Prolapse and vaginal rejuvenation
Vaginal rejuvenation surgery works to tighten the vagina on the posterior side of the vagina. This will not reduce or treat a cystocele. Often a rectocele is also present when there is vaginal looseness. If this is the case, a formal cystocele and rectocele repair with vaginal rejuvenation may be the ideal procedure for you. You can read more about the types of prolapse and associated symptoms at the link below. There are multiple approaches to these repairs. A consult with a urogynecologist who is board certified in Female Pelvic Medicine and Reconstructive Surgery is the best place to start to learn about treatment options.
Vaginal Rejuvenation vs. Pelvic Reconstruction
Surgical correction of anatomic vaginal defects, such as cystocele and others, falls under the broad category of "pelvic reconstructive surgery" and should be performed by a surgeon with experience in those procedures, such as a fellowship-trained Urogynecologist or general Gynecologist who devotes a significant portion of his or her professional education and experience to those procedures. Vaginal rejuvenation alone, will not address a cystocele. A mild cystocele without symptoms, such as incontinence, would not require mesh. The perineal repair can be incorporated into a vaginal rejuvenation, if the surgeon knows how to do it. I would not recommend laser treatment, such as Mona Lisa, because to my knowledge, there is no data or research studies to indicate that it could treat vaginal prolapse. On the other hand, ThermiVa, a non-surgical radio frequency (RF) energy device, has been shown in prospective studies to improve cases of prolapse by at least 1 degree on scale of 1-4, where 1 = mild prolapse and 4 = severe. From what you describe, you most likely have a "grade 1 or 2" cystocele. ThermiVa should help that and also help the overall health of that tissue, but would not likely address the perineal body. If you want to avoid surgery, then I would recommend giving ThermiVa a try. If you want to have all of your concerns addressed surgically, then I would recommend seeking a Gyn or UroGyn who also does cosmetic surgery and schedule a consultation.
Thank you for your question. The decision for surgery or not is a very personal one. There are several non surgical options. A cystocele is different from prolapse of the pelvic floor, but it does not hurt to do Kegel exercises. Just as one exercises other muscle to keep in shape and preserve tone. A second non surgical option could be ThermiVa. A radiofrequency treatment that can tighten the tissues and may help with mild prolapse. As long as the bladder has not descended too far down the vagina. Has a discussion about whether of not you are a candidate with a Board Certified Surgeon.
Cystocele and Vaginal Rejuvenation
Thank you for your question. With so much terminology and different types of repairs both invasive (surgical) and non-invasive confusion is quite common. Part of the reason is when we evaluate the vagina in its entirety there are many areas (compartments) that need consideration hence the multitude of anatomic names and procedures associated with them. Having said this vaginal rejuvenation is performed for tightening of the vaginal opening (introitus) and would indeed involve a "perineum repair" as you indicated. Repair of a cystocele would not be addressed with that procedure and likely have no real effect on your cystocele, positive or negative. Regarding repair of cystocele's, rectocele's, uterine prolapse, etc. the question is frequently asked as to whether they "need" to be repaired. The basic answer is if it is not causing you problems or affecting your quality of life then nothing "needs" to be done. If you are however experiencing negative effects to your quality of life then proceeding with repairs is wise. Regarding you concern over the use of a mesh implant this is not necessary for cystocele repairs and can be nicely accomplished with your own natural tissue. A open conversation with your surgeon, preferably an experienced gynecologist/urogynecologist with vaginal repairs will help you with these decisions. Wishing you well moving forward.
If you have no symptoms, avoid surgery even if suggested. MonaLisaTouch is not "surgery" and would be a cheaper therapy and non-invasive, but it is off-label so far for this (unsure % success.) If you are going to have anesthesia and surgery for vaginal opening, have a good GYN do it and address the cystocele.
You don't need mesh. An expertly conducted vaginoplasty with pelvic floor reconstruction will fix you.
Cystocele repair using your own tissues is an excellent choice for most women. Keep in mind that it will not tighten your vagina and is not considered vaginal rejuvenation. If you wish a tighter vagina, you will also need a vaginoplasty at the same time. I do this combo frequently and have patients fly in from out of town on a regular basis. Emails and phone calls start the process. A 2-day minimum stay in the NYC area is recommended.