My surgeons don't agree on a rectocele repair. My OB/Gyn said I'm a level 3 and need one. The Urogynecologist said I'm normal

I don't feel like I'm tight after 2 vag deliveries. I can't feel sex, my rectocele effects BM's, I have to "splint". when I wipe I feel like I could fit my whole hand in my birth canal. Nothing is hanging out I can hold a tampon in. I just can't get any traction on my clitoris when my partner is inside bc there is no muscle tone posterior. Why won't the Urogyn fix it? Should I just let my OB/GYN fix it? What procedure do I need? The uro took measurements and said all was fine. I dont feel fine.

Doctor Answers 9

My surgeons don't agree on a rectocele repair. My OB/Gyn said I'm a level 3 and need one. The Urogynecologist said I'm normal

it seems there is discrepancy on your examination, but meanwhile you are not feeling the same.

My suggestion to you is to find out who in your area is using femiscan machine ( it is a personal supervised kegal exam machine ) which will tighten your pelvic muscles.
After 3 months of doing that then find a gynecologist who is familiar with FemiLift laser vaginal rejuvenation and get 3 cycle of treatment with the doctor ( of course he need to exam you and make sure you are candidate for it ).
to increase sensitivity of your clitoris there is Oshot available, and there are certified doctors who are able to do it.
You are lucky if you can locate one gynecologist who dose offer all 3 of them together than you are in best hand.
Good luck and best of health

Rectoceles not always properly identified

Dear Casey13,

The fact that you have so many symptoms of a relaxed back vaginal wall tells me you do have a rectocele of some degree.  When the muscles get separated at the back vaginal wall it affects both bowel and sexual function which is what you describe.

I have had patients come to me whose doctors have told them they were fine and they did have various degrees of rectocele and pelvic relaxation, so there are doctors out there that do not recognize what they see or are not listening to their patients complaints of symptoms.  This may be partly due to the insurance-driven practices that don't allow for much time to talk and evaluate properly, and partly due to a lack of education or experience.

On physical exam there are 4 degrees of prolapse which describe the amount of stretched back vaginal wall  that is visible.  There is a big difference between not having prolapse and a stage 3, which is significant and would require surgical repair.  It sounds like your ob/gyn has recognized your problem and should be able to fix it and help with both the bowel and sexual function problems.  The traditional Posterior Repair (also called a colporrhaphy) is done with re-support of the perineal muscles in these circumstances or some other vaginal rejuvenation procedure if there is other damage/symptoms as well.

There are 7 vaginal rejuvenation surgeries described in the literature that address the acquired sensations of wide (too loose) and smooth vagina.  Smooth vagina is due to too much lubrication  or due to the loss of vaginal ridges called rugae and can reduce sensation for one or both partners.  These are treated differently than the feeling of being too loose.  There are 5 vaginal rejuvenation procedures that address the different areas of vaginal damage (the canal which has 4 walls and a central compartment where the cervix is), the opening including the hymeneal tissues, and the perineum.  These surgeries are a bit more extensive than the traditional procedures and are not usually covered by insurance.

I hope this information is helpful to you. 


Dr. Troy Hailparn

Troy Hailparn, MD
San Antonio OB/GYN
5.0 out of 5 stars 22 reviews

Opinions regarding rectocoele.

From your description - I think you would have a 'stage 2' rectocoele. All this means is that the bulge does not protrude beyond 1cm of  the hymenal ring -ie only at the vaginal entrance- 50% of women have no symptoms with stage 2 prolapse  - thus 50% of women correspondingly would.

If there is a lack of 'grip' it could also be that the 'perineal body' is somewhat weakened. These are the muscles that meet in the area between the anus and the back of the vaginal opening. Sometimes - they get separated at time of vaginal delivery - and don't always come together.

It is likely that you have a deficient rectovaginal septum - this is a thickening of connective tissue - that lies between the rectum/anus and vaginal wall - its role is to provide a platform that would normal stop the 'poo' bulging into the vagina - but rather travel in its normal direction through the back passage and out through the anus (sorry to be graphic).

I think any ob/gyn should be able to refashion the rectovaginal septum, re oppose the perineal muscles and attach the refashioned septum to the perineal body. In Australia - it would be unusual to need to augment these repairs with mesh as generally - they are effective repairs using just the bodies tissues.

Although I have a laser - I do wonder about the effectiveness of treating patients that have 'defecating' symptoms. If any femlift /monalisa touch surgeons have experience - I would be interested to hear about their experience.

Jonathan Kew, MD
Sydney OB/GYN

Get it done

If you are splinting to defecate, there is clearly a defect in at least the distal (end part) of the posterior vagina.  Its hard to believe there is no rectocele, but even if you can't see that you have a functional problem that should be fixed to improve your quality of life.  In cases like yours I typically would do a graft augmented posterior repair and a perineorrpahy.  In our practice we have basically 100% success rate in restoring defacatory function using this technique.

Symptomatic rectocele

You are pretty much answering your own question. You are symptomatic, that is all that there is to it.
If you have confidence in your GYN then let him or her do the surgery. You do not need any special aethestic procedure. Most board certified GYN's will be more than capable in correcting your condition and help you improve your quality of life. Good luck

Peter D. Weiss, MD
Beverly Hills OB/GYN

Rectocele Repair Tie Breaker

Splinting means you have to support the perineum and press inward against it in order to complete a bowel movement. If that's the situation, you're not normal and you will need a posterior repair of the lower vaginal wall and perineum at minimum. It doesn't really matter if there is a rectocele there or not. Sometimes the entire problem is caused by a defective perineum (a condition called perineocele). There are 3 levels of vaginal support. The deep vaginal supports are called level 1, the midvaginal supports are called level 2, and the vaginal opening supports are called level 3. If you want a tighter vagina, you'll get moderate improvement with a perineal repair, but for top-of-the-line vaginal tightening, you would require vaginoplasty at the same time.

Not tight with symptoms

Thank you for your question. I'm sorry you are having a hard time with your symptoms. Rest assured there are options though. Without examining you but, by reading your symptoms, it sounds like a rectocoele remain is appropriate and most GYN's are trained to perform them. You could see a second Urogynecology for their second opinion but they tend to focus more on urinary/blade symptoms. 
Alternatively you could under go vaginoplastu and perineoplasty to tighten the vaginal canal and help improve sensation with sex. I hope this is helpful and I wish you the best. 
~Dr. Poucher 

Rectocele Repair for improving vaginal muscle tone

Your description of splinting with bowel movement and loss of muscle tone indicate a injury to the pelvic floor musculature after childbirth.  A grade 3 rectocele means that the posterior vaginal tissue in prolapsing or bulging beyond the vaginal opening.  Since your urogynecolgist says your "measurements" are normal and you say nothing is "hanging out", I would be concerned that you have other issues that are not being addressed, such as nerve damage to the pelvic floor and rectal descent. Both of these problems would not be addressed with a rectocele repair.   I think you need to get a third opinion from a competent pelvic floor surgeon, as an improperly performed surgery may leave you with pain during sex from scar tissue and continued symptoms. 

Daniel Sternfeld, MD
Laguna Hills OB/GYN
5.0 out of 5 stars 1 review

Rectocele vs Laxity

I'm sorry to hear of your problem. This discrepancy is a common scenario. Prolapse can be identified in two ways. Most gynecologists use a very subjective method for identifying and grading prolapse. Sort of like eyeballing a patient to determine if they are having a heart attack.
Urogynecologist use a more objective method of staging prolapse based on very specific measurements. This is not taught very well if at all in most ob/gyn residencies in general. 
Based on your description of symptoms you are describing both vaginal laxity which is not a covered benefit as well a splinting which could be due to a rectocele or enterocele which is a covered benefit. Having a rectocele repair MAY improve your bowel problem of splinting but may not necessarily address vaginal laxity and may not have the same cosmetic result as a vaginoplasty. A Urogynecologist with special training in Aesthetic gynecology can correct any support defects as well as address your vaginal laxity.
I recommend seeking a second opinion by a Urogynecologist that also has special training in sexual function and Aesthetic gynecology.

Peter Castillo, MD, FACOG
Bay Area Urogynecologist
5.0 out of 5 stars 10 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.