Perineoplasty

What is perineoplasty?

Perineoplasty (also known as perineorrhaphy) is a surgical procedure to repair or change your perineum. Your perineum is the space between your anus and vagina. A perineoplasty may fix medical conditions, change the look of your perineum or address the feel of your vagina.

Your perineum helps support your reproductive organs and pelvic floor muscles. It also plays a role in sexual function. Its muscles and tissues contribute to vaginal tone and sensation. Vaginal tears during childbirth and other factors can damage or change this area.

There’s a lack of guidelines about when and how to do perineoplasty in the medical field. In general, medical reasons for perineoplasty may include:

• Treating vaginal tear complications, like excess scar tissue or bowel incontinence
• Treating or helping prevent pelvic organ prolapse
• Treating perineal pain

Cosmetic reasons for perineoplasty may include:

• Removing loose or excess skin in your perineum
• Improving vaginal friction during intercourse
• Improving the feeling of a wide vagina
• Decreasing vaginal gas

Talk to your healthcare provider if you have concerns or a lack of confidence about your perineum or vagina. They’re available to help you, not judge you. They may suggest other options. Or they may recommend perineoplasty to help your symptoms.

Does it tighten your vagina?

Sort of. Perineoplasty may improve the sensation of a wide or loose vagina. Pelvic floor muscle weakness is likely the true cause of this feeling. Perineoplasty can reshape or tighten muscles near your perineum. This may make your vagina feel tighter.

Perineoplasty doesn’t change your vaginal canal or the internal part of your vagina.

How should I prepare for perineoplasty?

It’s important to talk to a trusted medical professional before getting perineoplasty. Discuss your symptoms and desires for surgery with your gynecologist. They can answer any questions you have. They’ll also help you understand the risks and benefits, and if other options are available.

Ask them what the recovery process is like and how to plan for it.

What happens during this procedure?

Gynecological surgeons have different ways of doing perineoplasty. The specific steps often depend on the reason for it and if you’re getting more than one surgery.

In general, the steps include:

1. You get local or general anesthesia.
2. Your surgeon makes a cut (incision) in your perineum.
3. They cut out excess skin or scar tissue.
4. They repair the deeper muscles near your perineum. They may reshape the muscles or tighten them.
5. They close the edges of the incision with stitches.

Your surgeon will go over the steps of your procedure. Don’t hesitate to ask questions.

What are the potential benefits and risks of this procedure?

Perineoplasty may help treat medical issues, like vaginal tear or episiotomy complications. It may also help with cosmetic concerns, like how your perineum looks. In general, the satisfaction rate for this surgery is high.

But, as with all surgeries, there’s a risk of complications. They can include:

• Pain
• Bleeding
• Infection
• Scarring or adhesions
• Painful sex
• Altered sensation
• Not getting the desired outcome, like tightness or strength
• A need for reoperation

What happens after this procedure?

As with most procedures, your body needs time to heal after perineoplasty. You can expect some swelling and discomfort during the first several days. Most healthcare providers recommend ice and pain relievers to help with pain. Sitz baths may also be soothing in the first weeks of your recovery.

Your provider may give the following post-operative instructions:

• Don’t insert anything into your vagina for at least six weeks. This includes tampons and menstrual cups. Avoid sexual intercourse.
• Limit activities for at least four weeks. Don’t do heavy lifting or strenuous exercise during this time.
• Drink plenty of water and eat lots of fiber to avoid getting constipated. A stool softener may also help.
• Wear a sanitary pad if you have vaginal bleeding.
• Keep your perineum clean and dry.

After you’ve healed from surgery, most providers will recommend pelvic floor exercises to help strengthen the area. They may provide a list of exercises for you to do at home. Or you may see a physical therapist for several weeks.

What is the recovery time?

It takes between six and eight weeks to recover from perineoplasty. During your recovery, follow your healthcare provider’s instructions. You should limit your activities for at least four weeks and refrain from sex for six weeks.

Are vaginoplasty and perineoplasty the same?

No, they aren’t the same. Vaginoplasty is surgery for the inside of your vagina. It may repair or tighten your vaginal canal. Perineoplasty only helps to restore function and tightness to the muscles at the opening of your vagina and perineum.

In some cases, surgeons do perineoplasty and vaginoplasty at the same time.