Vaginoplasty - Procedure, Risks, Benefits and Recovery

Vaginoplasty, or surgical vaginal tightening, is a surgery to modify the structure or function of the vagina. It addresses various concerns affecting vaginal health and well-being, like childbirth, vaginal elasticity or congenital abnormalities.

The vaginoplasty surgery can improve comfort during intercourse, address urinary incontinence, and enhance sexual function.

Anatomy And Physiology

In the context of vaginoplasty, it's crucial to understand the normal anatomy of the vagina. It plays a pivotal role in sexual pleasure. It contains nerve endings that respond to stimulation.

1. Muscular Canal: The vagina is a muscular, fibromuscular tube connecting the uterus to the vulva (external genitalia).

2. Elasticity: The walls of the vagina are lined with a mucous membrane containing elastic tissue. This allows for expansion during intercourse and childbirth.

3. Microbiome: The vagina has a healthy balance of bacteria, which helps maintain a slightly acidic environment and protects against infections.

Vaginoplasty addresses a variety of concerns affecting the structure and function of the vagina. However, this procedure is not for everyone. There are certain reasons why someone should opt for the treatment:

1. Vaginal Laxity: Scarring from childbirth, injury, or specific medical procedures can cause the vagina to lose its tightness. This can cause discomfort during intercourse and difficulty maintaining sexual satisfaction.

2. Urinary Incontinence: Weakened pelvic floor muscles, often a consequence of childbirth, can contribute to urinary incontinence. Vaginoplasty can help tighten these muscles and improve bladder control.

3. Gender Confirmation Surgery: For transgender women, vaginoplasty creates a functional vagina that aligns with their gender identity.

4. Congenital Abnormalities: Some women are born with abnormalities in the vaginal structure, such as a septate vagina (a partial or complete division within the vagina) or vaginal agenesis (absence of a vagina). Vaginoplasty surgery can correct these conditions and create a functional vagina.

Consult a board-certified OB-GYN or plastic surgeon to determine the ideal candidate for vaginoplasty.

Vaginoplasty surgery offers a variety of improvements to address concerns related to the structure and function of the vagina. Here are some key benefits women may experience after undergoing this procedure:

1. Improved Sexual Function: Vaginoplasty can help restore or enhance sexual satisfaction by addressing issues like vaginal looseness or tightness.

2. Reduced Discomfort: The procedure can alleviate pain during intercourse caused by structural abnormalities.

3. Boosted Confidence: Vaginoplasty can address aesthetic concerns or congenital disabilities, increasing self-esteem and body confidence.

Thorough preparation for the surgery will ensure a smooth experience. The following are some of the crucial things to consider. 

Before Vaginoplasty

One must evaluate and understand a few things before going for the surgery. Below is a table for all the important things to be aware of before the surgery:

On the Day of Vaginoplasty

Arriving on time and getting admitted are not the only things to be done on the day of surgery. Take a look at some of the other crucial things to do before going in for the surgery:

The duration of vaginoplasty can vary from 1-3 hours, depending on the complexity of the procedure. The details of the procedure may differ based on the desired outcome. The following are the general steps involved:

1. Patient Preparation: The patient will be positioned on the operating table, lying on their back with legs elevated using stirrups.

2. Anaesthesia: General anaesthesia is administered to ensure comfort and relaxation throughout the procedure.

3. Surgical Site Preparation: To mitigate the risk of infection, the surgical area, including the vulva and surrounding skin, will be properly cleaned and sterilised. A sterile drape will be placed to isolate the surgical area.

4. Monitoring: Throughout the surgery, the patient's vital signs, such as heart rate, oxygen levels, and blood pressure, will be closely monitored to ensure safety.

Types of Vaginoplasty: There are two widely acclaimed types of vaginoplasty based on their approaches. The common approaches include:

1. Laser Vaginoplasty (Minimally Invasive)

   Laser vaginoplasty uses a laser to tighten vaginal tissues. The procedure is typically performed in an outpatient setting with minimal incisions. The laser beam delivers targeted thermal energy, stimulating collagen production and potentially improving mild laxity.

2. Open Vaginoplasty (Traditional)

   Open vaginoplasty involves surgical incisions to address various concerns. The surgeon may remove excess tissue, reposition muscles, or repair structural abnormalities. This approach offers more extensive correction for significant looseness, tightness, or anatomical problems. It's performed in a hospital setting.

The recovery period for vaginoplasty is 5-7 weeks, and it includes following the doctor’s advice and leading a healthy lifestyle. Below are the recovery phases of vaginoplasty and what should be done for speedy rehabilitation. 

In the Hospital:

Before getting discharged, the patient's condition will be constantly monitored based on the effects of anaesthesia, vitals, and pain. If everything is satisfactory, the doctor may recommend same-day discharge. 

At Home:

Following the doctor's instructions carefully at home is crucial for a smooth recovery after vaginoplasty. 

1. Follow a liquid diet in the initial weeks.

2. Proper wound care, including dressing changes as instructed.

3. Pelvic floor exercises or physiotherapy may be recommended for healing and function.

4. Medication regimens for pain management, infection prevention, and healing will be taken as instructed.

5. Restrictions on work, exercise, and sexual activity for 4-5 weeks or as advised by the doctor.

First Follow-Up Appointment:

It is important to pay attention to the follow-up appointment, which gives an idea regarding the current condition. 

1. It is typically scheduled within 1-2 weeks after surgery.

2. The doctor removes sutures (if applicable), examines the healing, and addresses any concerns.

3. Follow-up care instructions and schedules are provided based on the examination.

Vaginoplasty is a well-adopted surgical technique for vaginal reconstruction and repair. However, like any medical procedure, it's not without potential risks. 

1. Infection and Bleeding: As with any surgery, there's a risk of infection or excessive bleeding.

2. Vaginal Narrowing: In some cases, the vagina may become too narrow (stenosis) after surgery, causing discomfort during intercourse.

3. Fistulas: Rarely, abnormal connections (fistulas) may form between the vagina and the urinary tract (vesicovaginal fistula) or rectum (rectovaginal fistula).

4. Nerve Injury: Nervous damage near the surgical site can occur, potentially affecting sexual sensation.

5. Unsatisfactory Outcome: There's a possibility of being dissatisfied with the cosmetic or functional results of the surgery.

Vaginoplasty can offer various benefits, but it's essential to consider the cost before moving forward. The following table provides an overview of estimated expenses to give patients a better idea: 

Remember, the exact cost can vary depending on several factors, including:

Surgeon's Experience and Expertise: The surgeon's qualifications and experience performing the vaginoplasty can significantly impact the cost.  More experienced surgeons may command higher fees.

Hospital Fees and Location: The type of facility where the surgery is performed and its location will influence the overall cost.  Procedures in metropolitan areas or high-end facilities may be more expensive.

Type of Vaginoplasty Procedure:  The specific technique used during vaginoplasty (laser vs. open incision) can affect the cost.  Additionally, the complexity of the surgery due to the extent of correction needed will also be a factor.

Vaginoplasty offers a personalised approach to addressing various vaginal concerns. It can improve sexual function, alleviate discomfort, and potentially enhance self-confidence. By understanding the types of procedures, potential benefits, recovery process, and risks involved, you can decide whether vaginoplasty is right for you.