Perineoplasty (also perineorrhaphy) denotes the plastic surgery procedures used to correct clinical conditions (damage, defect, deformity) of the vagina and the anus. Among the vaginal-anal conditions resolved by perineoplasty are vaginal looseness, vaginal itching, damaged perineum, incontinence, genital warts, dyspareunia, intraoital stenosis, vaginismus, vulvar vestibulitis, and decreased sexual sensation. Depending upon the vaginal-anal condition to be treated, there are two variants of the perineoplasty procedure: the first, to tighten the perineal muscles and the vagina; the second, to loosen the perineal muscles.

A perineoplasty procedure repairs damage to the perineum and damage to the vulva that a woman might experience as a result of:

  • Child birth: The stretching of parturition can cause tears to the tissues, or might require cutting (episiotomy) should the woman’s birth canal prove too narrow to allow unobstructed passage of the infant. Moreover, any perineal tissue that presents either a cut or a tear can heal and fuse together before the stitches dissolve, regardless of whether or not the tissues originally were joined in that anatomic configuration.
  • Obesity: Excess weight can over-stretch and damage the structures of the perineum, and can also stress and cause the separation of the perineal muscles.
  • Inadequate innervation: Either an absence of nerves or too few nerves.
  • Sexual penetration

Clinically, women report a feeling of physical looseness in their vulva-vaginal area, which might be associated with decreased sexual satisfaction when compared to the degree of her sexual satisfaction before the incidence of the perineal damage. The indications can include detachment of the anal sphincter muscle, and the collapse of her rectum. Perineoplasty is occasionally associated with posterior colporrhaphy, and can be performed in conjunction with the procedure.

Patients complain about three problems when it comes to the vaginal opening (introits). The first issue is a cosmetic issue – the vaginal opening looks 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 that the vaginal opening is too small, or the patient complains of pain with intercourse. When the patient is questioned as to when this problem began, the most common answer is after the delivery of their last child. Typically, the woman will describe having a “tear and repair” or an episiotomy. Upon examination, the surgeon can usually reproduce the pain felt during intercourse, and this usually means that the patient has excess scar tissue at the opening of her vagina.

The third problem is that a patient may complain about less friction during intercourse, and will often ask about how to make her vaginal opening smaller so she can feel more during intercourse. In this case, the patient needs to be told that fixing just the opening of her vagina will not enhance friction with intercourse; she should consider surgical repair of the internal vagina as well as the opening.

The operation to fix a small vaginal opening or 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.

A perineoplasty procedure first involves a V-shaped incision to the posterior wall of the vagina. Incisions atop the V-incision can be flat, curved, or angled upwards, which incision is applied is determined by the degree of vaginal tightening to be achieved. Once the incision is made, any existing scar tissue and abnormal tissue fixations that resulted from previous injury or surgery are removed. Depending upon the degree of damage occurred to the perineum, the corrections can include the:

  • Pubococcygeus muscles
  • Bulbospongiosus muscles
  • Other muscles detached from their perineal attachments

Stitching of the muscles is carefully performed to avoid creating transverse ridges, and to produce a ridged interior surface in the vagina.

Perineoplasty is an outpatient procedure and rarely ever requires hospitalization. This procedure takes approximately thirty minutes and the patient is discharged the same day. She should refrain from sex for six weeks and avoid activities like cycling, stretching, horseback riding, and other strenuous activities.

Doctors Miklos and Moore are experienced vaginal reconstructive surgeons who have performed hundreds of perineoplasties. If you have any questions about your options, contact the doctors today!