The size of the vaginal opening is directly related to the size of the perineum. When patients complain of a large vaginal opening (gaping introits) they explains that the opening to their vagina is widened. This is usually the result of childbirth.
Patients complain of three problems when it comes to the vaginal opening (introitis). The first problem is a cosmetic issue – the vaginal opening looks to large or feels large. When the patient is questioned as to when this condition began the most common answer is since giving birth. The second problem is the vaginal opening is too small or the patient complains of pain with intercourse/sex. When the patient is questioned as to when the problem began the most common answer is after the delivery of my last child. Usually she will describe having a tear and repair or an episiotomy. On exam the surgeon can usually reproduce the pain that she feels during intercourse. This usually means the patient has excess scar tissue at the opening. The third problem is a patient will complain of less friction during intercourse and often will ask about making her vaginal opening smaller so she can feel more during intercourse. The patient needs to be told that fixing the just opening of her vagina will not enhance friction with intercourse. She should consider surgical repair of the internal vagina as well as the opening. This technique is called vaginal rejuvenation.
The operation to fix both a small vaginal opening and a large vaginal opening are both called a perineoplasty. The term perineum is the area between the opening of the anus and vagina. The term plasty means surgery and does not necessarily mean making it specifically larger or smaller.
If a patient has an enlarged vaginal opening the perineum must be reconstructed to build up its integrity. When this is done it will narrow the opening of the vagina. See the surgery below.
The perineoplasty is an outpatient procedure and rarely ever requires hospitalization. This procedure takes approximately 30 minutes and the patient is discharged the same day. She should refrain from sex for 6 weeks and avoid activities like cycling, stretching, horseback riding and other strenuous activities.