Labia majora do not connect at bottom of vagina and minimal perineal body. Does perineaplasty connect labia majora again ?
Doctor Answers 4
Fourth degree perineal laceration
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
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
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®
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Labia Majora and Perineum
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.