What is a vaginoplasty?

A vaginoplasty is the gynecological subspecialty that seeks to correct and improve anomalies . These anomalies may have a congenital, acquired, or involutional origin, requiring replacement or repair of the vulvar and vaginal anatomy and their functions. It’s divided in:

• Reconstructive or repairing surgery: this surgery aims to hide or reconstruct the destructive effects. These effects can be due to a congenital malformation, a tumor or oncogenic resection, a previous surgery or produced by childbirth.
• Cosmetic surgery: it is done to modify those areas of the body that are not satisfactory for the patient. These could be for sexual satisfaction, age, aesthetic reasons, among others.

What symptoms should we take into account to decide if we need one?

The symptomatology to be evaluated to make this decision can be very diverse. Symptoms can range from a complete prolapse of the uterus to rectocele or urinary incontinence. It can also be for aesthetic reasons of the labia minora of the vulva or a too wide vagina, etc.

Which can be the causes?

There are several causes among which we find:

• Complete absence of congenital vagina as in Rokitansky-kuster-Hauser syndrome (congenital aplasia of the vagina).
• Total vaginectomy for carcinoma (in these cases neovagina is performed).
• Acquired by one or more vaginal deliveries.
• Acquired by menopause.
• Other factors that affect the vaginal wall.

What is the operation about?

Depending on the cause we want to treat, the operation will be different. The neovagina, total vaginal hystrectomy plus anterior and posterior plasty if appropriate according to the cases with plication of the levator ani muscles, only rectocele fixing the posterior vagina to the peritoneum and leaving the amplitude of the vagina according to sexual desires. Also in menopause when there is dyspareunia (difficult or painful intercourse) local treatments can be administered to regenerate the vaginal wall weakened by hormonal depletion.

What benefits does it offer?

The benefits are based on the cause we treat:

• sexual pleasure
• Improved external appearance
• Correction of incontinence of urine and/or feces, in the case of prolapses
• Lead a normal and pleasant life

Hymenoplasty, a type of surgery that is also classified as female intimate surgery or cosmetic surgery, is a surgical procedure belonging to the specialty of gynecological surgery that lasts between 45 and 60 minutes and consists of restoring the hymen , a fleshy membrane in ring shape located at the entrance of the vagina whose physiological function is not clear and whose social value in some cultures lies in guaranteeing female virginity .

When the hymen is torn after sexual contact, the membrane breaks in the form of a “star” and the woman bleeds from the rupture of the hymen, therefore in hymenoplasty the hymen is reconstructed through different processes and a small hole is left for exit of menstruation and other fluids. The stitches reabsorb on their own.

Techniques to perform a hymenoplasty

The simplest is the one in which the remains that may remain of the  hymen are simply joined by  applying local anesthesia. It can only be done in some cases where the break is small.

You can also use a tearable biological material, called Alloplant, which is implanted at the entrance of the vagina in a way that mimics the “virginal” hymen, a technique similar to creating a membrane with a blood supply. Sometimes, it may include a gelatinous capsule of a laboratory-created substance that mimics blood.

A vaginal plastic surgery can be performed, in which an incision is made on both sides of the mucosa that lines the vaginal walls and joins each other. Unlike the other two techniques, in this case you must wait a while before having  sexual intercourse, since you have to give time for recovery and healing. A rest of at least 24 hours after surgery is recommended.

The risks of undergoing a hymenoplasty are:

• Pain
• Inflammation
• Infection in the treated area
• Hemorrhage
• Bladder or rectal damage (rare complication)

After surgery, the  hymen  will behave in the same way as before the first sexual intercourse, and the woman will even feel pain and bleed again as in “her first time”.

Influence of culture in the reconstruction of the hymen

It is a  highly requested surgical practice  for women whose culture places great importance on a woman’s  virginity  and in which the so-called  Virginity Test is practiced , a procedure that determines if a woman is a virgin. The test consists of an inspection of the hymen, assuming that it can only be broken as a result of sexual intercourse.

It emerged as a solution for those women who, without being  virgins,  wanted to appear it on their wedding night. The most consecrated reasons for this are the rejection of one’s own family and/or the husband’s family, as well as the rejection of one’s future spouse.

In some cases in certain countries it is punished with measures that can lead to death by stoning. There are numerous testimonies related to this topic. Also, various societies consider it necessary to ensure a lasting relationship.

The  reconstruction of the hymen  or hymenoplasty can, therefore, be an option for women who, due to social or family pressure, must arrive virgins at marriage.

It is necessary to know that there may be several reasons other than having had intercourse for which the woman may not have a  hymen  or not bleed during the first intercourse, such as:

• One in a thousand women are born without a  hymen.
• Up to 44% of women do not experience blood loss during first intercourse, which means that in some cultures where bleeding is tested, it would not occur.
• The  hymen can be broken by the introduction of a finger or a tampon into the vagina.
• Practice exercises such as horse riding, swimming, cycling or gymnastics.
• Excessive menstrual flow.

Reduction of the vaginal lips (labiaplasty) consists of removing excess skin and mucosa from the labia minora, harmonizing their contours and proportions.

The labia minora have a function related to the protection of the female genital system and vaginal lubrication. Throughout life, they can grow exaggeratedly (hypertrophy) or asymmetrically due to a number of factors, such as puberty, pregnancy, childbirth, use of anabolic steroids and genetic tendencies. Plastic surgery to reduce the vaginal lips (labiaplasty) consists of removing excess skin and mucosa from the labia minora, harmonizing their contours and proportions in relation to the rest of the vulva, without causing functional damage.

Currently, more and more women are looking for labia reduction surgery (labiaplasty). This fact may be related to fashion concepts such as reducing the size of lingerie and bikinis and even the use of fully shaved pubis and perineum. Women who have voluminous and apparent vulvas may be embarrassed in this context. In addition to the psychological discomfort, patients who have exposed and exuberant labia minora may experience discomfort due to the friction generated during the sexual act. The correction of these genital aspects increases female self- esteem and the quality of social and sexual life.

Surgical technique

• Antisepsis + anesthesia.
• Bilateral marking of the area to be resected on the labia minora.
• Removal of excess mucosa and skin from the labia minora.
• Review of bleeding areas.
• Closure of operative wounds.

Postoperative Guidelines

Recovery is quite fast. Relative rest for 2 to 3 days is usually required. After this time, the patient will be able to carry out most of her daily activities. Purple and bumps in the genital area are common and temporary. Major physical exertion and sexual intercourse should be stopped for at least 3 weeks. During the first week (2 to 3 times a day) it is recommended to maintain a rigorous hygiene of the region. Anesthetic ointments, cold compresses, and sitz baths may be necessary. Pain is not frequent.

COMMON QUESTIONS

Reduction of the vaginal lips (labiaplasty) – Indication

Plastic surgery indicated in women who have hypertrophy of the labia minora.

From what age is labiaplasty recommended?

From 17 – 18 years old.

What type of anesthesia is used in labiaplasty?

Local with sedation (most used), epidural with sedation or general.

How long does the sugery take?

From one to two hours.

What is the length of stay?

Hospitalization of six to eight hours. The patient is released the same day.

When will stitches be withdrawn?

Stitches do not need to be removed as they are absorbable.

Are there risks during or after plastic surgery?

Postoperative complications are rare. Among them we can mention: bleeding (hematoma), infection, opening of the surgical wound (suture dehiscence), asymmetry, residual excess of tissue, permanent change in sensitivity, etc.

Reduction of the vaginal lips (labiaplasty) – Result

Postoperative complications are rare. Among them we can mention: bleeding (hematoma), infection, opening of the surgical wound (suture dehiscence), asymmetry, residual excess of tissue, permanent change in sensitivity, etc.