Do I need vaginal reconstructive surgery or a urologist? I'm 34 and have had 4 vaginal deliveries. Cystocele present. (photos)

1. Can you "see" a cystocele? 2. Are the two balls on either side of my vaginal opening scar tissue and from what? What can I do about this? 3. Does the shape of my area look normal after 4 kids or do I need reconstructive surgery? My OBGYN says my cystocele isn't bad enough to do anything about but hasn't said anything about the appearance of my vagina.

Doctor Answers 8

Candidate for Vaginal Surgery

Women have a wide range of normal color, texture, size and asymmetries of their genitilia. This is true of the Vulva and all of its parts, the same as other parts of the body. Candidates for #labiaplasty and #vaginal surgery include women concerned about the appearance of their genitals, or those who experience discomfort, pain or difficulty with sexual relations.  Moisture can create problems such as yeast infections. More specific problems are noted below in each section. These problems may exist at birth or with growth and development. They can occur with childbirth or other trauma to the region. All of these issues can cause a woman great emotional distress that is often difficult to talk about with their partner, friends and even their doctor. So, the best way to make a final decision about continuing with vaginal rejuvenation would come in a consultation with a local board certified plastic surgeon. You would be able to take your questions and concerns directly to a professional and receive advice on the best procedure to help resolve your issue and bring your comfort in your vaginal region back to normal. 

Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Vaginal Rejuvenation/ Laser Vaginal Rejuvenation

It is best advised for you to have an actual examination, preferably with a thin speculum.

Most OBGYN practitioners will not perform this procedure if it is not medically necessary. The cystocele can be corrected through a mesh, sling or a burch procedure which is covered by insurance. These procedures only help alleviate the symptoms of stress urinary incontinence and nothing more.

If you are looking into having vaginal reconstruction to bring back the muscles and support tissues back, that procedure is considered cosmetic and is not covered through insurance, due to the fact that the doctor is not only using your own natural tissues to support the bladder but the doctor will also tighten the muscles back to how they were prior to having children. You will need to speak to a Cosmetic surgeon who specializes in Laser Vaginal Rejuveation. 

David Matlock, MD, MBA, FACOG
Los Angeles OB/GYN
4.9 out of 5 stars 10 reviews

Do I need cosmetic genital surgery?

Your photos look very good for a woman who has had four kids.  I don't see evidence of a herniation of your bladder or cystocele.  The skin tags you are referring to are just remnants of your hymenal ring.  They can easily be removed if they are bothering you by your gynecologist.  If you have issues with bladder leakage or vaginal laxity (looseness with sex) you can seek consultation from a Urogynecologisty/cosmetic gynecological surgeon.
Good Luck

Michael Litrel, MD, FPMRS, FACOG
Woodstock Urogynecologist
5.0 out of 5 stars 4 reviews

A primer on Cystocoeles- "should I have surgery?"

You look entirely normal! The "2 balls" you see are normal anatomy; they are linear "remnants" of your hymenal ring. There is no need to have vaginal reconstructive surgery unless you have FUNCTIONAL issues (incontinence, laxity, loss of sensation & tightness) or aesthetic issues (want to "elevate" the opening and make it look more "...pre-kids.") You cannot see a "minor" (first or second degree) cystocoele. You can see a "3rd degree" cystocoele as a large upper bulge through the vagina only with "push" or straining. In a  "4th degree" cystocoele the bladder is visible aty all times as a "sac-like" protrusion from the upper vagina.

"...If it ain't broke don't fix it." No need to have surgery just because you have a cystocoele, unless there are secual or urinary problems significant enough to cause a "...bother..."


Michael P Goodman, MD
Davis, CA, USA

Your vagina looks completely normal in the photo

I'm an expert in pelvic reconstructive surgery, but I can't see your cystocele in the photo. Your gynecologist's role is to screen you for disease and fix medical problems, not to delve into your perception of what your vagina looks like. That said, your vagina looks completely normal and every woman who has had children has slight loosening of the vaginal supports unless they delivered by cesareans.

Marco A. Pelosi III, MD
Jersey City OB/GYN
4.7 out of 5 stars 26 reviews

Cystocele repair

Thank you for your description and questions. First and foremost you need a proper evaluation for pelvic floor dysfunction by either a gynecologist who routinely performs these types of procedures or a urogynecologist.

Without a proper physical examination, it is very difficult to ascertain the degree of prolapse or pelvic floor dysfunction. The little "scar tissue"  area you are referring to is most likely just normal vaginal ruggae  that enlarged with childbirth.    These typically do not cause discomfort but can be removed for aesthetic purposes if the patient desire so.

you may be a very good candidate for a non-surgical vaginal tightening procedure  which would also address mild issues of urinary stress incontinence.

Best of luck

David Ghozland, MD
Santa Monica OB/GYN
5.0 out of 5 stars 27 reviews


Hi, the two bumps you are seeing are not a cysto ele, they are normal hymnal remnants that can sometimes become more prominent after childbirth. They can be reduced if they bother you. The shape of your vagina appears normal however if the apoearance bothers you or if you feel or see other bulges you should see a Board Certified Urogynecologist, otherwise known as a Female Pelvic Medicine and Recontructive Surgery specialist. This is a Board Certified subspecialty of Ob/Gyn and Urology and requires several more years of training vs a generalist in these fields. If your having symptoms of vaginal laxity or have cosmetic issues with the apoearance of your vagina , ensure that the Specialist also has extensive experience in Cosmetic Surgery and Vaginal Rejuvenation Surgery. 

Best of Luck, 

Dr Robert Moore, FACOG, FPMRS, FACS

Urogynecology/Cosmetic Vaginal Surgery 

Atlanta - Beverly Hilks- DUBAI 

Robert D. Moore, DO
Atlanta Urogynecologist
5.0 out of 5 stars 9 reviews


Dear Ashland;

Thanks you for sharing.   To answer your questions:

1) I can not see your cystocele.  2) The two balls of either side or remnants of your hymenal ring - this is normal, this is NOT scar, you don't need to do anything about it unless it bothers you --- then they can be resected to make it look smooth  3) The shape of your vagina looks normal  4) Your Ob/Gyn sounds very honest-- you never need to fix a cystocele unless it is giving you symptoms.

You are not experiencing any problems so don't fix the cystocele to do so would be unnecessary.   Your ob/gyn should NOT say anything about the appearance of the vagina if there is nothing wrong with it.  If you mean aesthetics of your vagina or vulva he still should not say anything because aesthetics is a personal decision only you can make.  Only you can say whether you don't  like the way it looks.  

No surgeon should tell a patient they need a nose job either......only the patient should make that decision and then the surgeon can make recommendations pro or con.

John R Miklos MD
Urogynecology & Cosmetic Vaginal Surgery
Atlanta ~ Beverly Hills ~ Dubai

John R. Miklos, MD, FPMRS, FACS
Atlanta Urogynecologist
5.0 out of 5 stars 20 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.