Question 1

What is a vaginoplasty?

Accepted Answer

A vaginoplasty is a surgical vaginal rejuvenation procedure that tightens the vaginal canal. It's usually performed with a perineoplasty, which surgically tightens the vaginal opening. These procedures enhance sexual function and enjoyment by improving the sensation of friction and fullness. They also improve the appearance of the vaginal opening.

Because a vaginoplasty tightens the levator muscles (aka the Kegel muscles) and helps support the bladder and urethra (the tube that carries urine out of the body), it can also reduce urinary incontinence.

The original meaning of the term vaginoplasty referred to the gender affirmation procedure. If you’re a transgender woman interested in the procedure that converts penile and scrotal skin into a new vagina, labia, and clitoris to create fully functioning female genitalia, see our guide to MTF Vaginoplasty.

If you were born without a vagina or are considering vaginal reconstructive surgery, learn about neovagina surgery.

Question 2

What causes vaginal laxity?

Accepted Answer

Women frequently inquire about a vaginoplasty after giving birth, when they find that their vagina doesn’t feel or function like it did before having children.

“Women who come to me say, ‘Things have changed, it’s not the same anymore,’” reports Dr. Troy Robbin Hailparn, an OB-GYN in San Antonio, who has performed more than 3,000 vaginal surgeries.

Such was the case with this RealSelf member, the mother of a 3-year-old: “After having my son, my vagina never went back to how it used to be. Sex is not pleasurable. I’ve been doing Kegels daily but nothing seems to work.” Her question to doctors: “Is there any type of surgery that will make me tight again?”

The enormous stress childbirth puts on the vaginal muscles, ligaments, and tissues can cause changes that affect how loose or tight the canal feels.

The vaginal tissue gets stretched to the point that the underlying muscles start to separate. As a result, “the vagina becomes widened, so that there’s no pressure on the G spot or clitoris during intercourse,” explains Dr. Christine Hamori, a Boston-based plastic surgeon who specializes in vaginal cosmetic surgery.

But there are multiple causes for vaginal laxity, says Dr. Hailparn. Other factors include genetics, the aging process, and menopause. For instance, a lack of estrogen can lead to a loss of the vaginal ridges called rugae that help grip the penis during sex.

Overstretching from significant weight gain and loss can also contribute to vaginal laxity, as can chronic straining or penetration by large partners. “Over time, that can take a toll,” says Dr. Mark Scheinberg, an OB-GYN in Deerfield Beach, Florida.

Question 3

What are the pros and cons of vaginoplasty?

Accepted Answer

Pros

The procedure tightens the vaginal canal, which many RealSelf members (who give the procedure a Worth It Rating of over type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el) say boosted their confidence in intimate situations and increased sexual satisfaction.
Because it tightens the levator muscles (aka the Kegel muscles), a vaginoplasty, may help reduce urinary incontinence.
Post-operative pain is easily managed. RealSelf member sashany says she never felt pain after the procedure, just mild discomfort.
Results can last 10 years or longer. While muscles and tissue naturally relax with age, they won’t become as lax as they were prior to your surgery.
Depending on your goals, a vaginoplasty may also be combined with another genital aesthetic procedure, such as a labiaplasty.

Cons

Vaginoplasty surgery does not treat medical conditions like a prolapsed bladder or rectum, though these issues can be fixed during the same operation.
Surgical risks include bleeding, scarring, infection, and some loss of sensation.
You’ll have at least three to five days of downtime, and will be advised to abstain from sexual activity for at least six weeks.
It’s a relatively expensive surgical procedure (see more on cost below), and because it's considered an elective cosmetic procedure, health insurance plans is unlikely to cover it. However, if it's performed in conjunction with procedures to address a documented medical issue, some of the cost may be covered by insurance.
There’s no guarantee that the results will be life-changing. One RealSelf member who said it was “Not Worth It” says her vaginal canal was still not tight enough after the pricey surgery.

Question 4

How much does vaginoplasty cost?

Accepted Answer

The price you pay will depend on credentials of your surgeon, where your procedure is performed, what kind of anesthesia you have, and the complexity of your procedure.

See our complete guide to vaginoplasty costs

Question 5

Who's a good candidate for vaginoplasty?

Accepted Answer

Vaginoplasty can benefit women who have loose or lax sensation in their vagina, such as a lack of grip during sexual intercourse or a feeling like they can’t hold on to a tampon.

“There can also be gas-like noises (aka queffing) during sex that can be embarrassing, and the penis can fall out due to lack of support at the vaginal opening,” says Dr. Hailparn. “Patients also commonly complain about feeling too wet or too smooth during sex. Excess mucous secretions can cause too much slip-and-slide, reducing sensations for one or both partners.”

A loss of vaginal ridges called rugae (due to scarring from childbearing, aging, pelvic relaxation, or lack of estrogen) can also cause a sensation of “smooth vagina.”

If Kegel exercises, pelvic floor physical therapy, or Emsella treatments haven’t done enough to strengthen the levator muscles, you’re probably a good candidate for surgery. “Kegel exercises can help some women slightly tighten the muscles in the pelvic area, but they can only do so much,” says Dr. Kristine Gould, an OB–GYN in Lawrenceville, Georgia.

In fact, performing Kegels can be impossible for many women following childbirth, which can cause the pelvic floor muscles to separate. “Often when doctors ask women to squeeze these muscles, they can’t because they’re no longer connected,” says Dr. Hailparn. “Imagine the birth canal as a toilet paper roll that’s cut from one end to the other. That’s what often happens after childbirth.”

During your consultation, your provider will perform a pelvic exam, to see if the vaginal muscles are indeed separated. “They’ll perform a physical exam and help you develop appropriate expectations concerning surgical results or steer you toward nonsurgical options,” explains Dr. Brady.

Most doctors on RealSelf advise waiting at least a year after childbirth before having a vaginal tightening procedure, since it takes time for your vagina to regain its tone.

You can still have a baby in the future, but keep in mind that a vaginal delivery will undo the results of the surgical tightening. Delivering via a C-section can help minimize any damage.

Dr. Usha Rajagopal, a San Francisco plastic surgeon, notes that “If a patient has unrealistic expectations of how tight their vagina can become or has medical complications, general health issues, severe heart concerns, lung problems, or is on blood thinner medicines, she is not a good candidate for vaginoplasty surgery.”

Question 6

Can a vaginoplasty help with prolapse?

Accepted Answer

The focus of vaginoplasty is to tighten the vaginal and perineal muscles, to enhance sexual sensation for you and your partner.

The procedure is not intended to solve common gynecological problems that often accompany a loose vagina, including bladder and/or rectal prolapse (aka cystocele and rectocele), which happens when part of the bladder or rectum wall bulges into the vagina.

It’s important to correct these issues, which can worsen over time. But fixing them doesn’t significantly increase tightness within the vagina or at its opening.

“Muscle tightening is not a component of an anterior and posterior repair (aka an A&P repair), the procedure used to restore the support and suspension of the pelvic floor,” explains Dr. Marco Pelosi, an OB-GYN in Bayonne, New Jersey.

He says that the small amount of vaginal skin that’s removed from the center of the posterior vaginal wall during an A&P repair will create a slight vaginal tightening as a natural consequence—but it won’t be of nearly the same degree done during a vaginoplasty.

Plus, “if a patient with pelvic floor damage undergoes a vaginal tightening without addressing the damaged supports, the risk of failure of the vaginal tightening procedure will be increased,” Dr. Pelosi says.

An experienced provider can evaluate all of your symptoms and correct them during a single operation. “In my practice, many patients undergoing surgery for a prolapsed bladder or rectum will also choose to have vaginoplasty performed at the same time, allowing their insurance to mitigate some of the fees for the facility and anesthesia charges,” explains Dr. Wesley Anne Brady, an OB-GYN in Dallas.

Question 7

Is vaginoplasty safe?

Accepted Answer

The procedure does carry some risks, including infection, bleeding, temporary numbness, pain during intercourse, loss of sensation, and scarring.

You can mitigate these risks by choosing an experienced, board-certified surgeon who uses the latest surgical techniques.

Question 8

What happens during a vaginoplasty?

Accepted Answer

In most cases, vaginoplasty surgery is done in a private surgical center or hospital under general anesthesia, though some surgeons perform the procedure with a spinal or epidural block for the pain.

The surgery can also be performed in-office, with IV sedation (aka twilight anesthesia) or local anesthesia. It’s a matter of preference for the patient and surgeon.

There’s more than one surgical technique to create a tighter vagina. This technique, outlined by Dr. Michael Goodman, a Davis, California, OB-GYN who teaches other surgeons how to perform the procedure, is one that’s commonly performed:

First, your doctor will measure and mark out the area in need of tightening.
They’ll then make a diamond- or kite-shaped incision encompassing skin of your vaginal floor as deep as three inches into the vaginal canal, with the “wings” of the kite at 4:00 and 8:00 o’clock at your vaginal opening, coming down to the bottom of the diamond/kite just above your anus.
“All of the skin in your vagina and perineum—and especially scar tissue, which doesn’t stretch or contract—from childbirth lacerations and repairs is excised, and all of the deep muscles and strong fascia are then carefully reattached and brought together to build up the vaginal floor and vulvar vestibule and perineum,” says Dr. Goodman. If you’ve had local anesthesia, that can be helpful at this point: “If you can do Kegels, your doctor can better locate the exact right place to put the sutures,” Dr. Goodman explains.
The fascia is pulled, like a blanket, to the center to cover the muscles.
Any excess skin is removed, and the incision is closed in a careful, purposeful, aesthetic manner, to bring the appearance of the vaginal opening a bit closer to how it looked “pre-babies,” says Dr. Goodman.
Finally, your doctor will insert vaginal packing (a kind of internal bandage), and you’ll be released to go home.

RealSelf Tip: Some surgeons now perform what’s known as a “site-specific defect repair,” which proponents like Dr. Scheinberg say is an improvement on a traditional vaginoplasty techniques because it provides for a more solid, lasting result.

“The vagina is connected on six sides, and the vaginal tissue doesn’t just stretch during childbirth, it actually tears in several places,” he explains. “Each of these defects need to be individually evaluated and repaired by specific methods. If you just do a one-size-fits-all procedure, you’re not putting things back to where they were in the first place.” When he’s done performing a vaginoplasty, Dr. Scheinberg says “it looks like the patient is 18 years old again.”

Besides tightening the vagina, a site-specific defect repair procedure can usually take the place of pelvic organ prolapse mesh procedures, to treat pelvic organ prolapse and stress urinary incontinence. It also corrects most cystocele and rectocele defects—all with typically less postoperative discomfort than a traditional vaginoplasty, according to Dr. Scheinberg.

The downsides? This surgical technique takes more time (often 3 hours vs. 45 minutes) and is more expensive than other methods. It’s also not performed by as many surgeons (Dr. Scheinberg estimates that only several hundred are trained to do it, world-wide), so it can be difficult to find one who does.

Question 9

How long does recovery take?

Accepted Answer

Depending on the extent of your procedure and how your body heals, you can expect to need 3 to 5 days of downtime after a vaginoplasty procedure, and up to 6 weeks to fully recover. Here’s what to expect during that time.

You’ll have some swelling, discomfort, and a lot of pressure (that gets worse when standing up), especially during the first week. “My patients always tell me that it feels like they have to make a bowel movement all the time,” says Dr. Pelosi. That feeling should subside by the end of the first week. You may have prescription pain medicine at this time.
The vaginal packing will be removed the next morning following surgery. At that point, you can begin cleaning the incision and genital area after each trip to the bathroom, following your doctor’s instructions.
“Many women are unable to urinate immediately after surgery due to muscle spasms, anesthesia and swelling,” says Dr. Brady. “These patients have a urinary catheter placed and return to have it removed at the first post operative appointment, usually two to four days after the surgery.”
You should be able to go back to work after four to five days, depending on your surgeon’s advice.
The swelling should go down by the end of week two. You can help alleviate it by icing and not standing for long periods.
“It is very important to avoid constipation during the recovery period,” Dr. Brady warns. “Patients may choose to perform a bowel cleanse prior to surgery and/or use stool softeners or Miralax during the postoperative journey.”
The University of Michigan’s surgical department recommends not driving for two weeks after vaginoplasty surgery, saying that “It will be helpful to have friends and family available to do errands for you for a couple of weeks.” This includes driving you to and from your follow-up appointments with your surgeon. Some providers allow you to drive after one week, provided you’re no longer taking prescription pain medication.
Avoid soaking in a bath or hot tub or visiting a sauna until at least three weeks after your surgery (or longer, if advised by your doctor).
It’s normal to have brown or even yellowish discharge in the first four to six weeks as sutures dissolve.
Any labial swelling will start to go down by the six week mark.
Your interior vaginal sutures should have dissolved all the swelling resolved by six to eight weeks after surgery. At this point, you should be left with a tighter vaginal opening and canal.
You can safely have sexual intercourse after six weeks. “I tell patients to start slow and use lots of lubrication,” says Dr. Brady. At this time you can also resume exercise, lifting heavier items, and using tampons. You’ll notice the vaginal walls and exterior areas are “more natural and pliable,” says Dr. Pelosi.
You may experience temporary urinary incontinence while your urethra is swollen, which can last up to 12 weeks.
Some patients will need to use a dilator to gradually expand the vagina. Your doctor can advise on if, when, and how you should approach dilation.
Vaginal stretching exercises and scar massage may be advised, using estrogen cream or vitamin E oil, when restrictions are lifted.

RealSelf Tip: To avoid the risk of infection, it’s important to keep up a strict personal hygiene routine. Wash your hands before and after any contact with the genital area, shower daily, and avoid wearing tight clothing because friction can help transfer bacteria.

“The pain on days 3–10 has been very manageable. If I stand too long or sit on something hard, I do feel pain—but it gets less every day. Ice packs have been a lifesaver!”—daisyunicorn, RealSelf member

Question 10

When will you see results, and how long will they last?

Accepted Answer

Your results should be apparent six weeks after surgery, once most of the vaginal swelling has resolved.

You'll see and feel your final results four to six months post-op, when you'll be fully healed.

The study Vaginal Rejuvenation: From Scalpel to Wands (International Journal of Women's Dermatology) says that the procedure improves women’s sexual function, with 81.6% of patients saying they were very satisfied, 14.5% were satisfied, and only 3.9% were not satisfied with their results. RealSelf members report similar satisfaction levels.

Results typically last about 10 years, depending on how much the muscles were tightened and how much they’re stretched in subsequent years. With the natural aging process, your muscles may loosen, but they shouldn’t feel as lax as they did pre-surgery.

“Nothing in life is permanent, and results may fade minimally to modestly with age and use,” says Dr. Goodman. “You may need a minor ‘re-do’ after 10 years or so.”

For the best long-term results, improvement should not end with surgery, says Dr. Goodman. “Your surgeon should shepherd you through a series of pelvic floor strengthening classes and/or supply you with and teach you how to use an electronic vaginal muscles strengthening device.”

Dr. Pelosi encourages his patients to begin or continue pelvic floor muscle exercises regularly to boost the results. “Surgery brings the vaginal muscles closer together, but only exercise makes them stronger and thicker.”

Question 11

Vaginoplasty before and after pictures

Accepted Answer

The vaginoplasty photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 12

Can vaginoplasty make you too tight?

Accepted Answer

It’s not uncommon for women to feel too tight shortly after surgery, when freshly healing tissues are stiff, inelastic, and swollen. As the healing process progresses, the initial tightness should subside. Additionally, “I have my patients perform vaginal stretching exercises with estrogen cream for two weeks after we lift restrictions to aid with those issues,” says Dr. Brady.

Good communication with your provider can help avoid an ongoing issue. “It’s important for patients to discuss with their surgeon how tight they want to be,” says Dr. Hamori. “Partner size is also important,” so as not to over tighten the vaginal opening.

“Patients usually choose to be as tight as they were after they lost their virginity but before they had their first vaginal delivery,” says Dr. Brady. “This is approximately 2 to 3 centimeters or two fingers on exam.” (In fact, the procedure is sometimes called "virgin tightening surgery.")

If you’re post-menopausal, this may affect how tightly your tissues can be sutured. “If you measure and tighten a woman in menopause the same exact way you do with a woman who is not, she’s going to wind up too tight,” says Dr. Pelosi. So while you’d still be a candidate for the procedure, your surgeon will need to account for tissue elasticity differences.

Women may also be too tight relative to the size of their partner. Continued sexual intercourse can improve this, as your body naturally loosens with activity.

In addition to finger stretching, the use of progressively larger vaginal dilators will help resolve excessive tightness. A typical routine starts with the largest dilator you can insert comfortably for 5–10 minutes three times a week until you reach the size you want, Dr. Pelosi explains. “If it’s still too tight, Botox injections into the muscle might help. And when all else fails, a surgical adjustment can always be done.”

Though excessive tightness is a known complication of vaginoplasty and perineoplasty, choosing an experienced surgeon can help prevent this issue. “The art of this procedure is in gauging the amount of tightening during the surgery that will leave behind a vagina that’s tight enough, but not so tight that sex is painful or impossible at the end of the healing process,” says Dr. Pelosi.

Question 13

What other surgeries you can have with a vaginoplasty?

Accepted Answer

Many women combine this procedure with others to repair related issues in the genital area, pelvic floor, or anus.

Labiaplasty reduces the size of a prominent labia minora (the inner vaginal lips of the vulva), while a majoraplasty contours the labia majora.
Sphincteroplasty tightens the anal sphincter. Dr. George Shashoua, an urogynecologist in Austin, Texas, says that it can resolve “issues with a disruption to the sphincter surrounding the anus, resulting in fecal incontinence.”
Perineoplasty tightens the muscles between the anus and the vaginal opening. Your surgeon may suggest this procedure instead of a vaginoplasty, if only the vaginal opening is loose.
Clitoral hood reduction reduces the folds of skin around the clitoris, to improve its aesthetics and allow for more direct stimulation.
Pelvic floor reconstruction reverses vaginal or pelvic organ prolapse (POP), where your uterus, urethra, bladder, or rectum protrude into the vagina.

Question 14

What are the alternatives to vaginoplasty?

Accepted Answer

“Vaginoplasty is the surgical gold standard for vaginal tightening to which all nonsurgical vaginal rejuvenation procedures are compared,” says Dr. Hamori.

If you’re not ready for surgery or aren’t a good candidate, there are few nonsurgical options to rejuvenate the vaginal tissues—though none actually tightens the muscles.

Radiofrequency (RF) treatments like ThermiVa work by heating the tissue in the vagina, causing it to tighten and promoting collagen growth. The treatment, which isn’t FDA-approved for vaginal rejuvenation, takes just 30 minutes and has no downtime. According to Dr. Pelosi, you can expect only a 20–30% improvement in laxity. Results may also be temporary, lasting a few months to a year or more.
Lasers like FemiLift, a fractional CO2 laser, can stimulate collagen, elastin, and blood flow in the vaginal canal. After three to five treatments, you may feel tighter and more lubricated and have a decrease in urinary incontinence. diVa Vaginal Therapy works similarly. The MonaLisa Touch is a laser that addresses postmenopause hormonal issues: dryness, inflammation, and pain during sex. You’ll likely get some tightening of vaginal tissue, but that’s not the goal of this procedure.
vFit is an at-home LED light therapy device that can boost collagen production to improve tissue elasticity and increase moisture and sensation.

Question 15

Sources & studies

Accepted Answer

Callens, Nina, et al. “Long‐Term Psychosexual and Anatomical Outcome after Vaginal Dilation or Vaginoplasty: A Comparative Study.” The Journal of Sexual Medicine, Elsevier, 16 Dec. 2015.

Department of Surgery. “What to Expect: Vaginoplasty at Michigan Medicine.” Michigan Medicine, Apr. 2019.

Desai, Sejal A, et al. “Vaginal Rejuvenation: From Scalpel to Wands.” International Journal of Women's Dermatology, Elsevier, 7 Mar. 2019.

VAGINOPLASTY

Wesley Anne Brady, MD

Karyn Repinski

BEFORE & AFTER PHOTOS

Wesley Anne Brady, MD

Karyn Repinski

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Wesley Anne Brady, MD

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BEFORE & AFTER PHOTOS

Wesley Anne Brady, MD

Karyn Repinski

VAGINOPLASTY QUESTIONS

Scar revision and vaginoplasty - Should I combine the surgeries, if not, which one should be prioritized first?

Bladder prolapse and vaginoplasty

Appropriateness for revision?

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