The opening of my vagina & internally feel and look loose (childbirth x2)? Sex has been affected. Labia minora also hurts?

What is the BEST AND MOST EFFECTIVE surgery to make my vagina TIGHT inside & throughout, as well as the opening? What is the correct surgery for the labia issue? My labia minora hurts while sitting too long or during sex. Even while wearing jeans. Can the both be done at the same time?

Doctor Answers 7

The BEST procedure to raise your perineum and tighten vagina for better sex, minimize labial size, and make it all look pretty?!

Sometimes I/we equivocate on answers to your RealSelf queries. This time there is ONE very sure answer! A combination perineoplasty/posterior colporrhaphy repair/sexual vaginoplasty with add-on reduction labiaplasty WILL accomplish what you want, but only if it is performed by a cosmetic gynecologist or urogynecologist who is savvy & experienced in, and SPECIALIZES in this type of work.

Who does this in your area?? Dr. Red Alinsod in Laguna Beach; Drs. David Matlock and Alex Simopoulos in Los Angeles, and myself up North in Davis, CA are amongst the most experienced in your area and we all have performed well> 500 labiaplasties and 150 sexual tightening/aesthetic vaginal repairs. Compare prices, interview, see who "feels best" for you and is most cost effective (sometimes it pays to travel, sometimes best to stay in your own backyard.) Our "out-the-door" (including surgeon, facility, anesthesia & supplies) cost in Davis, CA for the full procedures outlined above is $9750. 

A perineoplasty builds, firms & aesthetically contours the vaginal opening. A "posterior repair, " or "posterior colporrhaphy" gets rid of the bulge-like herniation through a thinned-out/weak vaginal floor, and a true vaginoplasty bulks, supports, and tightens the vaginal floor & vaginal barrel by removing scar tissue and, in a layered fashion re-approximates the fibromuscular tissue of the vaginal sidewalls and floor. A labiaplasty, either via V-Wedge or linear modification, minimizes the size and aesthetically contours the inner lips, diminishing the chafing and discomfort experienced by some women with "robust" sized labia. There, however, is a big "if" here, and that is IF your surgery is performed by an experienced expert.  If not, the odds of success are appreciably lower...

YES, both can be done at the same time. We do this all the time at our office (combine PP/VP with LP) and are able to perform ALL under local anesthesia in an outpatient setting. There are perhaps only 2-3 locations in the entire U.S. where all may be performed together in a safe, "awake" setting under local anesthesia, minimizing the extra costs and risks of full general anesthetic. Personally, I have been the lead (responsible) author of  half dozen evidence-based articles in first-line medical literature on the outcomes, performance, and rationale for genital plastic/cosmetic surgery (see weblink below)

Best wishes,

Michael P Goodman, MD

Davis, CA, USA

Best way to correct childbirth changes in San Jose

Many women experience changes following pregnancy including urinary incontinence and prolapse while others experience changes in appearance or sexual function.

Depending on my findings during a consultation and exam, a common combination of procedures that I offer is a Vaginoplasty to improve sexual function and Labiaplasty to improve the discomfort and appearance from long labia. 

Alll of these issues can be corrected requiring the experience of a fellowship trained urogynecologist with specialized training in both Reconstructive Surgery and Aesthetic Intimate Surgery. There are only a few Urogyns around the country with this combination of skills. It is important to do your research to obtain comprehensive care for your personal and intimate needs.

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Peter Castillo, MD, FACOG
Bay Area Urogynecologist
5.0 out of 5 stars 15 reviews

Laser Vaginal Rejuvenation® (LVR®) and Designer Laser Vaginoplasty® (DLV®) procedures combined


Sexual wellbeing is important to a happy, well balanced life. In addition to physical pleasure, sex strengthens emotional bonds between partners, and adds excitement to life.

One of the most common complaints gynecologists hear from their patients experiencing vaginal relaxation is that “sex isn’t the same”. Women say they feel “loose” and have very little sensation.

Now there is a safe, quick, and effective way to treat vaginal relaxation. Laser Vaginal Rejuvenation® (LVR®) is a 1-hour outpatient surgical procedure that restores vaginal muscle tone, strength, and control. It will also effectively decrease the internal and external vaginal diameters as well as build up the perineal body. Sexual gratification for the female is directly related to the amount of frictional forces generated according to Masters and Johnson. We can accomplish this with laser vaginal rejuvenation. 

Vaginal Relaxation – A Common Problem

As a woman’s body experiences childbirth and natural aging process, the muscles and ligaments surrounding her vagina can become damaged or weakened resulting in a condition known as vaginal relaxation. Symptoms of vaginal relaxation include stress urinary incontinence (SUI), loss of functional control, and decreases sexual gratification for both the woman and her partner.

Many women are dissatisfied with the aesthetic appearance of their genitalia. Irregular genital structures can be the result of hereditary characteristics, childbirth, trauma, and aging. LVR certified gynecologists are trained in techniques of Designer Laser Vaginoplasty® (DLV®) procedures.

DLV is a group of cosmetic laser procedures which repairs, enhances, and beautifies the genitalia. The most common DLV procedures is the Laser Reduction Labioplasty (reduction of labia minora).

Both procedures can be performed on the same day. I recommend a consultation in order to receive detailed information as well as a personalized quote.

David Matlock, MD, MBA, FACOG
Los Angeles OB/GYN
4.9 out of 5 stars 10 reviews

Labiaplasty + Vaginoplasty Combo

thank you for sharing.

Prior to mentioning that a labiaplasty and vaginoplasty combination is a great way to go and that we do these all the time together under local anesthesia.  I would first recommend a proper evaluation of your pelvic floor.  Given that you have had the honor of birthing 2 babies vaginally, I would make sure to be evaluated and address any other issues with your pelvic floor that may need to be corrected during your procedure. 

Best of luck.   

David Ghozland, MD
Santa Monica OB/GYN
5.0 out of 5 stars 27 reviews

Vagina rejuvenation and labiaplasty

Dear CP427:

Thanks for sharing your questions. First let me start by saying yes both can be done at the same time  if you choose a surgeon with the right experience and expertise.  Let us discuss each of your issues separately:

1) Labia minora reduction - the two most common techniques are linear resection and a wedge resection. based upon your photos and you desires I would recommend a linear resection. Each surgeon has their own technique and their technique coupled with artistic talent is what gives a woman their results.  In a study performed in 2010 a review of 550 of patients requesting labiaplasty over a 3 . 5 year period , patients were interview ed about their postoperative expectations.  99% of  the caucasian woman ( of which I assume you are based upon your photos--  though i might be wrong) wanted their labia reduced so they no longer protruded beyond the majora and 99% preferred a lighter skin color i.e. pink versus dark.  Of  course the surgeon  should ask you personally on what you hope to achieve as you might not be in agreement to 99% of caucasian women.

2) Vaginal Rejuvenation or tightening surgery--- 

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 in the  world wide literature and only those surgeons who wrote the paper can claims these results.     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 and this depends upon whether their is more than just the floor of the vagina is broken.  If more is broken and you have a cystocele ( bladder drop) and uterine drop/prolapse this all would be addressed at the time of your appointment.  

I hope this is helpful and please choose a surgeon with experience, expertise, a great reputation and one who achieves great results.

John R Miklos MD

Atlanta  ~ Beverly Hills ~ Dubai

John R. Miklos, MD, FPMRS, FACS
Atlanta Urogynecologist
5.0 out of 5 stars 19 reviews

Whats the best surgery to have?

From your description it sounds like you may need a vaginoplasty and perineoplasty to tighten the canal and the opening.  For the labial irritation, a labiaplasty may be indicated.  These operations are all performed at the same time by a qualified specialist.  I don't see any photos so your an examination by a specialist is the best bet to give you a specific answer to what you need.  

Michael Litrel, MD, FPMRS, FACOG
Woodstock Urogynecologist
5.0 out of 5 stars 3 reviews

Vaginoplasty is the undisputed world champ for vaginal tightening

Vaginoplasty makes you tightest. Nothing even comes close. However, you may need pelvic reconstruction to achieve an excellent vaginoplasty result and this can only happen if your surgeon is trained and skilled in knowing when and how to perform pelvic reconstruction at the same time. Painful labia come in all shapes and sizes. Since you haven't mentioned if they are small, medium or large, I can't really give you more than generic info that labiaplasty works well to reduce enlarged labia, clitoral hood contouring is frequently necessary and these can certainly be combined with vaginoplasty and pelvic reconstruction.

Marco A. Pelosi III, MD
Jersey City OB/GYN
4.6 out of 5 stars 24 reviews

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.