A&P repair & vaginal tightening; Won't doing one without the other increase the chance of failure?

My PC muscle is fine but vagina is very loose. The mesh surgery I had in 2001 did not address this problem. I'm told I need an A & P repair, which is covered by insurance, but that tightening the vagina is cosmetic. Won't doing one without the other increase the chance of failure? What to do? Thanks.

Doctor Answers 2

Loose vagina. A-P repair. Vaginal tightening.

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An "A-P Repair" performed by a Urogynecologist or a Gyn with at least 10 years experience will help considerably, but not totally, especially if a major portion of your problem is with vaginal laxity. It would be a shame if your surgeon was not on your wave length regarding your desire for good tightening.

What to do?

Best to see a gyn who is also savvy and trained in vaginal tightening-- it is well worth the modest additional work for him/her to pay attention to the outer 1/3 to 1/2 of your vagina and specifically remove scar tissue, specifically approximate the "levator muscles," BUILD UP THE PERIEAL BODY AND DO A 3-4 LAYER CLOSURE as well as a cosmetic plastic repair of the opening.

Specifically request these things from your surgeon. If he/she balks, find another surgeon.  I have operated on several wonen who had had a previous A-P repair, only to discover that the surgeon paid no attention to tightening and re-approximating the muscles, or to an aesthetically pleasing closure.  Do your homework-- shop around for a surgeon who will attempt to follow your surgical requests.

Also-- part of the work is yours; make sure your surgeon directs you to a good program of pelvic floor physical therapy after you are healed.   A repair of this sort is greatly enhanced and longer lasting if you strengthen your vaginal floor musculature!

Check below for more info (specifically # 7; see also "vaginoplasty" and "perineoplasty" sectiions under the "Vaginal Cosmetic Surgery" drop-down), and- Best Wishes!

Michael P Goodman MD

Vaginoplasty Muscle Tightening with A&P Repair

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An A&P repair will restore the support and suspension of the pelvic floor. This will stabilize any looseness of the bladder (cystocele) and of the posterior vaginal wall (rectocele). Muscle tightening is not a component of this procedure and will not improve the result. However a small amount of vaginal skin is removed from the center of the posterior vaginal wall with this procedure and this will create a slight vaginal tightening as a natural consequence, but it will not be of the same degree normally done for cosmetic reasons. Conversely, if a patient with pelvic floor damage such as cystocele or rectocele undergoes a vaginal tightening without addressing the damaged supports, the risk of failure of the vaginal tightening procedure will be increased.

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.