Vaginoplasty - how much pressure do you feel under local anesthesia?

A small handful of Cosmetic Gynecologists are trained and experienced in performing a surgical vaginal tightening operation ("Vaginoplasty + Perineoplasty") under safe, awake, local anesthesia, most trained by the 2 major acolytes of "local vaginoplasty," Drs. Red Alinsod and Michael Goodman. There are several important reasons why "local" is best for Vaginoplasty, and I'll discuss these after I answer your question. While I personally have performed 250 vaginoplasties, over 125 via "local" anesthesia, and have asked and discussed with my patients what they are experiencing, I personally (on myself) have never had this surgery performed, so my answer is from repeated observations only. There is virtually no pain from VR under "local," with these exceptions: 1. Very short-lasting "stinging" from injection of the anesthetic; 2. Transient "Pressure" (like a deep aching/pulling) upon tying the sutures used in rebuilding the vaginal floor; and 3. Occasional transient sharp pulling discomfort during suture placement if the suture "binds" one of the pelvic floor musculature nerves when the suture is tied. If this happens, the surgeon promptly backs out and replaces the suture to a safer place. Overall, the huge majority of my patients do extremely well under "Local," and are happy they chose this route.

So... why choose "Local?" 1. It is safer; 2. Recovery is easier, both immediately, and long-term; 3. (and most important...)- your surgeon can do a better job of tightening & rebuilding, as with you awake (s)he can have you contract your pelvic floor muscles for better identification of the muscle body, and better suture placement into and just beneath the fibrous muscular sheath when re-approximating/rebuilding the vaginal floor. The surgeon is not as timid as (s)he would be under a "General" anesthesia where the surgeon does not know if she/he is compromising a nerve. Under "Local," your surgeon can be more aggressive in your reconstruction, as if a nerve is being compromised, (s)he will immediately know, and quickly re-locate the suture with really only a momentary amount of discomfort.

Overall, in experienced hands, "local" works quite well, and the huge majority of my patients are happy they chose to have their surgery performed under a local anesthetic. RealSelf's web reference below provides additional information...

Very Best for a successful procedure and recovery. Michael P Goodman, MD, FACOG, IF, AAACS.
Sacramento, CA, USA

Best