beverly Hills ~ Dubai

John R. Miklos, MD, FPMRS, FACS
Atlanta Urogynecologist
5.0 out of 5 stars 19 reviews

A brief anatomy lesson...

The muscles that support the pelvis run from front to back. They are called the levator ani muscles. There is a gap between the muscles in the front where they split off to the left and to the right to attach to the left and right branches of the pubic bone. That's where your vaginal opening goes. You can't close the front or your vagina will be permanently sealed. See the video link and you'll understand:

Marco A. Pelosi III, MD
Jersey City OB/GYN
4.6 out of 5 stars 24 reviews

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.