Perineoplasty is a surgical procedure that focuses on deformities, defects and damage of a woman's anus and vagina. The surgery specifically removes scar tissue, bulges and unwanted skin, and then tightens or loosens the perineal muscles as well as the vagina.

An additional benefit of perineoplasty is that by making these adjustments, the surgery also serves to restore the woman's self-confidence and increase her physical levels of sexual pleasure.

What is Perineum?

The perineum is the area between the anus and the vagina. Although small, the perineum has the important role of being a structural support for many surrounding organs and encompasses muscles that play a vital role in vaginal tightening and relaxation.

What Causes Perineal Injury?

Having a particularly difficult vaginal delivery is the most common cause of perineal damage. Even an uncomplicated birth can cause physical trauma to the vaginal and perineal muscles. Sometimes an incision (episiotomy) is made in the perineum to make it easier for the baby to come out. Careless sutures performed by a less experienced physician to correct a natural tear or planned cut can result in improper healing of tissue, muscle, and the perineum. This can result in severe scars, pain and discomfort. Of course, multiple births can make these problems even worse. Perineoplasty can correct these and promote proper healing by reopening the sutured area and re-suturing it correctly.

Excess weight and obesity can strain the entire body, including the perineum and the structures it supports. It can also stretch the muscles, causing them to lose their flexibility.

Losing weight rapidly due to an illness or excessive dieting can present in some people as sagging and destruction of skin. These unwanted effects can occur outside the body as well as internally, causing permanent sagging of the perineum and other muscles, even if the weight pressure is removed. It may regain its original shape for a while during the day, but eventually after a few years the indentations and depressions become permanent.

What Other Conditions Does Perineoplasty Treat?

  • Vaginal itching
  • Vaginal laxity: Laxity of the vaginal opening may cause decreased sexual sensation
  • Vaginismus: Involuntary contractions of the vagina during intercourse
  • Vulvar vestibulitis: Severe pain during intercourse or tampon insertion
  • Genital warts
  • Urinary incontinence
  • Vaginal stenosis: Narrowing of the vagina, usually caused by cancer treatment
  • Dyspareunia: Pain during intercourse due to a small vaginal opening
  • Cystocele: Bladder protrusion into the vagina
  • Rectocele: Protrusion of the rectum
  • Aesthetic improvement: Loose or saggy tissue, tightening of protrusions to give the area a more attractive visual appearance

How is Perineoplasty Performed?

Perineoplasty is an outpatient procedure that usually takes about an hour under general or local anesthesia. Rarely requires hospitalization.

During perineoplasty, a 'V' shaped incision is made in the posterior vaginal wall. Scar tissue, protrusions and other damages are removed. Depending on the reason for the surgery, the muscles are either stretched or loosened to correct the problem, and then carefully stitched. After a short recovery period, the patient can go home.

Recovery Period After Perineoplasty

Patients should avoid having sex for six weeks. It is also recommended to avoid strenuous activities such as cycling, horseback riding, heavy lifting or stretching during this time. Tampons should not be used. Most patients should be able to return to work after a few days.

Pain and discomfort are usually minimal to moderate and can be treated with over-the-counter pain medications or a doctor-prescribed prescription medication. Minor bleeding and a small amount of discharges are normal.

Some dizziness or nausea may occur for a day or two as a result of the anesthesia, but this resolves after forty-eight hours.

The incision site should be kept clean and dry. The stitches will dissolve on their own in about two weeks. It is important to drink plenty of water and increase fiber intake during this time to prevent constipation.

Possible Complications of Perineoplasty

The risk of developing complications after perineoplasty is low. However, the doctor should be contacted if any of the following occur:

  • Excessive bleeding
  • Signs of infection
  • Constipation
  • Foul-smelling vaginal discharge
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