Definition and Overview
A vaginoplasty is a surgical procedure that tightens, reconstructs or restores the vagina's original appearance. For this reason, the procedure is also referred to as vaginal tightening, vaginal plastic surgery, or vaginal reconstruction.
A vaginoplasty can be performed as an elective cosmetic or reconstructive plastic surgery procedure. It can also be combined with other types of genital surgeries, such as labiaplasty or hymenorrhaphy.
Prior to undergoing a vaginoplasty, patients are advised to discuss its risks and benefits with the surgeon who will perform the procedure or a counsellor to ensure that they are making the right decisions. Most physicians also help patients explore other non-surgical options, such as Kegel exercises prior to seeking a vaginoplasty so patients are able to avoid the risks and possible complications that are associated with the procedure.
Who Should Undergo and Expected Results
A vaginoplasty is beneficial for any woman who has:
- Given birth
- Malignant growths or abscess in the vagina
- Congenital defects affecting the vagina, the urethra or rectum
- Uterine prolapse, or when the urinary bladder protrudes into the vagina
- Vaginal prolapse
- A rectum that protrudes into the vagina
- Experienced trauma to the genital area that affects the vaginal structure
The procedure is also typically performed as a part of sex reassignment surgery.
Congenital disorders that can be resolved with a vaginoplasty include:
- Congenital adrenal hyperplasia - This is the most common congenital vaginal disorder that requires a vaginoplasty as treatment. Caused by the absence or insufficiency of the hormones cortisol and aldosterone, it affects the way the external genitals develop or form. In such cases, the procedure may be performed when the patient is very young, or around 1 to 2 years of age.
- Vaginal atresia – This condition is characterized by a deformed or non-functioning vagina
- Vaginal agenesis – This is a condition wherein the vagina does not develop fully and does not have a canal
- Mayer-Rokitansky-Kuster-Hauser disorder – This is a condition wherein the vagina is completely absent
- Mullerian agenesis or aplasia – This condition occurs when the Mullerian duct fails to develop properly
A woman who has given birth and feels that her vagina has lost its original tightness can undergo the procedure. The muscles of the vagina tend to get stretched, loose, and weak due to childbirth. Although this does not have a major effect on a woman’s health, it may affect her sexual life by decreasing the vagina’s ability to feel certain sensations. Thus, many women undergo a vaginoplasty for the purpose of enhancing their sexual pleasure. When performed for this purpose, the procedure is considered as purely cosmetic or elective and referred to as vaginal rejuvenation.
Women who have given birth multiple times have more to benefit from the procedure than women who have given birth only once. It is also beneficial for those whose vaginal muscles fail to improve even after doing Kegel exercises on a regular basis. After a vaginoplasty, the patient can expect to experience better muscle strength and control, which effectively improves the strength of sensations she experiences during sexual intercourse. Patients who have undergone the procedure report heightened sexual responses, greater friction, and more powerful orgasms. As an added benefit, the procedure also improves the physical appearance of the vagina, which gives women added sexual confidence.
When performed as a treatment for cancer, malignant growths, or trauma, the procedure is considered as reconstructive in nature.
When performed to treat congenital disorders, such as when the vagina did not develop properly, or for sex reassignment purposes, it is considered as a vaginal construction surgery.
How Does the Procedure Work?
A vaginoplasty works by removing excess vaginal mucosa along the vaginal lining to reduce the size of the vaginal muscles. However, the specific manner in which the procedure is performed differs depending on the purpose or desired outcome. The specific techniques used in performing the procedure are the following:
McIndoe surgical technique – In this technique, the appearance of the vagina is improved by surgically constructing a canal from the urinary bladder and urethra going to the pelvic and rectum area. It usually requires a skin graft taken from another part of the patient’s body, such as the thighs or buttocks.
Vecchietti procedure – This is a modern laparoscopic surgical technique that can produce a vagina that is similar to a real normal vagina in both depth and width.
Wilson method – Also known as a penile inversion technique, this is used in cases where vaginal construction is required.
It may be difficult for a woman to walk during the first few days following the procedure, but this will eventually pass. Patients are advised to wait for 4 to 6 weeks before it is safe to have sexual intercourse.
Possible Risks and Complications
A vaginal tightening procedure is fairly safe, but it is associated with some risks and complications, which include:
- Necrosis, or tissue death
- Vaginal shrinkage
- Stricture, or when the vaginal orifice becomes too narrow, a condition that requires another surgery
- Posterior vaginal wall
- Genital pain
- Rectovaginal fistula
Vaginal prolapse, which more commonly affects those who undergo a vaginoplasty for sex reassignment purposes
Other risks involved are those that are commonly associated with any surgical procedure. These include:
Due to the role of the external genitalia in a woman’s life, patients are typically advised to carefully consider the long-term effects of the procedure, such as its impact on future childbirth as well as its emotional and psychological effects. For this reason, patients are normally advised to undergo counseling prior to the procedure.
Miklos JR, Moore RD. Labiaplasty of the labia minora: patients' indications for pursuing surgery. J Sex Med. 2008;5(6):1492–5
Goodman MP. Female genital cosmetic and plastic surgery: a review. J Sex Med. 2011;8(6):1813–25