Q: Is it safe to weight-lifting seven months after vaginal reconstruction for laxity? A: No, it is not a good idea, and I’m surprised to hear from your surgeon quote: “… didn’t seem overly concerned about it.” Dr. Mark Pelosi III answered your question quote “It’s a good idea to refrain from lifting anything over 30 pounds in the first 8 weeks after vaginoplasty to minimize stress on the muscles that have just been repaired.” Also, he posted a marketing video, which had nothing to do with your question, but a vaginal tightening surgical technique. Dr. Camille Cash also posted her marketing video unrelated to your questions. Furthermore, Dr. Cash suggested you ask your surgeon about it. In your question, you presented that quote, “ My doc didn’t seem overly concerned about it.” I assumed that it was the reason that you wrote to the RealSelf. I will answer your questions openly and honestly since I am participating in the RealSelf program not for the marketing of my practice but to help women. In general, your question is about the scar strength and its relation to the postoperative time in which it is safe to reactivate your weightlifting. Differences in scar formation include age, location, direction, local tissue condition, surgical technique, incision-edge eversion, stretched-out or site-specific defects, and general health. Additionally, a surgeon’s knowledge of the stages of scar formation and tissue self-regeneration is imperative to answer your questions correctly. There are well-known stages of scar formation a) Inflammatory stage that lasts from 0 to 4 days, proliferative phase from 4 to 21 days, remodeling is from 21 to 12 months. Therefore, it is apparent that you should not re-initiate your weightlift at your current postoperative time. It is essential to distinguish between the vaginal reconstruction of site-specific defects of the vaginal wall and vaginal tightening. Site-specific vaginal wall defects reconstruction is a surgical operation requiring intimate knowledge of the vaginal walls’ gross, topographic, functional, and surgical anatomy and adjacent vital structures that fuse with the vaginal wall (the urinary bladder, urethra, and rectum, and the pubovaginalis muscles). Additionally, the lateral vaginal supportive structures are different, and there is no vital structure connecting to it. Although it is not your question, the videos published here obligated me to share well-documented medical data. Vaginal tightening, as presented by Dr. Marko Pelosi III’s video here, is not a procedure that should be offered in any case due to potentially severe complications that include but are not limited to urinary or fecal incontinence. Also, in this video, Dr. Pelosi III made many conflicting surgical anatomy statements about the vaginal anatomical structures and confused them with the vaginal wall neighboring anatomical structures. Four walls create a vaginal canal in the like garden hose, a) the anterior vaginal wall fuses with the urinary bladder and urethra; b) the posterior vaginal wall that fuses with the anterior rectal wall; c) 2-lateral walls, which are directly fuses with the pubovaginalis muscle. It is well-established that the muscular vaginal layer (circular and longitudinal muscle) is a smooth type of muscle and can only be repaired by addressing the site-specific defects and pelvic floor muscles support the vagina, but they are not vaginal musculatures. The vaginal wall consists of mucosal, muscular, and adventitia layers. In conclusion, I will strongly suggest to seek an opinion from a doctor (not from your original surgeon) who will be able to rule-in or to rule-out a vaginal additional vaginal site-specific defect(s) and make a decision with you whether or not to repair them since weightlifting increases the intraabdominal pressure that can worsen your vaginal sit-specific defects. With regards,Prof. Dr. Adam Ostrzenski, USA