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.
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
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.
- 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?
- 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.
- 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.
- 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.
- 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.
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.
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.