Introital ‘plastic’ repair (Fenton’s procedure)
What is an introital ‘plastic’ repair (Fenton’s procedure)?
Fenton’s procedure is a technique for enlarging the entrance to the vagina.
The vaginal introitus can only really be enlarged at the complex composed of forchette, upper perineum and perineal body.
The vaginal introitus is made wider for women who suffer from persistent superficial dyspareunia (painful intercourse) related to a tight or scarred introitus that has not responded to conservative measures.
What is the vaginal Introitus?
The vaginal introitus is the entrance to the vagina, an area bounded superiorly by the suburethral epithelium, laterally by the junction of the vaginal walls and labia minora and inferiorly by the complex composed of forchette, upper perineum and perineal body.
Indications for Fenton’s procedure
Persistent pain during sexual intercourse, where the pain is located at the back of the vaginal entrance and where examination reveals the presence of scar tissue, restricted tissue movement and tenderness.
- Episiotomy scar.
- Childbirth tear scar.
- Scar from previous vaginal surgery.
- Vaginal epithelial tear during sexual intercourse.
- Scarring resulting from radiotherapy treatment.
- Lichen sclerosus.
- Lichen planus.
Surgical technique for the Fenton’s procedure
A vertical incision is made at the entrance of the vagina. The length of this incision is determined by the degree of stricture found and the intended degree of opening required.
The incision is made through the vaginal epithelium at the forchette and can be carried upwards towards the lower aspect of the posterior vaginal wall and below into the upper aspect of the perineum.
It is often necessary to dissect into the underlying perineal body muscle and divide the upper aspect of these in the midline in order to facilitate a decent degree of tissue mobilisation.
The subcutaneous tissue of the vaginal epithelium is mobilised to the left and right as well as the distant ends of the vertical incision.
The incision is closed transversely so that the two vertical ends of the incision meet in the midline and the middle adjacent parts of the incision end up on the left and right of the new wound.
Internalised (subcutaneous or interrupted buried) sutures reduce the risk of scar tissue forming on the closed incision.
- No coitus for 6 weeks.
- No digitation of the vagina.
- No strenuous activities for 6 weeks.
- Gentle dabbing of area for cleansing without rubbing.
- You may be required to use oral antibiotics for a few days.
Potential complications include:
- Partial or complete breakdown of reconstruction.
- Infection without wound breakdown.
- Temporary painful coitus.
- Repeat procedure required to achieve less painful coitus.
- Recurrence of symptoms.