Perineoplasty - is it possible to loosen the area with another surgery?

The perineum can sometimes be loosened with vaginal dilators and botox injections. If there is thick scarring, however, these won't work and you will need surgery. It's called a reverse perineoplasty, it's not major surgery and the recovery is mild. If done properly, it works great and looks great. If done wrong, it will look weird. That's why I recommend that you set up a virtual consult with an expert and travel if you must.

Using vaginal dilators works well with stretching the perineum. The key is to be consistent. Your cosmetic surgeon will inform you on the brand of vaginal dilators they prefer and the use of them. Another option is having the perineoplasty loosened (reversed) to allow for better penetration. This has to be done by a qualified surgeon. This procedure is short and the recovery is not as involved as the original perineoplasty.

Thank you for your question It is rare that the muscles are what is interfering with penetration. It is usually the skin fold at the perineal- vaginal junction This can be easily and inexpensively opened by making a small v shaped excision at the “posterior orifice” which should allow easy penetration Moisture comes from vaginal vascular supply. When removing vaginal tissue there is less area to supply moisture. That might be improved with radio frequency or laser treatments which treat dryness or by use of lubricants Just an added note: surgery should not sew muscles but the surrounding tough tissue layer called fascia to bring the muscles into position

Hello Jesuis1,
The solution to your problem depends on how long ago you had your surgery and what your examination is like. It may be that the perineal skin was aproximated so that your opening is too small for easy penetration. If this is the case you may require a revision. If your suregry was recent then you may need more time. The dryness in the area may be due to scar tissue or other age related factors.
In all, I don't have enough information to help you too much.
Go to the link below to assess my expertise in this surgical specialty as well see hundreds of B/A photos of these procedures. From that link you may schedule a virtual consult via phone or zoom, at which time we can discuss in-depth your anatomy, expectations, and concerns. Women from all over the world travel to my Center for their vaginal surgery.
Best of luck,

Hello Jesuis1, I am wondering how long ago your surgery was as it may just take time as this area is healing for the elasticity and moisture to come back. If the surgery was several months ago and there is scarring at the opening or inside the opening then this would need surgical release. This is not a major procedure, it is easily performed in the outpatient setting and would significantly relieve your symptoms. Hope this helps!

"Overtightening" is one of the risks of a vaginal tightening operation, and one that is greater from a surgeon who is not an "offcial" cosmetic gynecologist, trained by one of the accepted cosmetic Gyn trainers, Drs Michael Goodman, Red Alnsod, Alex Bader, Troy Hailparn, David Matlock, Adam Ostrzenski, or Marco Pelosi. That out of the way, your therapy that will lead to comfortabl sexual intercourse will depend on whether the overtightened area is at the opening (the "Introitus"), or more deeply inside (also termed "hourglassing.") Outside is easier to overcome, utilizing progressively larger dilators. Internally, while dilators may aso "work," a surgical release of the "too-tight" suture(s) may be necessary. The "captain of the ship" in your therapeutic reversal of this complication should be your surgeon, who may be sufficiently knowledgable to provide the proper dilators and guide your therapy, or your surgeon may elect to work with a pelvic floor physical therapist, Either way, the odds of successfuly overcoming this issue are great. My suggestion is to either go to your surgeon (the best option financially,) or to an acknowledged expert in vaginal recontruction (perineoplasty + vaginoplasty) to begin a therapeutic dilation protocol. Re: the dryness, this could be simply from the "newness" of the surgery, from removal of Bartholin's glands, or from unrelated menopausal dryness issues. Either way, a smart cosmetic Gyn surgeon should be able to guide you as to the proper therapy. Best regards, Michael P Goodman, MD, FACOG, IF, AAACS. Specialized Genitopelvic Revision Surgeon, Davis, CA, USA

Yes, it is possible. The technique used is dictated by the type of defect. Overall, a revision or reverse perineoplasty are procedures with high satisfaction and resolution of symptoms.