Perineum, also known as perineal body, is the area between the vaginal opening and the anus. Underneath the visible skin of the perineum are connective tissue, muscles, and nerves. It is a highly erogenous zone with multiple nerve endings. It forms a base for the support of pelvic floor muscles, which in turn supports the bladder, rectum, and uterus.
The area is prone to tearing during vaginal birth, which can lead to disfigurement and dysfunction. In addition to childbirth, other elements may affect its appearance and functionality. This can result in female sexual dysfunction due to negative body image and lack of sexual arousal. Damage to the perineum can also lead to bladder and bowel control problems.
Perineoplasty is a reconstructive procedure to strengthen and tighten the perineum. The vaginal opening is narrowed, and any scarring or disfigurement is corrected. The procedure has aesthetic and functional benefits and addresses intimate concerns arising from a deficient perineum.
Vaginal birth is by far the leading cause of perineal damage. However, other life factors can also play a role in deforming the perineum and altering its functional status. Causes of saggy and disfigured perineum beyond childbirth include:
- Extreme body weight fluctuations
- Injury to perineal structures from trauma
- Scarring from previous perineal surgeries
- High impact exercises
- Other gynecological diseases
- Genetics (hereditary connective tissue disorders)
The impact of perineal damage and looseness is multifold and affects quality of life negatively. With a deformed perineum, women often face the following issues that can be addressed with perineoplasty:
- Problems with sexual arousal
- A sense of looseness and laxity around the vaginal opening
- Vaginismus or painful vaginal contraction during intercourse
- Difficulty in emptying the bowel
- Prolapsed pelvic organs
- Loss of libido
- Low self-esteem
The perineoplasty surgery has significant aesthetic and functional benefits. After the surgical restoration of the perineum, you can expect enhancement in your quality of life due to:
- Tightening of wide vaginal opening
- Removal of unsightly scars from previous surgeries
- Correction of any disfigurement in the perineal area
- Improvement in vaginismus and painful sex
- Enhancement of sexual sensations
- Correction of overtightened vaginal opening
- Boosting of self-esteem
You need a pre-procedure consultation with your cosmetic gynecologist. Discuss your intimate concerns and expectations from the procedure with your surgeon. The extent of the corrective process is decided after a thorough assessment of your issues. You may be suggested other complementary procedures like vaginoplasty according to your individual requirements.
The Perineoplasty surgery can be carried out under general, regional or local anesthesia. The mode of anesthesia is decided according to your comfort and preference and your surgeon’s. Perineoplasty is performed by minimally invasive microsurgical technique.
A small diamond-shaped incision is given at the vaginal opening, and excess skin or scarred tissue is removed. Underlying muscles and connective tissue are repaired to provide support to the area. The overlying wound is stitched with dissolvable sutures by bringing back the gapped edges together.
The procedure is usually done as a day case, and patients are encouraged to sit up and walk when they feel comfortable. The patients can go home within a few hours once they have passed urine without difficulty. Light household activities can be resumed after the first 72 hours. Some of the important tips to consider for optimum results and smoother recovery are mentioned below:
- Wear loose-fitting bottoms and ice the area intermittently in the initial few days to decrease swelling and discomfort.
- While you can take a shower right away, you should avoid taking baths for 2 to 3 weeks until the wound has healed.
- Vaginal bleeding/discharge is common for the first few days and should not cause a concern. Use sanitary pads and avoid tampon use to reduce chances of infection.
- Keep yourself hydrated and take a fiber-rich nutritious diet to avoid constipation and straining. This can be painful and can impair wound healing. Your doctor may also prescribe you laxatives for the initial post-operative days.
- Avoid heavy workouts for a few weeks. Do light-intensity workouts instead, like going for a walk. You are also encouraged to do Kegel’s exercises to strengthen your pelvic floor.
- Returning to work depends on the nature of your job. You can go back after a week, but if your work involves lifting heavy objects, then it’s better to rejoin the workplace after a month’s break.
- Wait for 4 weeks before you resume sexual activity to let the sutures absorb and allow the wound to heal.
Some of the potential risks associated with the procedure are:
- Unsatisfactory results
- Dyspareunia 10%
You are not considered a suitable candidate for perineoplasty if you have one of the following conditions:
- Active genital infections
- Abnormal pap smear results
- Coagulation disorder
The perineoplasty success rate in addressing the sensation of wide vagina is reported to be
87.9% at 6 months follow up. The procedure also renders a significant improvement in female sexual function. The partner satisfaction rate is reported at 92.6%.
Although vaginal birth is the commonest cause of perineal damage, many other factors may also lead to perineal scarring and disfigurement. This can alter its functional status and lead to problems in intimacy.
Perineoplasty is a restorative procedure that brings back the normal physiological status and aesthetic appearance of this highly erogenous zone. If you are unhappy with your intimate appearance or you experience issues in your sexual life due to saggy/scarred perineum, then perineoplasty is an effective option for you.
Published on January 4, 2024 and Last Updated on January 4, 2024 by: Priyank Pandey