Labia majora do not connect at bottom of vagina and minimal perineal body. Does perineaplasty connect labia majora again ?

had 4th degree :(

Doctor Answers 6

Perineoplasty is all about reconnecting the labia majora and reconstructing the perineal body

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A well executed perineoplasty restores the muscles that have detached from the center of the perineal body. This includes the muscles of the labia majora (the bulbocavernosus muscles), and the transverse perineal muscles. When these are repaired the labia are reconnected and the perineal body is made longer, thicker and tighter.

Why do I look this way after fourth degree?

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A fourth degree laceration during childbirth is when the tears are so bad that the vagina and the rectum are one big hole together.   Surgical repair of this injury in the delivery room is not always done well.  The goal in the delivery room is to restore anatomy as best as possible and to stop bleeding and to make sure a woman does not defecate into her vagina.  But six months later women can be upset about how they look and how much their sexual relationships are affected.  Reconstruction of the vagina often needs to be done as your baby gets older.  This would include repairing prolapse, reconstructing the vaginal canal and the opening.  Your appearance and functionality will improve greatly.  Good luck!

Fourth degree perineal laceration

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Fourth degree perineal laceration is considered one of the most complex ones following a vaginal delivery; therefore it requires a thorough repair of all affected layers. An adequate repair after a prolonged/complicated vaginal delivery is frequently not performed for a variety of reasons. Two of the most critical muscles are usually lacerated ( bulbocavernosus and superficial transverse perineal ), which if not approximated right may result in a weak and narrow perineal body ( the area between the entrance to the vagina and the anus) and separated labia minora and/or majora. Based on your description, perineoplasty seems to be the most reasonable approach since if performed right, could and should restore the perineal body and bring both labia to their pre-vaginal delivery position, ultimately restoring the desired appearance. Hope, it helps and you will find the right solution/experienced surgeon.

Best of luck to you and your baby.

Yvonne Wolny, MD

Can perineoplasty bring together the bases of labia majora & minora

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Yes it can, if done right. You'll need to send pics for more info, or go to an experienced genital plastic/cosmetic surgeon for a personal consultation. Please look at my pics of perineoplasty & vaginoplasty on RealSelf to see what I'm talking about...


Michael P Goodman, MD

Davis, CA, USA

Changes to perineum after 4th degree tear

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Hello Courtney,

Congratulations on your baby, but sorry to hear about your difficult obstetrical delivery. The perineum and labia majora are different structures, but do connect and meet. Now, following your 4th degree you are noticing a narrow/small perineal body which may likely be associated with a rectocele and complex symptoms including poor flatal/stool control, heaviness, pressure, difficulties with bowel movements and vaginal looseness.

You should consult with a reconstructive and cosmetic vaginal surgeon, preferably a urogynecologist with experience in vaginal rejuvenation, if you are considering a repair. See link below for more information on vaginal surgery and advice on finding the best surgeon for you.

Best of luck,

Oscar A. Aguirre, MD
Aguirre Specialty Care - Pelvic Surgery & Intimate Aesthetics®

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 38 reviews

Labia Majora and Perineum

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Dear Courtney:

In theory a perineoplasty if done correctly should allow for the bulbocavernosus muscles to connect to the transverse perineal muscles.  The transverse perineal muscles  ( think about the term - transverse means horizontal, perineal - means the area between the anus and vaginal opening ) were cut or were torn during the epsitiotomy.  These muscles may have been put back together during your surgery and they may have not held.  It doesn't matter what the reason is at this point more importantly you recognize there is a problem

The problem with most surgeons is they do not even look for the muscles at the time of surgery to restore the perineum.  It has been my experience watching dozens of ob/gyns, midwives do not actually put the transverse perineal muscles back together. It has also been my experience the surgeons just suture  the perineal tissue and skin together to do the perineoplasty and neglect the muscles.  Please choose a surgeon who understands reconstruction - and not just consider this a plastic surgical procedure. You need surgeon who understands the potential complications associated with this type of surgery in terms of  anatomical, physiologic and sexual function.  I would not be surprised if you didn't suffer with fecal urgency, fecal incontinence, and gas leakage.  You also might have less friction with intercourse at this time.  Please choose a surgeon who understands the function as well as the anatomical structures. Choose a surgeon with experience, expertise, a great reputation and one who gets results. Please see the step by step surgery and the muscles of which I am referring to in the link below

John R Miklos MD

Atlanta ~ Beverly Hills ~ Dubai

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.