Vaginoplasty (vaginal rejuvenation) or reduction of the vagina is specialized surgery that was considered taboo for a long time but which has undergone significant development in recent years, particularly in the United States. It can give very good results provided that the operative indication is correct and the surgeon has mastered the technique.
The most frequent request concerns narrowing or tightening of the vagina which has become too lax, gaping, distended or dilated and, also therefore, providing less intense pleasure. Often the request takes place after multiple births, but this is not always the case.
First of all it is advisable to carry out a meticulous clinical examination in order to not be mistaken concerning the diagnosis and, additionally, to not miss any other problem that might exist (prolapse, descent of organs, fistula, incontinence etc.). Once the vaginal laxity is confirmed, the patient’s request must be studied carefully even at the risk of disappointing her. An honest, clear and precise explanation has to be the rule. It is important not to make false promises or have undue expectations, beyond what the surgery could do.
Before considering surgery, pelvic and perineal rehabilitation, such as after childbirth, should often be considered. Sometimes this one solution can prove to be effective provided it is followed assiduously (for at least 3 months or even 6). If rehabilitation fails, surgery can be considered.
Several surgical techniques exist:
Vaginoplasty Light: Lipofilling or hyaluronic acid
Lipofilling: The procedure consists in using liposuction to remove fat from a place where it is present in excess, (the belly, sides, hips, thighs, knees, etc.) and, after centrifuging and purifying it, injecting it circumferentially under the vaginal mucosa. The fat thus applied makes it possible to reduce the diameter of the vagina. It’s a simple, painless, solution that lasts over time. The anesthesia is not necessarily general and the stay in the hospital or the clinic very short (outpatient surgery). The pain is moderate and a return to work possible the next day or the day after. The main risk is injury to the urethra during the injection procedure. This technique is performed for moderate vaginal laxity. The result is immediately visible but it is important to understand that 30% of the injected fat will be absorbed within 3 months of the procedure. The remaining 70% will remain permanently, however. The cost of the procedure depends on the anesthesia chosen and the amount of fat to be injected.
Hyaluronic acid: Hyaluronic acid is a molecule naturally present in the body and absorbable. The principle is exactly the same as for lipofilling except that in the present case there is no need for anesthesia other than local and the hyaluronic acid is absorbable, that is to say that it will disappear over time ( on average 12 months). The injections must therefore be repeated every year. The price depends on the amount of hyaluronic acid to be injected.
Surgical vaginoplasty or vagino-perineoplasty
This is a more demanding technique than the first 2 described and was introduced more than 30 years ago. It is reserved for the most important forms of vaginal laxity. The principle is to remove all the excess mucosa in the vagina (vaginoplasty) and to reattach the vagina to the levator muscles (perineoplasty). Simply removing the mucous membrane from the vagina without fixing it to the levator muscles does not produce any results. The post-operative effects last longer than for the light vaginoplasty (hospitalization is required for at least one night, sometimes a urinary catheter is necessary, pain lasts for 10 to 15 days, and time off work is necessary for 10 to 15 days). The main risk is injury to the urinary tract as well as recurrence.