Had a vaginoplasty 3 months ago. Still not very much friction felt during sex. Will this tighten up more as time goes on?

I had a vaginaplasty 3 months ago and it is better but still not very much friction felt during sex. Doing lots of Kegels. Will it get tighter as time goes on. Or will another surgery be necessary? I went to a plastic surgeon who does lots of this type of surgery. It feels tight at the opening but further up feels like it did before I had the surgery.

Doctor Answers 7

BEWARE! Plastic surgeons do great perineal work, but it takes a Cosmetic GYNECOLOGIST or Urogynecologist to do INNER work!

No, it will not tighten. While many Plastic Surgeons are trained to do external work (aka"perineoplasty"), they 98% of the time are not trained to work 3-4 inches deeply INSIDE the vagina, expose the pelvic floor muscles, decompress your rectocoele, bring the muscular support and "pillars" together, truly tighten the inner vagina and re-build the vaginal/pelvic floor. I may get flack for this, but you went to the wrong surgeon. For aesthetic work and tightening of the opening only, a Plastic Surgeon is fine, but if you wish a true VAGINAL TIGHTENING operation, see only a cosmetically-trained Gynecologist or Urogynecologist. 

If it is vaginal tightening you wish, not just aesthetic repair, you will need to have your work re-done. In my practice I have operated on several women who were initially operated on by a surgeon not trained to do the deep muscle-approximating/tightening necessary for true tightening; aesthetically fine, but no deep muscular foundation.

ALSO, do not let any doc tell you that they will use RF ("ThermiVa") or Laser ("FemiLift, etc) to "...tighten the inside." WON'T WORK! These modalities only tighten the vaginal skin a bit-- will loosen right away...

Best wishes,

Michael P Goodman, MD

Davis, CA, USA

No, not likely to tighten more on it's own!

Hello Biotgirl,

Why did you go to a plastic surgeon to have your vaginoplasty?! Seems like only the entrance to your vagina was tightened. I'm sure it looks better, but unfortunately the deeper, inside portion of your vagina wasn't operated on and thus isn't working as well as you'd like.

You need to see a reconstructive and cosmetic vaginal surgeon, preferably a Urogynecologist with experience in Vaginal Rejuvenation procedures, for a second opinion. While it is true, some women may not be as tight as they'd like following vaginoplasty, you owe it to yourself to see the specialist whose primary focus is vaginal health, reconstruction and rejuvenation to get you the best possible outcome. Some women have experienced so much trauma from vaginal deliveries that even a vaginoplasty by an expert may not get them exactly where they'd like to be. This has to do with many factors, including the quality of your tissues, muscles, nerves, your pelvic floor function, etc.; things that are out of your control. What women do have full control over though, is their decision on choosing the best possible surgeon for their rejuvenation. Do your research and choose wisely on who will perform your revision vaginoplasty.

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 34 reviews

Vaginoplasty 3 months ago - still not tight

Dear BTG:

I am sorry to hear of your experience and  I agree with both of the previous answers given.  I will tell you I have been performing  vaginal tightening procedures since 2000 and have performed 1000s too---- I am not a plastic surgeon as I am a reconstructive vaginal surgeon and spent 8 years after medical school training  in gynecologic, urogynecologic, cosmetic gynecologic and now neuropelvic surgery.  Most doctors  who train specifically in plastics have little if no training in reconstructive pelvic surgery.   Though one of the surgeons who answered previously to me stated the surgeon can tighten the pubococcygeal muscles and vaginal opening........this is only partially true. This is what most surgeons do, they only tighten the distal 1 or 2 inches of the vagina.  They should also tighten the levator ani muscles and not just the bottom 1-2 inches.  This the most common reason for failure when I investigate failures of other surgeons.  (** I then read Dr Pelosi's statement --- and you will see he and I agree on how the surgery is to be done).  We show and share a thorough understanding of the pelvic floor and its reconstruction.

If you are not tight 3 months after the vaginoplasty surgery it is my experience that NO PATIENT has ever gotten tighter by waiting longer.  Even in my hands my success rate is 90% the first year for successful vaginal rejuvenation i.e. tightening.  It is possible for the surgeon to tighten you appropriately during the surgery but during the healing period the patient just does not heal appropriately, the sutures pull out, she doesn't scar in well and the surgery  fails.  I give my patients a guarantee that basically states:  "if you are not tight enough in the first 24 months you can return to me and I will not charge you a "surgeons fee"  for your second surgical rejuvenation procedure. 

Best of luck in your care.

john R Miklos MD

Atlanta ~ Beverly Hills ~Dubai

John R. Miklos, MD, FPMRS, FACS
Atlanta Urogynecologist
5.0 out of 5 stars 20 reviews

A real vaginoplasty shouldn't feel loose 3 months after surgery

There is quantity and there is quality. McDonald's sells more food than the finest restaurant in Manhattan, but it doesn't taste so good...You will need a revision when you are completely healed. Six months would be sufficient. I get the impression that your "vaginoplasty" was a perineoplasty and didn't addess the levator ani muscles (the kegel muscles) deep within the vaginal canal. I fix these McDonald's "vaginoplasties" on a regular basis.

Marco A. Pelosi III, MD
Jersey City OB/GYN
4.7 out of 5 stars 26 reviews

3 Months Post-Op, Less Friction

Candidates of Vaginal Rejuvenation or Vaginoplasty surgery are women who desire a more youthful appearance and function of the vulva and vaginal area.  For some women, the effects of childbirth, aging, trauma, and/or genetics, causes their vaginal tissue and muscles to become stretched, which results in loss of strength and tone in the vaginal area. This may result in decreased intimacy and sexual satisfaction. In some cases, the laxity of tissues can be visible. 

The lining of the vagina can be reduced, removing excess and redundant mucosa decreasing the diameter of the canal. The muscle ring, pubococcygeus, at the entrance or introitus can be tightened.  These procedures along with exercises such as Kegles can help keep the muscle tone in this area. Aesthetic Vaginoplasty, in many cases, can increase friction during intercourse, giving women more control of vaginal muscles, increasing sexual satisfaction, while also creating a more attractive and appealing appearance to the vaginal area.

The best thing to do is to take your questions or concerns to your surgeon for a follow-up appointment and have the area checked in order to make sure that healing is progressing well.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Will I tighten up more as time goes on?

The simple answer is that you will not.  An ideal vaginoplasty will be a bit on the tight side at first and then loosen up to the right amount so that sex is enjoyable for both partners.  A painless procedure called a thermiva may be enough.  But you should be evaluated for pelvic organ prolapse by a FPMRS/Urogynecologist or GYN that specializes in this.  

Michael Litrel, MD, FPMRS, FACOG
Woodstock Urogynecologist
5.0 out of 5 stars 4 reviews

Vaginal tightening

I you still are having sensation problems you should consider potential hormonal therapy and non-invasive vaginal tightening procedures, such as the CO2 laser (V-Lase). You still have options so she a knowledgeable physician who deals with all these options and find out what is best for you.

Robert L. True, MD
Grapevine OB/GYN
4.9 out of 5 stars 9 reviews

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.