What kind of vaginal surgery do I need?? (photos)

What kind of vaginal surgery will I need? I have had 3 vaginal deliveries.. I know I will need a labiaplasty I'm finding more and more uncomfortable. wearing underwear is bothering me and irritating the skin.. but I also wonder what would help with the inside being completely exposed. Also does insurance help pay a portion if at all? Thank you in advance!

Doctor Answers 11

Candidate for a labiaplasty

There is a trend to have less prominent labia, but this is a matter of choice and there are no medical reasons to do so other than improving your appearance down there. Candidates for a Labiaplasty procedure are women who are concerned about the appearance of their labia or experience discomfort due to exceptionally large or long labia of either the inner our outer lips. Labia unevenness can result in discomfort with intimate contact, chronic rubbing, as well as psychological discomfort, which leads to the inability to wear certain types of tight clothing. Most women live with these symptoms, and actually are not even aware that a certain surgical procedure exists to help to correct this problem and restore their femininity.

Post vaginal delivery gaping introitus

Congratulations on your 3 vaginal births!.  The stretching (and sometimes tearing) that occurs during a vaginal birth can cause both temporary and permanent change to the vagina and vulva.   One non-surgical option is to improve the pelvic floor muscles but doing pelvic floor exercises to improve the muscular support of the vaginal walls. (Kegel Exercises).  I recommend doing these if you do not already do them.   Your gynecologist can assess your pelvic muscle strength and check that you are doing the muscle tightening correctly.  Also, avoiding straining for bowel movements is important to prevent further stretching or damage of the tissues.  After maximizing your improvement with non-surgical means, you can see your gynecologist for a "colporrapy", repair of the vagina walls , and "perineorraphy", repair of the vaigna opening . A labiaplasty could be performed in conjunction with either of these two procedures.Best wishes!

Vaginal Reconstruction Options

Candidates for #labiaplasty and #vaginal surgery include women concerned about the appearance of their genitals, or those who experience discomfort, pain or difficulty with sexual relations.  Moisture can create problems such as yeast infections. #Labialplasty is probably the most common of the Vaginal Enhancement procedures. A candidate for a Labiaplasty procedure is concerned about the appearance of her labia or she may experience pain and discomfort from large, long or uneven labia; usually of the inner lips or labia minora.  This may result in chronic rubbing, which leads to difficulty in  wearing tight clothing , such as leggings; tight shorts and bathing suits can reveal a “Camel Toe”  which can be corrected with treatment. Enlarged or uneven labia may have a significant psychological impact and severely affect normal sexual relations.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.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

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Labial and Vaginal Rejuvenation after Childbearing and Vaginal Delivery

After pregnancy and childbearing (especially with vaginal delivery), many women experience lengthening and widening of the inner labia minora. Some women just develop that way even without having had children. It looks like from the photos provided one may benefit aesthetically from a labiaplasty with a wedge excision of the labia minora to make the labia appear smaller, and perhaps some form of labial "puff" to the outer labia majora to plump them back up (add labia majora wedge excision for some tucking up of the outer lips if they are pendulous when you stand up). After the hormonal changes of having had children, the outer lips often deflate and become a little loose. Injecting your body's own fat into them can plump them up and it appears more youthful in so doing.  The above will all help with the inner labia minora being housed or protected by the outer labia majora to prevent some of the symptoms you are having such as irritation of the inner lips.As far as the inner vaginal looseness and seeing some of the tissues there, after being examined and cleared by your Ob/Gyn for any type of organ prolapse or abnormal lab test, you could wait a certain amount of time after your last delivery, do pelvic floor and Kegel exercises for awhile and see if things get better with mother nature and time. If not, you could potentially undergo an external repair and tightening of the vaginal opening if you had any of that soft tissue or mucosa tear with the delivery (or for women who have had an episiotomy disruption). Internal vaginal tightening can be treated nowadays with noninvasive, nonsurgical methods with less downtime, internal scarring, and complications of a surgical procedure. For example, I offer the Sciton diVa laser vaginal treatment which can be done as a standalone treatment in the medspa/ office without anesthesia, or in combination with labiaplasty surgery in the operating room. It doesn't hurt and takes only about 5-10 minutes. It works! My staff and I have had it done as we are all moms; in fact, I am a mother of young twin boys so had some of the same issues and even mild stress urinary leakage with jumping on the trampoline with my sons or laughing. The DiVa laser fixed this as well with 2 treatments, not to mention the tightening effect which can be beneficial for other reasons!  ;)Good luck, there is hope!

You'd benefit from both Vaginal and Labial Rejuvenation

Hello Lyssax3,Thank you for your post and photo regarding your interest in Vaginal Rejuvenation, a compilation of procedures that can be tailored to your specific needs and interests. Please visit the link below of our comprehensive website to become familiar with all the rejuvenating options available to you.

Many women I see for vaginoplasty consultation have pelvic prolapse which is a medical condition covered by insurance.  If you have such a condition then your insurance company could be billed to repair this. Please visit the urogynecologic section of my website, to become more familiar with these problems.  Laser Perineoplasty and Laser Reduction Labiaplasty are not covered by insurance.

A new option available to my patients since 2013 is the new Alma CO2 laser, FemiLift.  This is an in-office Laser Vaginal Resurfacing procedure which I offer for vaginal tightening and/or urinary stress incontinence.  At the time of your consultation I would be able to determine if you are a candidate.  My office the first in the country to offer this option.

There are only a handful of fellowship-trained urogynecologists in the world who perform these surgeries in adequate volumes to be proficient and adept. I recommend you seek out such an expert who is experienced in both reconstructive and cosmetic vaginal surgery. Be prepared to travel.Best of luck,

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 21 reviews

You don't need vaginal surgery, you want vaginal surgery

Your labia are not enlarged at all. I would recommend you schedule a consultation with your gynecologist first to see if there is a source of irritation that may respond to topical therapy. From what I see, you have slightly irritated labia minora that are on the small side of normal. I doubt that reducing them will improve your symptoms. As for the inside being exposed, I don't see any exposure in the photo. A better answer would require a consultation.

What kind of surgery do I "need" with robust lips and a "3-kid vagina..."

Hello,I think you understand that you don't "NEED" surgery- you "want" surgery to deal with issues involving appearance, "feeling" and sexual function... I understand the toll vaginal childbirth(s) can take on vaginal width, the scarring over the posterior vaginal wall that occurs that limits vaginal "stretch" and pliability, and the breakdown and aesthetic battering that occurs at the opening, vulvar vestibule, and perineum/perineal body (the area between the vaginal opening and anus.) Of course your husband/partner has said nothing. He cares about YOU and anything that is attached to & part of you is OK with him. He is just happy to BE THERE... But it's not about him of course, I understand. It is about revising the appearance of the perineum, vestibule and vaginal opening closer to your pre-kids "veejayjay..." so you can smile when you cleanse and inspect yourself. It's about removing all the lax scar tissue from the pelvic floor, re-approximating the levator muscles and recto-vaginal fascia to reconstruct the pelvic floor, decompress your rectocoele, bring the pelvic floor muscles together, narrow the vaginal barrel, reconstruct the perineum and perineal body to strengthen the opening and change the angle of the vagina so as to provide so much more friction and "feeling" and push the penis upward to more stimulate the G-spot and internal and external clitoris. It may be about utilizing FemiLift or ThermiVa on the upper vagina to modestly tighten it and more importantly strengthen the skin and fascia to minimize embarrassing incontinence, it may be about adding an "O-Shot (tm)" to enhance orgasmic strength, and it definitely IS ABOUT adding a course of pelvic floor physical therapy to the mix to STRENGTHEN your muscles to support, enhance, and lengthen the success of your surgery. It also may be about a careful remodel of the labia to produce a more “colea”, “streamlined” appearance. This can be accomplished by a MINDFUL,  AESTHETIC, and strongly layered surgical repair, perhaps enhancing it with Laser and/or PRP technology. Who can and should do this and what do you look for? Look for a gynecologist who can prove that she or he is also quite savvy in the importance and techniques for re-building not only the pelvic floor but the perineal body and vaginal opening as well. Look for a surgeon who is an “artist,” proven by dozens of ‘before and after” photos of results from different LP and VP procedures. A surgeon who has performed at least 20 of these specific sexual vaginal tightening procedures (>100 would sure be nice), who has performed > 100 labia[plasties (if that will be part of your surgery, who has alternate tools (laser; RF) at his or her disposal, and who also informs you of the importance of post-operative physical therapy and automatically incorporates this therapy into his or her program. At our office we have a standard price for complete vaginoplasty, posterior repair and perineoplasty (US$7250), and a standard price for perineoplasty mini-vaginoplasty as well ($6000.) We give 50% discount for any "add-on" procedures like FemiLift or labiaplasty. These prices are "out-the-door" and INCLUDE  all facility charges, equipment, supplies, and local anesthesia. YES, these procedures may be performed, with excellent exposure, under safer, easier-to-recover-from LOCAL anesthesia. Of course, the exact technique and needs can't truly be assessed until personal evaluation, but most experienced surgeons can, via photos and an in-depth discussion which can even be by phone, give you a price approximation. While you may be reimbursed a portion of the surgical fee by your insurance company, you should be prepared to pay cash to your experienced surgeon. If you will be having a vaginal tightening operation, it is possible your insurance will pay a large portion of your hospital bill , but usually in the end at least in our office it is less expensive, and a far easier recovery, if your surgery is performed in-office under “Local.” Of course, even if your surgery is tentatively planned after a telephone consultation, it would take a careful in-person evaluation before surgery to determine whether that practitioner can most likely meet your needs. Best wishes for successful surgery. Research carefully, & don't be afraid to travel if you cannot find the ideal surgeon in your community. You only have one body, and one vagina, you know; research with care anyone you will be trusting that to... The weblink below, and other areas of the site, especially blogs, can provide you with additional useful information. Michael P Goodman, MD Davis, CA, USA

Vaginal reconstruction versus vaginal rejuvenation & labiaplasty

Dear Ms Lyssax:
I appreciate you sharing your story and photos but the answer to your question is NOT possible until you are examined.   Many surgeons who perform plastic surgery do not understand the normal and abnormal herniation of the vagina's internal anatomy. Women who have had 1-2-3 or more children or predisposed to having  not just mild relaxation of the vaginal walls but also moderate and severe vaginal and uterine prolapse. When a woman has a lack of friction with intercourse many surgeon will recommend a vaginal tightening i.e. vaginal rejuvenation by tightening the floor of the vagina and the opening.  All to often patients who feel their insides are coming out have a much more dire problem.   They often have uterine vaginal prolapse and surgeon who are not well versed in pelvic floor reconstruction and are only attempting to tighten the patient are doing the patient a disservice.   If you only needed a labia reduction surgery any cosmetic vaginal surgeon who has a good reputation and good skills will suffice, but in your situation you need a thorough evaluation prior to engaging in surgery.  Do not make the mistake of letting some surgeon who doesn't really understand vaginal reconstruction offer you an inferior surgery and then 6 month later your back in his/her office because the results are less then desirable.
What is vaginal rejuvenation?  As mentioned above 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.   But you don t know if you want of need this--- one surgeon was suggesting it to really just narrow the opening of the vagina so you don't see the internal skin coming out.   You see for many patients who have had multiple childbirths many need more than just tightening procedure they actually need vaginal reconstruction. Interestingly YOU did not mention anything about being tightened......only YOU can tell the surgeon if you want or need to be tightened.
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. The urogyencologist has extensive training and is the most experienced of all surgeons in operating on the relaxed vagina.  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).  Plastic surgeons, dermatologists, an family practice doctors who have perform cosmetic vaginal surgery do little concept of vaginal reconstruction.  They are not trained in residency to do vaginal surgery nor have they spent 7 years learning vaginal reconstructive surgery like a urogynecologist.  In fact I do not know of any plastic surgical residency in the nation who dedicates more than a few months to training their resident on vaginal surgery.    Vaginal Prolapse is basically the same as the vagina falling down and each area of the vagina which falls 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. 
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. Often this surgery needs to be accomplished laparoscopically i.e. small incisions through the abdominal wall.   However most urogynecologist have not been trained in the concept of cosmetic vaginal surgery or  vaginal rejuvenation .When I reviewed your photos above ( difficult to see the details at the opening of the vagina) it appears the ceiling of the vagina is falling downward suggesting either a cystocele, urethrocele or both.   You certainly would benefit from a thorough evaluation by a urogynecologist or a pelvic floor surgeon.  A cosmetic surgeon for a labiaplasty and a quick fix to tighten the inside of the vagina will not suffice.  So I caution you to choose a surgeon wisely............choose a surgeon who can accomplish both of your needs: 1) cosmetic labia surgery  2)  decreasing the exposure of the 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.
John R Miklos MD
Urogynecology & Cosmetic Vaginal Surgeon
Atlanta ~ Beverly Hills ~ Dubai

What do you NEED?

Thanks for your question and photos.  The question is a loaded one - what do you need?  Primarily, that depends upon your symptoms and concerns.  After 3 babies, you will certainly have some stretching of the vagina and all surrounding tissues, possibly some degree of prolapse of either the bladder or rectum, possibly some dysfunction of the anal sphincter, you may feel that sex has lost the feeling that it once had, you may leak urine unexpectedly with coughing, sneezing, laughing, etc.  You mention feeling "irritated," like your underwear are scratching - that is most likely from the fact that your labia and vaginal opening are stretched open, exposing the tissues meant to be on the inside and not touching your underwear.  All of this is fixable, but the type of surgery will be very much dependent on the presence of these other symptoms I mentioned.  Based on your photos (and lacking a more in-depth discussion and physical exam), my recommendation would be for a vaginoplasty (also referred to as "vaginal rejuvenation") with a perineorrhaphy (reconstruction of the perineal body or tissue between vagina and anus.  If you were to have additional symptoms, there could be more to do as well.  Please see a qualified specialist who has experience in these procedures - a board certified Uro-gynecologist with additional training and experience in reconstruction and cosmetic surgery of the female genitalia would be my first choice - you should be able to find more than one in the Boston area.  One other non-surgical option I would recommend is ThermiVa.  As opposed to the vaginal lasers on the market, ThermiVa uses radio frequency energy to rejuvenate the entire area and addresses all of the symptoms I listed above, plus a few that I didn't.  It may be a safer, less expensive option that addresses all of your concerns.

Labiaplasty + Vaginoplasty

Thank you for sharing.  You would benefit from both procedures.  In regards to having insurance pay for it, I would consult with your gynecologist or cosmetic surgeon and if there is some prolapse which is likely given that you have had 3 prior vaginal deliveries, then perhaps part of it could be covered under insurance. Best of luck.

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.