Clinic 360

Perineoplasty Surgery

Perineoplasty is a surgical procedure designed to repair and tighten the perineum, the area between the vagina and anus. This procedure is often sought after childbirth or aging, as the perineal muscles can become stretched or weakened, leading to discomfort, reduced vaginal tightness, or aesthetic concerns. At Clinic 360, Dr. Giannoulias specializes in perineoplasty to restore both function and appearance, improving comfort, confidence, and overall pelvic health. Whether performed alone or combined with other vaginal rejuvenation procedures like vaginoplasty or labiaplasty, perineoplasty can help enhance both daily comfort and sexual satisfaction.

Who is a Good Candidate for Perineoplasty?

Perineoplasty is ideal for women who experience:

A loose or weakened perineal area due to childbirth or aging.
Discomfort during intercourse or daily activities.
Aesthetic concerns about perineal scarring or asymmetry.
Mild vaginal laxity that does not require a full vaginoplasty.

Understanding Perineoplasty and Its Benefits

The perineum, located between the vagina and anus, can be affected by childbirth, trauma, weight changes, or congenital conditions, leading to excessive stretching, tearing, or muscle separation. This can result in gaping introitus (an enlarged vaginal opening), causing vaginal laxity, discomfort, and a sensation of “openness.”

Difficult childbirths, especially those involving tearing or an episiotomy, can leave excessive scarring. In some cases, non-invasive laser treatments can soften scar tissue, while thick scarring may require surgical removal. Even without complications, vaginal childbirth places significant strain on the perineal muscles, and improper healing—whether due to natural trauma or incorrect suturing—can lead to pain and muscle dysfunction. Perineoplasty corrects these issues by reopening and resuturing the perineal area to promote proper healing and restore muscle function.

Loosening the Perineal Muscles

While most perineoplasties focus on tightening, some conditions require loosening the perineal muscles. Dyspareunia (painful intercourse) and vaginismus (involuntary muscle contractions) can make sexual activity difficult. In these cases, perineoplasty can be performed to release tension, allowing for a more comfortable vaginal opening.

Vaginoplasty vs. Perineoplasty

While vaginoplasty is primarily a cosmetic procedure, perineoplasty—though also considered cosmetic—addresses both aesthetic and functional concerns. It is often performed to correct issues caused by perineal damage, such as vaginal looseness, itching, incontinence, and reduced sexual sensation due to weakened vaginal muscles. Some women also choose perineoplasty for aesthetic reasons, such as reducing excess skin or bulging in the area.

A key difference between the two procedures is their focus: vaginoplasty tightens the internal vaginal canal, while perineoplasty restores the perineal area at the base of the vaginal opening. The procedure involves making a small incision, removing excess tissue, and suturing the perineal muscles back together for improved function and appearance. Like vaginoplasty, perineoplasty is a minor surgical procedure that typically takes about one hour to perform under local or general anesthesia.

How is Perineoplasty Performed?

The procedure is performed under local or general anesthesia. Dr. Giannoulias removes excess scar tissue and tightens the perineal muscles, restoring strength and support to the area. The incisions are carefully sutured for a natural, refined appearance. If needed, perineoplasty can be combined with vaginoplasty for more extensive tightening.

Perineoplasty Recovery

Most patients experience mild swelling and discomfort for a few days, with full recovery taking about 4-6 weeks. Patients should avoid strenuous activities and sexual intercourse during this time to ensure proper healing. Dr. Giannoulias will provide personalized aftercare instructions to support a smooth recovery.

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Perineoplasty FAQ

What is perineoplasty?

Perineoplasty is a surgical procedure that aims to correct damage to the area between the vagina and anus, known as the perineum.

What different types of perineoplasty are there?

Depending on the condition to be treated, there are two variations of perineoplasty: one aims to tighten the vagina and perineal muscles, and one to loosen them. Both procedures can also involve the removal of excess skin and scar tissue.

What is the difference between vaginoplasty and perineoplasty?

While both vaginoplasty and perineoplasty are considered cosmetic procedures, vaginoplasty is targeted at the inside of the vagina and aims to tighten the vaginal muscles and reduce the diameter of the vaginal opening. Perineoplasty is designed to target a number of clinical conditions, such as vaginal looseness, itching, incontinence, or decreased sexual sensation, which can result from damage to the perineal muscles. Some women undergo perineoplasty for aesthetic reasons if, for example, they are embarrassed by excess skin or bulging in the perineal area.

What types of conditions benefit from perineoplasty?

Gaping introitus, or an enlarged vaginal opening, is a condition where the vagina feels “open” or “gaping.” This could result in feelings of vaginal laxity and a loss of sensation during sexual intercourse. Gaping introitus is often caused by trauma to the perineum, childbirth, aging, weight gain, weight loss, or congenital conditions that can cause the transverse perineal muscles to stretch, tear, or even separate completely. Some women experience trauma to the perineum as a result of episiotomy: a planned incision to the base of the vaginal opening performed by a surgeon to facilitate childbirth, which may heal incorrectly and require repair. For women with scarring resulting from episiotomy, non-surgical laser procedures can “soften” excess scar tissue and extra skin can be surgically removed.

Dyspareunia is a condition characterised by painful intercourse caused by an overly tight vaginal opening, or by vaginismus, which is the involuntary contraction of the perineal muscles. In these cases, loosening of the perineal muscles is required.

What happens during the perineoplasty procedure?

The procedure involves making a small incision at the base of the vaginal opening and suturing perineal tissue back together in order to tighten and shorten the muscles. In cases where loosening is required, a “triangle” of skin is removed from the base of the vaginal opening. Muscles are also adjusted to widen the vaginal canal.

How long does perineoplasty take?

Like vaginoplasty, perineoplasty is a minor surgical procedure that typically takes about an hour to perform.

What other procedures can be performed with perineoplasty?

Perineoplasty is sometimes combined with colporrhaphy, which aims to correct specific defects caused by weakness of the vaginal wall, such as cystocele (protrusion of the bladder into the vagina) and rectocele (protrusion of the rectum into the vagina). In some cases, severe damage to the perineum can cause the weakening and collapse of the rectal sphincter muscle, a condition which can be corrected by combining perineoplasty with an anal tightening procedure.

What kind of anaesthetic is used during the perineoplasty procedure?

Local or general anaesthetic may be used during the procedure.

How long is the recovery time following perineoplasty?

Patients can normally return to sedentary work within about a week following the procedure. Sexual activity should be avoided for at least 4-6 weeks, as should tampon use and any strenuous activity. Minor swelling, bruising, and tenderness can be expected for a few days following surgery, as well as mild to moderate pain or discomfort. These can be treated by applying a cold compress to the area, and through prescription pain medication.

What are the risks associated with perineoplasty?

Like any surgical procedure, perineoplasty comes with a number of risks, such as those associated with anaesthesia, scarring, bleeding, and infection. The clinic takes every measure to ensure these risks are mitigated. When general anaesthesia is used, a qualified anaesthesiologist will be present. Scarring is usually minimal and confined to discrete areas. In fact, perineoplasty may even reduce scarring that may have been caused by previous trauma to the perineum, such as episiotomy. The risk of infection can be greatly reduced by exercising good post-operative hygiene, keeping the area clean and dry, and by taking any prescribed antibiotics and following all instructions for post-operative care. While bleeding is a risk associated with any surgery, it is usually minimal. It is important to inform your surgeon of any anti-coagulant medications you may have taken, such as blood thinners or Aspirin, as well as foods such as garlic and alcohol, which naturally interfere with blood’s ability to clot.

What is the cost of perineoplasty?

The cost of perineoplasty varies according factors such as the extent of work being done, the type of anaesthetic, and the number of simultaneous procedures. Booking a consultation is the best way to accurately price your procedure.

Is perineoplasty covered by my insurance?

Perineoplasty is considered a cosmetic, and therefore elective procedure, and is usually not covered by insurance.

Who is a good candidate for perineoplasty?

Patients who have suffered trauma to the perineum, such as episiotomy, or experienced a loosening of the perineal muscles with age or childbirth are good candidates for perineoplasty. For women who feel that their vaginal entrance has become “open” or “gaping,” or who have excess skin or bulging in the perineal area, perineoplasty could be an effective treatment. Conversely, for patients who suffer from excessive vaginal tightness, such as vaginismus, which causes painful intercourse, perineoplasty can lead to renewed vaginal comfort.