Medicine has moved into the realm of asthetics in the recent years. Different people have different ideas about how they look and how they feel. Certainly, as a student, my gynae teachers have taught me to "Treat a woman as a 'WHOLE' and not as a 'HOLE' ". This will then include the opposite end from where gynaes work - the psychological and emotional aspect.
Before touching on Vaginoplasty, I must mention that I am seeing more patients requesting Labioplasty ( reduction of the labia ). Some patients, especially those below 40 years of age, are very upset by their enlarged labia. Some complain that penetration was more difficult and they feel the pain when their partner search for the point of entry. Others feel depressed when their partners look at their vulva and there were complaints that the partners have been turned off by the sight. Labioplasty is a simple surgery to cut away excess labia skin using a straight cut or a zig-zag interlocking cut. Stitching is done using very fine sutures and these are removed in about 1 week. Labioplasty can be done as a day procedure with excellent results.
The pelvic floor muscles in females control the bladder, womb and bowel. These 3 organ systems are lined one after another in the above order. When one organ system is damaged, it is likely that the neighbouring organs are involved as well.
The 3 main culprits for the pelvis floor muscles damaged are pregnancy/childbirth, menopause and obesity. Some people are born with weak collagen muscle tissues and can have a lax vagina when young and even without childbirth.
Certainly the main damage is from pregnancy and childbirth. The baby's head going through the vagina can cause overstretching and tearing of the pelvic floor muscles. This is even worse as patients often do not do pelvic floor (Kegel's) exercise when pregnant and after delivery of the baby. Many do not know that this exercise can reduce or prevent pelvic floor damage.
If a doctor were to put the index finger into the vagina and the thumb into the anus, pinching them together will often give the findings of a hollow between the thumb and finger. This is due to damage of the pelvic floor muscles and damage of the tissue in that region called the perineal body. Not uncommonly it is due to poorly healed or poorly cut (episiotomy) from childbirth. This gives the lax or open vulva/vagina feeling to the patient and her partner. This usual complaints are "looseness", "no strength", "no sensation" and "no fun".
More patients are seeing me for Vaginoplasty these days. In simple term Vaginoplasty is the surgery to "tighten the vagina". Some do this for themselves; many do it for their partners. Certainly if this situation reaches the "no fun" stage if intercourse, relationship can be affected. These patients often have a prolapse of the pelvic organ as well.
The greatest sex organ of the human is between the ears - the brain. The brain needs signals and feedback to function even better. Stimulation of the clitoris and vulva provide positive pleasurable feedback. This is gotten often through fore play. The act of intercourse will have the penis penetrating the vagina. With the female lying flat on top of the male, she would achieve clitoral stimulation. However for satisfactory vulval/vaginal stimulation, it often requires good fit at intercourse. This is the most common complaint from my patients - the problem with a "good fit".
An interesting finding was that a search through the internet portals such as "Yahoo" and "Google" on "Vaginal cosmetic surgery" revealed hundreds of sites. A search through the "Medline" ( for medical journals and research ) revealed none. This may be a matter of terminology but the objective and the outcome may well be the same.
For my patients requesting Vaginoplasty, I always abide by my teachers' wisdom of treating the patient as a "whole". It is important to understand the psychological and emotional aspects of the couple. This will certainly help in managing expections and improving successful outcome.
In Vaginoplasty, I repair the perineal body and join the pelvic floor muscles back with sutures. The vaginal skin will be fashioned in accordance with the amount of tightness of the pelvic floor muscles. This surgery can be done as a day procedure, with minimal pain and complications, and with good success rates under skilled hands.