Will vaginoplasty address urine and rectal prolaspe?

I am 52, and have 3 grown children. I had an Hysterectomy 3 years ago and has been diagnosed with rectal prolaspe. My pelvic floor muscle is also damanged, and well as slight urine problem when I cough and jump. Will a Vaginoplasty address all those issues? How much would that cost? will it be local or general anesthesia? I am trying to avoid doing several surgeries. I like to do an all inclusive surgery. I am in Northern California, and can travel within California.

Doctor Answers 4

Rectocele and stress incontinence can be addressed at time of vaginoplasty

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Rectocele and rectal prolapse although sound similar are often used incorrectly by doctors. This is an important distinction because they mean different problems and are managed very differently. A rectocele where the rectum bulges into the vagina is the most common scenario. Think of a wall that separates the rectum from the vagina that has weakened and stretched following childbirth. When you bear down or do something strenuous that pressure pushes the rectum forward causing a bulge that protrudes through the vagina. Over time this bulge increases in size and may take may years before you become aware of it. If this is what you are experiencing then yes this can be addressed at the same time as your vaginoplasty. The stress urinary incontinence that you describe can also be addressed at the time of surgery however it is a separate procedure called a midurethral sling and does not add much time to the surgery. Your doctor should to clarify the type and severity of your incontinence prior to agreeing to do a sling procedure. Although the vaginoplasty is not covered by insurance, your incontinence procedure would be covered.

Rectal prolapse or rectocele?

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Rectal prolapse is not the same as rectocele. The first is a prolapse of the entire rectum through the anus. The second is a bulge of the rectal wall into the vaginal canal with nothing happening at the anus. Rectal prolapse is treated with rectal resection and/or fixation - it's major surgery done through the abdomen or through laparoscopy. It has nothing to do with vaginoplasty. You would want to have this done first. Vaginoplasty simply tightens the vaginal canal. It is not designed or intended to improve urinary leakage.

Candidates for Vaginoplasty. Cost of Vaginoplasty

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Hello Friend from Folsom,

While I would need to examine you in person to assess your individual anatomy and give you viable options for your individual situation, I will answer you basically below...

I'm not sure exactly what you mean by "rectal prolapse.'  If you mean that the rectal mucosa is prolapsed through the rectal opening, the repair is a  procedure separate from pelvic floor reconstruction, and one that is performed by a colorectal surgeon. But, if you mean that there is a large "bulge" produced by the rectum pushing or "herniating" through the floor of the vagina with a "pushing our" vagianl opening bulge, this is a situation that may be repaired along with a pelvic floor support operation ("posterior repair/posterior colporrhaphy") which may be performed by a Gynecologist or Urogynecologist.  Unfortunately, however, the huge majority of Gyn's and Urogyn's are not trained in the propritarily-named operation, "Vaginoplasty," which alludes to the overall tightening of the vaginal barrel for the express purpose of enhancing sexual function and orgasm, or in the skill of aesthetically reconstructing the vaginal opening.  For that, you would need to see a "Cosmetic Gynecologist" who also has reconstructive skills, or talk your network Urogynecologist into being mindful of your sexual and aesthetic desires...

As relates to your incontinence, again, this would need individual evaluation.  While a "sling" procedure is "standard-of-care" for moderate to significant incontinence, you very well may be well-treated by a pixillated fractional CO2 Laser treatment to the upper vagina or an "anterior colporrhaphy," both of which would also tighten the far upper vagina. So far as the surgical venue, in my hands I perform virtually all my vaginal tightening operations (perineoplasty; posterior colporrhaphy; vaginoplasty) in my office surgical suite under local anesthesia which  feel is safer, less expensive, and better performed in the patient can "show" her surgeon her vaginal muscle bundles during surgery by being awake enough to contract her muscles... Post-op physical therapy of the pelvic floor, which should be incorporated int any good vaginal rejuvenation program will lead to greater longevity of your repair. 

Very best,

Michael P Goodman MD

Vaginoplasty for rectal prolapse and urine incontinence

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Although "vaginoplasty" itself does not address these issues, repair of bladder and rectal prolapse can be, and most frequently are, addressed at the same time. The good news for the patient is that everything is taken care of during the same operation and the recovery time is relatively no different. Please read on for more Vaginoplasty details: 

Your story and concerns are in good company with almost ever other patient that undergoes vaginal rejuvenation and turns out to be an enormous (sexual) self-confidence booster thereafter.
Vaginal Rejuvenation (a.k.a. vaginoplasty) is performed to reconstruct (more or less tighten) the vaginal vault most commonly following natural vaginal birth. Again, like most other surgery, the experience of and “attention to detail” (a.k.a. compulsiveness) by the surgeon is the most important element to achieving a good result. Although there is some merit to Kegal exercises, many patients with laxity after natural vaginal birth fail to obtain sufficient tightening. For these patients, vaginoplasty, tightening of the vaginal vault muscles from the introits (opening) up to the cervix is typically the best solution. The procedure is commonly done on an outpatient basis in about an hour under either deep intravenous sedation or general anesthesia. Recovery is gradual but probably the worst for the first 4-5 days until swelling starts to reside then patients feel better each day thereafter. Sexual activity is usually refrained for about 6 weeks. In a study I was involved in back in 2009, 87% of vaginoplasty patients were satisfied with their results and had an improved sexual experience post-operatively. Typical (all inclusive) fee at my office/surgery center is $8500. Glad to help.

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.