How is a vaginoplasty performed and can it be performed without correcting a rectocele?

Question

Concerns after procedure. Is it normal to expect that the vagina would be tightened all the way to the cervix? I recently had a vaginoplasty and my husband and I are becoming increasingly unhappy with my results. I have tried to politely ask my surgeon for help, however, without physically checking me, his reply was,” have I done my kegals?” Should I consider a revision with another surgeon?

Burcak Tok, MD · Answer

When performing vaginal tightening, it is necessary to think individually, and if there is an enlargement in the entire vaginal canal, of course, it is necessary to narrow the entire canal. At the same time, if necessary, rectocele and cystocele repair should be added to the operation for a successful result.

Mark N. Scheinberg, MD · Answer

Thank you for your question The word vaginoplasty means plastic surgery of the vagina. It isn’t a specific procedure (except when referring to the creation of a new vagina ) so surgeons can be doing different procedures and calling them vaginoplasty but the quality of the effects can vary greatly. Most surgeons are doing an “anterior and posterior repair “ which is a standard gynecological procedure but isn’t optimally designed for patients who are looking to narrow the vaginal canal. The vagina is connected six ways( Orifice or opening, apex, anterior or bladder side, posterior or rectal side, and two lateral sides. The vaginas fascia which is its support structure can only stretch so much and develop multiple tears which allow bulging or prolapse of vaginal mucosa or skin. The anterior/posterior repair is a one size fits all procedure which doesn’t address the direction of the tears so the results have greater chance of failure. The “site specific defect repair “ procedures fix the tears where the tears are giving a more solid result. So, yes a rectocoele needs to be repaired if you want good results. You need to do your homework in choosing a surgeon if you want a revision Make sure they evaluate the six sides of the vagina and if possible understand and perform site specific defect repair

Marco A. Pelosi III, MD, FACOG, FACS · Answer

The typical vaginoplasty tightens the outer muscles of the perineum and the inner muscles (the kegel muscles) called the levator ani muscles. These muscles do not go "all the way to the cervix". The vaginal skin is also tightened, but less so because overtightened skin doesn't stretch comfortably during sex. If a rectocele is present, it MUST be fixed because an unrepaired rectocele would put direct pressure on the levator ani muscle repair and cause it to fail. If your muscles are in bad shape to begin with, the quality of the repair will not be as intense as if they were in better shape. Kegel exercises will always improve muscle tone and should be a regular part of your daily routine to maintain and improve results. They need to be done properly. If you are considering a revision, the first thing you would require is an exam to assess the status of your muscles and to check for a rectocele.

Michael Litrel, MD, FACOG, FPMRS · Answer

The Canal and opening should be done as high up as possible. This requires repairing the prolapse first and then reattaching all the muscles.  My ebook is free and explains all this in detail. Sorry you are having issues.

Alexander Hamers, MD · Answer

Dear Syh093,
first of all, after the primary healing fase of a vaginoplasty (mostly 6 weeks) yes you should and need to do some Kegel! Since the vaginal tightness depends on its muscles and these can only be tightened by training (Kegel) like any other muscle. 
A vaginoplasty can only treat the entrance and the outer 3 to 4 inches (10cm) and not up to the cervix, but this should make the important improvement to you and your intimate live with your partner. The dilated pelvic flor muscles mostly on the posterior wall are sutured and tightened. 
the question if a rectocele always needs to be treated in the same surgery depends on the severity and on the decision you took with your treating surgeon, either it is a plastic surgeon or a (cosmetic) gynecologist

Burcu K. Arslan, MD - Account Suspended · Answer

Hi , according to patient’s need sometimes we can combine device treatments like laser or radio frequency while we are doing vaginoplasty. By this way we can do thigtening whole vaginal canal. And then also if needed should tight up the muscles with surgical technique for satisfaction&hellip;

How is a vaginoplasty performed and can it be performed without correcting a rectocele?

Answers (6)

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