Does a patient need rejuvenation or reconstruction? The only way you will know is to be assessed by a surgeon who is well versed in both reconstruction and vaginal rejuvenation. Rejuvenation is utilized when a patient is worried about a cosmetic/or function type problem ( i.e. sex is not tight enough) and reconstruction is utilized when a patient knows she has prolapse as there is a bulge or pressure and she wants to get rid of the symptoms. This is restoration of the anatomy without worrying about vaginal tightening.
What is vaginal rejuvenation? Vaginal rejuvenation really means the internal tightening of the vagina and tightening of the vaginal opening usually to enhance friction for intercourse. In experienced hands this surgery is approximately 85-90% successful as defined by the patient ( i.e. she is satisfied with the enhancement of friction during the act of intercourse 12 months after surgery). There are only 4 papers written on this topic and my partner, Dr Moore and I are co-authors of two of these papers. This surgery is usually accomplished by performing posterior vaginal wall surgery ( known as a posterior repair and coupling this with a levator muscle plication) + a vaginal opening repair known as a perineoplasty. This requires experience, expertise, and good knowledge of the pelvic floor. Patients who have had spinal trauma i.e. lower back injury, chronic straining due to "constipation' and or lifting heavy things, multiple childbirths may need more than just tightening procedure they actually need vaginal reconstruction.
What is vaginal reconstruction? Vaginal reconstruction is what most urogynecologist have been trained to do...to reconstruct the vagina to give the support back and this does NOT focus on tightening the vagina. Reconstruction is for the restoration of the anatomy and also to fix things like urine and fecal leakage or retention. The urogyencologist has extensive training and is the most experienced of all surgeons in operating on the relaxed vagina. The second most experienced surgeon for vaginal reconstruction would be the gynecologist. The urogyn is trained by first spending 4 years in a residency in obstetrics and gynecologic surgery and instead of going out to practice they then tspend 3 more years of subspecialty training in vaginal reconstruction or the rebuilding of the vagina (when it falls down aka vaginal prolapse - see the next few paragraph for an explanation). Vaginal Prolapse is the general term for a woman who has one or many areas each area of the vagina or uterus which has fallen.
Each area has its own descriptive name" Uterine prolapse - the uterus is falling down into the hollow of the vagina and towards the opening of the vagina in severe conditions the uterus can actually fall out of the vaginal opening and it hangs between a womans legs. Cystocele - the deeper portion of the ceiling of the vagina gives way and the bladder which is being supported fall downward into the hollow of the vaginal canal. Often these patients will suffer from frequency and urgency of urination as well as vagina pressure. If the condition is very severe the patient will have difficulty emptying her bladder. Urethrocele - the ceiling of the vagina near the opening of the vagina gives way and the urethra sags. Often these patients will suffer from cough urine leakage ( aka stress urinary incontinence) Rectocele - the floor of the vagina gives way and the rectum pushes upward into the vaginal canal producing a bulge pushing towards or out of the the opening of the vagina. Often patients will complain of difficulty emptying their rectum of stool and then this becomes a catch 22 situation where the harder you strain to get your stool to evacuate the worse the rectocele can get and the larger the rectocele gets the more difficult it is to evacuate. Urethrocele means there is a lack of support of the urethra and often (but not always) these patients will leak with coughing and sneezing. Urogynecologist have been trained to treat the anatomy of the vagina to support each of these structure as well as consider the function of urination and defecation as they perform surgery. However most urogynecologist have not been trained in the concept of cosmetic vaginal surgery or vaginal rejuvenation .
You certainly would benefit from a thorough evaluation by a urogynecologist or a pelvic floor surgeon/gynecologist. But you would probably want to choose someone who is also trained or has expertise in vaginal rejuvenation. Remember Vaginal rejuvenation means to tighten the vagina so its enhances intercourse for the woman. So I caution you to choose a surgeon wisely............choose a surgeon who can accomplish both of your needs: 1) restoring friction during intercourse and 2) decreasing the pressure inside of the vagina ( which maybe best accomplished by restoring the supportive anatomy of the vagina and NOT JUST TIGHTENING the vaginal opening. Choose a surgeon who is specialized in urogynecology or vaginal floor reconstruction and cosmetic vaginal surgery. Please see both sections of my website to get a full understanding and the different between cosmetic vaginal surgery and vaginal reconstruction. Remember your choice of surgeon should be based upon: experience, expertise, reputation and results and do not solely focus on location, convenience and cost.
John R Miklos MD
Urogynecologist & Cosmetic Vaginal Surgeon
Atlanta ~ Beverly Hills ~ Dubai