Do I need a vaginoplasty?

I had four vaginal births with no complications. 3-4 years between consecutive deliveries. I had little tearing during my first 3. I was 33 when I had my last baby. I don't feel as tight during intercourse, and many times I feel pressure from lower vaginal wall on rectum during sex. Do I need vaginoplasty?

Doctor Answers 6

Candidate for Vaginal Rejuvenation

Women have a wide range of normal  color, texture, size and asymmetries of their genitilia. This is true of the Vulva and all of its parts, the same as other parts of the body. 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. More specific problems are noted below in each section. These problems may exist at birth or with growth and development. They can occur with childbirth or other trauma to the region. All of these issues can cause a woman great emotional distress that is often difficult to talk about with their partner, friends and even their doctor.

Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

You need evaluation by a Reconstructive and Cosmetic Vaginal Surgeon

Thank you for your post. You need to see a urogynecologist with experience in both reconstructive and cosmetic vaginal surgery to help you understand what you have and what your options are. You have had 4 vaginal deliveries and are now experiencing vaginal pressure on rectum during sex. You need to be evaluated for vaginal prolapse, a condition covered by insurance. If you decide to surgically correct this then a vaginoplasty could be performed at the same time to ensure improved anatomical support and vaginal function. See link below for information on what you should look for in a surgeons training and experience to improve your chances of excellent results.Best of luck, 

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

Vaginoplasty or more...

Four children is a lot of wear and tear in the vaginal canal. You need an evaluation, but most likely would benefit from vaginoplasty and maybe a perineorrhaphy.    See a cosmetic gynecologist and get evaluated to make sure there is no other prolapse and what the best surgical route would be.

Need both vaginal tightening and repair

Thank you for sharing but it appears that based on what you described that you may need more then just a vaginal tightening.Make you get a evaluated by an experienced vaginal reconstruction surgeon who can assess pelvic floor dysfunction and manage it along with a vaginal tightening procedure.Your scenario is quite common and very easily fixed.Best of luck

Vaginal rejuvenation & vaginal reconstruction

Thanks for sharing.....It already appears you know the answer to your question as you are the patient and you are not enjoying intercourse to the extent you once did.  From content of your letter it appears you may need both rejuvenation and 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 really a cosmetic/function type problem and reconstruction is not.  
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 multiple childbirths many 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 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 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).  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 .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.  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 MDUrogynecologist  & Cosmetic Vaginal SurgeonAtlanta ~ Beverly Hills ~ Dubai

After 4 deliveries, you might need a little more than a vaginoplasty

Many women experience damage to the supports of the vagina with childbirth along with vaginal laxity. A vaginoplasty focuses on tightening both the deep and superficial vaginal muscles and skin. However, if the pelvic supports of the vaginal walls are damaged (and this is very, very common), then the vaginoplasty will fail. Muscle tightening only works well when their attachments are properly anchored. You need a full pelvic and vaginal evaluation by an expert in pelvic reconstructive surgery who also performs vaginoplasty. The video link illustrates the anatomy for  you:

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.