Vaginoplasty with labiaplasty before and after photo courtesy of Dr. Wesley Anne Brady, board-certified OB-GYN in Dallas, Texas. Results may vary.
Vaginoplasty with labiaplasty before and after photo courtesy of Dr. Wesley Anne Brady, board-certified OB-GYN in Dallas, Texas. Results may vary.
Vaginoplasty with labiaplasty before and after photo courtesy of Dr. Wesley Anne Brady, board-certified OB-GYN in Dallas, Texas. Results may vary.
Vaginoplasty with labiaplasty before and after photo courtesy of Dr. Wesley Anne Brady, board-certified OB-GYN in Dallas, Texas. Results may vary.
Vaginoplasty with labiaplasty before and after photo courtesy of Dr. Wesley Anne Brady, board-certified OB-GYN in Dallas, Texas. Results may vary.
Vaginoplasty with labiaplasty before and after photo courtesy of Dr. Wesley Anne Brady, board-certified OB-GYN in Dallas, Texas. Results may vary.
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.Â
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 youâre 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.
Women frequently inquire about a vaginoplasty after giving birth, when they find that their vagina doesnât feel or function like it did before having children.Â
âWomen who come to me say, âThings have changed, itâs not the same anymore,ââ reports Dr. Troy Robbin Hailparn, an OB-GYN in San Antonio, who has performed more than 3,000 vaginal surgeries.Â
Such was the case with this RealSelf member, the mother of a 3-year-old: âAfter having my son, my vagina never went back to how it used to be. Sex is not pleasurable. Iâve been doing Kegels daily but nothing seems to work.â Her question to doctors: âIs there any type of surgery that will make me tight again?âÂ
The enormous stress childbirth puts on the vaginal muscles, ligaments, and tissues can cause changes that affect how loose or tight the canal feels.Â
The vaginal tissue gets stretched to the point that the underlying muscles start to separate. As a result, âthe vagina becomes widened, so that thereâs no pressure on the G spot or clitoris during intercourse,â explains Dr. Christine Hamori, a Boston-based plastic surgeon who specializes in vaginal cosmetic surgery.Â
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.Â
Overstretching from significant weight gain and loss can also contribute to vaginal laxity, as can chronic straining or penetration by large partners. âOver time, that can take a toll,â says Dr. Mark Scheinberg, an OB-GYN in Deerfield Beach, Florida.
Pros
Cons
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.
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 canât hold on to a tampon.
âThere 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,â says Dr. Hailparn. âPatients 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.âÂ
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 âsmooth vagina.âÂ
If Kegel exercises, pelvic floor physical therapy, or Emsella treatments havenât done enough to strengthen the levator muscles, youâre probably a good candidate for surgery. âKegel exercises can help some women slightly tighten the muscles in the pelvic area, but they can only do so much,â says Dr. Kristine Gould, an OBâGYN in Lawrenceville, Georgia.Â
In fact, performing Kegels can be impossible for many women following childbirth, which can cause the pelvic floor muscles to separate. âOften when doctors ask women to squeeze these muscles, they canât because theyâre no longer connected,â says Dr. Hailparn. âImagine the birth canal as a toilet paper roll thatâs cut from one end to the other. Thatâs what often happens after childbirth.â
During your consultation, your provider will perform a pelvic exam, to see if the vaginal muscles are indeed separated. âTheyâll perform a physical exam and help you develop appropriate expectations concerning surgical results or steer you toward nonsurgical options,â 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.Â
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 âIf 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.â
The focus of vaginoplasty is to tighten the vaginal and perineal muscles, to enhance sexual sensation for you and your partner.Â
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.Â
Itâs important to correct these issues, which can worsen over time. But fixing them doesnât significantly increase tightness within the vagina or at its opening.Â
âMuscle 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,â explains Dr. Marco Pelosi, an OB-GYN in Bayonne, New Jersey.Â
He says that the small amount of vaginal skin thatâs removed from the center of the posterior vaginal wall during an A&P repair will create a slight vaginal tightening as a natural consequenceâbut it wonât be of nearly the same degree done during a vaginoplasty.Â
Plus, âif 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,â Dr. Pelosi says.Â
An experienced provider can evaluate all of your symptoms and correct them during a single operation. âIn 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,â explains Dr. Wesley Anne Brady, an OB-GYN in Dallas.
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.
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.Â
The surgery can also be performed in-office, with IV sedation (aka twilight anesthesia) or local anesthesia. Itâs a matter of preference for the patient and surgeon.Â
Thereâs 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 thatâs commonly performed:Â
RealSelf Tip: Some surgeons now perform whatâs known as a âsite-specific defect repair,â which proponents like Dr. Scheinberg say is an improvement on a traditional vaginoplasty techniques because it provides for a more solid, lasting result.Â
âThe vagina is connected on six sides, and the vaginal tissue doesnât just stretch during childbirth, it actually tears in several places,â he explains. âEach of these defects need to be individually evaluated and repaired by specific methods. If you just do a one-size-fits-all procedure, youâre not putting things back to where they were in the first place.â When heâs done performing a vaginoplasty, Dr. Scheinberg says âit looks like the patient is 18 years old again.â
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 defectsâall with typically less postoperative discomfort than a traditional vaginoplasty, according to Dr. Scheinberg.Â
The downsides? This surgical technique takes more time (often 3 hours vs. 45 minutes) and is more expensive than other methods. Itâs 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.
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. Hereâs what to expect during that time.
RealSelf Tip: To avoid the risk of infection, itâs 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.Â
âThe pain on days 3â10 has been very manageable. If I stand too long or sit on something hard, I do feel painâbut it gets less every day. Ice packs have been a lifesaver!ââdaisyunicorn, RealSelf member
Your results should be apparent six weeks after surgery, once most of the vaginal swelling has resolved.Â
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 womenâs 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 theyâre stretched in subsequent years. With the natural aging process, your muscles may loosen, but they shouldnât feel as lax as they did pre-surgery.Â
âNothing in life is permanent, and results may fade minimally to modestly with age and use,â says Dr. Goodman. âYou may need a minor âre-doâ after 10 years or so.â
For the best long-term results, improvement should not end with surgery, says Dr. Goodman. âYour 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.âÂ
Dr. Pelosi encourages his patients to begin or continue pelvic floor muscle exercises regularly to boost the results. âSurgery brings the vaginal muscles closer together, but only exercise makes them stronger and thicker.â
The vaginoplasty photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.
Itâs 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, âI have my patients perform vaginal stretching exercises with estrogen cream for two weeks after we lift restrictions to aid with those issues,â says Dr. Brady.
Good communication with your provider can help avoid an ongoing issue. âItâs important for patients to discuss with their surgeon how tight they want to be,â says Dr. Hamori. âPartner size is also important,â so as not to over tighten the vaginal opening.
âPatients usually choose to be as tight as they were after they lost their virginity but before they had their first vaginal delivery,â says Dr. Brady. âThis is approximately 2 to 3 centimeters or two fingers on exam.â (In fact, the procedure is sometimes called "virgin tightening surgery.")
If youâre post-menopausal, this may affect how tightly your tissues can be sutured. âIf you measure and tighten a woman in menopause the same exact way you do with a woman who is not, sheâs going to wind up too tight,â says Dr. Pelosi. So while youâd still be a candidate for the procedure, your surgeon will need to account for tissue elasticity differences.Â
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.Â
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 5â10 minutes three times a week until you reach the size you want, Dr. Pelosi explains. âIf itâs still too tight, Botox injections into the muscle might help. And when all else fails, a surgical adjustment can always be done.âÂ
Though excessive tightness is a known complication of vaginoplasty and perineoplasty, choosing an experienced surgeon can help prevent this issue. âThe art of this procedure is in gauging the amount of tightening during the surgery that will leave behind a vagina thatâs tight enough, but not so tight that sex is painful or impossible at the end of the healing process,â says Dr. Pelosi.
Many women combine this procedure with others to repair related issues in the genital area, pelvic floor, or anus.Â
âVaginoplasty is the surgical gold standard for vaginal tightening to which all nonsurgical vaginal rejuvenation procedures are compared,â says Dr. Hamori.Â
If youâre not ready for surgery or arenât a good candidate, there are few nonsurgical options to rejuvenate the vaginal tissuesâthough none actually tightens the muscles.
Updated July 29, 2021