Concerns about vaginal rejuvenation - would this be safe with existing issues?

Question

I have significant damage to my pelvic floor muscles due to operative birth 16 months ago (diagnosed with imaging). This includes perineal muscles and levator ani. At the minimum I would like to have a perineal reconstruction, but in getting help for my issues multiple physical therapists suggested I have some kind of hypermobility or connective tissue disorde. It sounds like this causes difficulty healing from surgery. my stitches came out from my perineal tear and had to heal as best they could on their own, so I’m scared That if I try to have a Perineoplasty or pelvic floor reconstruction the same thing will happen. The ultrasound also found that what the doctor who delivered my baby had sutured as a “barely second degree tear” (her words) was actually a 3a tear. So I have a lot going on and I just don’t know if any of these procedures could be helpful or even safe

Anna Chacon, MD, FAAD · Answer

First, I want to say that your concerns are very reasonable. What you’re describing is much more complex than a typical “vaginal rejuvenation” question. A documented 3A obstetric anal sphincter injury, levator ani injury, perineal muscle damage, and possible connective tissue or hypermobility disorder all deserve careful consideration before any additional pelvic surgery is planned.

The most important thing is that vaginal rejuvenation procedures are not the same as reconstructive pelvic floor surgery.

Cosmetic vaginal rejuvenation is usually aimed at tightening the vaginal canal, improving appearance, or addressing mild laxity.
Perineoplasty or pelvic floor reconstruction is intended to restore damaged anatomy, improve support, reduce symptoms, and potentially improve bowel, urinary, or sexual function.

Given your history, I would be much more focused on reconstruction and functional recovery than on rejuvenation.

The fact that your tear was initially described as a “barely second-degree tear” but later identified on imaging as a 3A tear is significant. A 3A tear involves the external anal sphincter, and inadequate recognition or repair can contribute to ongoing pelvic floor dysfunction, pain, weakness, or bowel symptoms. The levator ani injury also suggests that the pelvic floor muscles themselves have sustained meaningful trauma from the operative birth.

Your concern about poor healing and stitches coming apart is particularly important. In people with hypermobility spectrum disorders or connective tissue disorders such as Ehlers-Danlos syndrome, wound healing can indeed be more challenging. Tissue may be more fragile, sutures may not hold as well, scars can stretch, and recovery may take longer. That does not automatically mean surgery is unsafe or impossible, but it does mean that the surgeon should be aware of the possibility and plan accordingly.

A few reassuring points:

A previous wound breakdown does not guarantee that a future repair will fail.
Reconstructive surgeons can often use different suture techniques, layered closure methods, and postoperative restrictions that are more protective than those used immediately after childbirth.
Delayed reconstruction is sometimes technically easier and more successful than attempting to repair severely traumatized tissue immediately postpartum.

Before deciding on surgery, I would want several questions answered:

Are you having bowel control problems, urgency, or leakage?
Is the main issue pain, pressure, bulging, sexual dysfunction, or a feeling of looseness?
Have you been formally evaluated by a urogynecologist or colorectal surgeon who specializes in obstetric anal sphincter injuries?
Has anyone performed a connective tissue or hypermobility assessment (for example, a Beighton score or referral to genetics/rheumatology when appropriate)?

The combination of levator ani injury plus a possible connective tissue disorder makes it especially important to have a multidisciplinary evaluation rather than proceeding directly to a cosmetic or office-based tightening procedure.

In many cases, patients with injuries like yours benefit from:

Specialized pelvic floor physical therapy (which you’ve already started),
Endoanal ultrasound or pelvic MRI to define the anatomy,
Assessment of anal sphincter integrity,
And a discussion of whether a targeted perineal reconstruction could improve function and support.

One thing I would be cautious about is undergoing energy-based vaginal rejuvenation treatments (laser or radiofrequency) without a clear reconstructive plan. These treatments are not designed to repair a 3A tear or levator muscle injury, and there is limited evidence that they would address the structural problems you’re describing.

Based on what you’ve shared, I do think that a perineoplasty or pelvic floor reconstruction could potentially be helpful, but only after a thorough evaluation by a urogynecologist or pelvic reconstructive surgeon experienced in obstetric birth injuries. Your history of wound healing problems and possible connective tissue disorder means that the decision should be individualized very carefully, but it does not mean you are automatically a poor candidate for reconstruction.

You’ve been carrying a lot of uncertainty and fear after what sounds like a very difficult postpartum experience. The fact that your concerns are grounded in documented imaging findings and previous healing complications is important, and seeking a careful, specialized assessment is a thoughtful and appropriate next step rather than an overreaction.

Concerns about vaginal rejuvenation - would this be safe with existing issues?

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