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Perineoplasty Surgery

A perineoplasty is a plastic surgery which targets and corrects the area between the vagina and anus, known as the perineum. While this area seems small, it provides structural support to a number of surrounding organs and houses muscles that contribute to vaginal tightening and loosening.
Perineoplasty Surgery
Depending on the condition to be treated, there are two variations of the surgery: one involves the tightening of the perineal muscles and vagina, and the second involves loosening them. Both procedures can also include the removal of unwanted skin and scar tissue.

Vaginoplasty vs Perineoplasty

  1. While vaginoplasty is a largely cosmetic procedure, a perineoplasty, though also considered cosmetic, typically addresses a number of clinical conditions that result from damage to the perineal area, including vaginal looseness, itching, incontinence, and decreased sexual sensation due to the inability of the vaginal muscles to properly contract. Some women may undertake a perineoplasty for aesthetic reasons if, for example, they feel embarrassed about excess skin and bulging in the area.
  2. Another difference between vaginoplasty and perineoplasty is that while vaginoplasty targets the inside of the vagina, a perineoplasty focuses on the area at the base of the vaginal opening and the surrounding muscles and tissues. The procedure involves making a small incision at the base of the vaginal opening and suturing perineal tissue back together. Like vaginoplasty, a perineoplasty is considered a minor surgical procedure, and typically takes about an hour to perform, under local or general anaesthesia.

What are some conditions perineoplasty aims to correct?

  1. Trauma to the perineum, childbirth, weight gain, weight loss, and some congenital conditions can cause excessive stretching, tearing, or even separation of the transverse perineal muscles, leading to a condition known as gaping introitus, or enlarged vaginal opening, which could lead to vaginal laxity during sex and a general feeling of “openness” in the vaginal area.
  2. Some women experience difficult or complicated childbirths which can include tearing or episiotomy, which is a planned incision to the perineum or vaginal wall made by a surgeon during labour in order to facilitate childbirth. As a result of such complications, the perineum endures significant trauma and some women are left with excessive scarring. In such cases, non-invasive laser techniques can “soften” scar tissue and excessively thick scar tissue can be removed surgically.
  3. Even without complications, vaginal childbirth can place great stress on the vaginal and perineal muscles, or perineal trauma may be incorrectly sutured by an inexperienced doctor, nurse, or midwife, causing muscles to heal improperly and leading to pain, discomfort, and muscle malfunction. A perineoplasty aims to correct such conditions by reopening and resuturing the perineal area in a way that promotes proper healing.
  4. A perineoplasty is sometimes performed in combination with a colporrhaphy, which seeks specifically to correct defects in the vaginal wall such as cystocele (protrusion of the bladder into the vagina), and rectocele (protrusion of the rectum into the vagina). Such conditions can cause the muscle of the vaginal wall to function improperly and lead to pain and discomfort during sexual intercourse, as well as incontinence. In some cases, severe damage to the perineum can cause collapse or dysfunction of the rectal sphincter muscle, a condition which can be corrected by combining a perineoplasty with an anal tightening procedure.
  5. Some conditions call for a loosening of the perineal muscles. Dyspareunia is a condition characterized by painful intercourse, often caused by an overly tight vaginal opening, or by vaginismus, wherein the muscles of the perineum contract involuntarily, making sexual intercourse very difficult. Both cases can be corrected with a special kind of perineoplasty in which sections of skin are removed from both the front (anterior triangle) and back (posterior triangle) of the vaginal opening, allowing for the loosening of the vaginal muscles.

Who is a Good Candidate for a Perineoplasty?

Good candidates for a perineoplasty include patients who suffer from any of the aforementioned conditions, or women who have simply undergone difficult or traumatic childbirths, possibly necessitating episiotomy, which have resulted in damage to the perineal muscles and a feeling that the entrance to the vagina is “open” or “gaping.” Conversely, patients who suffer from excessive tightness of the vaginal opening, a condition which can cause painful intercourse, may also benefit from a perineoplasty. For most of these conditions, a perineoplasty is an effective treatment that can repair and restore the perineal muscles, leading in many cases to renewed vaginal comfort and sensitivity.

Perineoplasty Recovery

Recovery from a perineoplasty is similar to that following vaginoplasty. Full recovery takes about 6 weeks and patients are advised to refrain from sexual activity until this time, as well as any heavy lifting, strenuous activity, or tampon use.
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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. However, patients undergoing perineoplasty to correct specific medical conditions may qualify for coverage. It is recommended that patients contact their health insurance providers for more information.
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.