Laser vaginal surgery & vaginoplasty
What is vaginoplasty?
Vaginoplasty is a simplistic blanket term for surgery to either reconstruct or construct a vagina.
Vaginal relaxation and prolapse is the loss of the optimum structural architecture of the vagina. The vaginal muscles become relaxed with poor tone, strength, control and support. The internal and external vaginal diameters can greatly increase. The muscles of the perineum (the group of supporting muscles right outside the vaginal opening at the bottom) thin and separate in the midline producing a weakened, poorly supportive, thinned out perineal body.
Vaginoplasty can be defined as:
It is difficult, from the literature, to appreciate the differences between these three and there is significant confusion and misrepresentation amongst many doctors organisations, individual doctors, patients and patient groups.
I take a rather simplistic but practical approach. In the first instance, a ‘cosmetic’ or ‘plastic’ procedure by definition should be about ‘appearance.’ Thus cosmetic vaginoplasty can only really refer to surgery carried out on the vagina to improve appearance. The interesting fact is that in most cases where the vaginal walls are well supported, the vagina is not actually on view, unless there are protruding structures such as skin tags and hypertrophic hymenal remnants.
Any surgical procedure to the vagina that addresses problems with fascial, muscular or epithelial support must be ‘reconstructive’ by definition. Truly cosmetic or plastic vaginal procedures are defined as above. Vaginal procedures that are claimed to be plastic or cosmetic are likely to be, in most cases, not surgery of any merit. This is because damage to the vagina is rarely limited to the vaginal epithelium and usually involves the fascial and muscular supports.
This section only deals with reconstructive vaginoplasty for the improvement of sensation during sexual intercourse.
Vaginoplasty for Sexual Function
The patient below complained of reduced sensation during intercourse, the impression of a bulge within the vagina and the impression that the vagina was much more patulous than it had been before having children. On direct questioning she reported being embarrassed by the occurrence of vaginal flatus, faecal trapping, much reduced ability to achieve orgasm through vaginal stimulation and felt disconnected during intercourse because of reduced feedback during movement of her partner. On clinical examination she was noted to have a grade 2 prolapse of the anterior and posterior vaginal wall. She had marked vaginal wall relaxation. The interior diameters of the vagina were capacious. She had grade 2 uterine descent and evidence of perineal body detachment.
This photo shows all the levels of damage to the posterior vaginal wall; the vaginal epithelium is stretched and thin, the fascial connective tissue is torn in the midline and the levator muscles are disrupted. What cannot be seen in this photograph is the uterine descent into the mid-vagina which has reduced total vaginal length. More obvious is the perineal body which is detached, contributing to the patients impression of having a patulous vagina and symptoms of reduced sensation and vaginal flatus.
The fascial repair has been completed restoring the deepest level of integrity of the posterior vaginal wall. This has also closed the enterocele protruding through the top of the vagina. There is effective reduction of the diameter of the upper and middle posterior vagina. The distal aspect of the levator ani muscles have been reconstructed, thus reducing the diameter of the distal vagina. Plication of the upper part of the levator ani muscles has not been done as it is associated with a higher level of dyspareunia.
The fascial and muscular defect have been corrected in a ‘site-specific’ manner. The vaginal wall epithelium, stretched and loose, has been trimmed to contour the underlying tissue. Excess tissue excision has been avoided as this may result in scar tissue and dyspareunia. The result is a vagina which is no longer capacious. The levels and angles of support have restored at 3 levels. The outcome reported by the patient was improved sensation during intercourse, absence of vaginal flatus and a very strong feeling of an improvement in self image and confidence.
Rejuvenation” has been described in a variety of ways:
- ‘to make young again’
- ‘restore to youthful vigour’
- ‘restore to a former state,
- ‘make fresh or new again.’
Vaginal rejuvenation has attracted media attention in the last few years. It has been used by doctors offering the service to distinguish the surgery from conventional prolapse surgery and as a marketing tool. It was initially decried by official medical bodies as unnecessary and potentially dangerous.
Surgical vaginal rejuvenation can be carried out using different modalities for primary dissection of the vaginal epithelium
Laser vaginal rejuvenation:
- Diode laser
Non-laser vaginal rejuvenation:
- Cutting diathermy
Dr Onuma does not use the knife or scissors as a primary cutting tool in the vagina. He uses either the laser or cutting diathermy. There is no advantage to either laser of cutting diathermy in terms of the degree of vaginal support or reduction in vaginal diameter that can be achieved. The laser is superior in terms of tissue healing, promotion of collagen formation, reduction of scar tissue and possibly a greater degree of improvement in sensation.
Vaginal rejuvenation for the enhancement of sexual function is reserved specifically for those women who complain that as a result of diminished vaginal sensation (due to vaginal wall relaxation) their enjoyment of sexual intercourse has been dimiinished. It can also be of significant value in women who, as a result of vaginal wall scarring (e.g. result of tears or episiotomy during childbirth or previous vaginal surgery) suffer from pain during intercourse or an overtight vagina where intromission has become painful or impossible.
Women who have lost their libido need to seek appropriate assistance in resolving the lifestyle or medical issues that have caused their problem. Dr Onuma will not operate on women who he feels will not benefit from surgery.
FAQ regarding the surgery of LVR™ and Vaginoplasty
Below are answers to some of the commonly asked questions that we receive. We also offer a complimentary telephone conversation with our gynaecological surgeon, Dr Onuma, to discuss your issues. Clinical advice can only be given if you are a known patient. You can schedule a telephone discussion through Marianne or Kylie by calling +618 8344 6085 or you can make a request via E-mail (firstname.lastname@example.org). Simply provide your telephone number, email address and the best time to contact you. Our policy is to return your call or E-mail within 48 hours. We are continuously updating our web site in order to provide you with a comprehensive and user friendly site that educates, describes, and explains our patient services. Our goal is to provide women with knowledge and choice.
Q: I am interested in having the procedure, can you explain more about it.
A: Because we offer numerous services it is hard to respond to a general question such as this. Dr Onuma would encourage you to make contact to determine your individual circumstances and the options available to you.
Q: How long does laser vaginal rejuvenation take?
A: The surgical time depends on the extent of the procedure. In general the procedure takes about one hour. Where there is significant vaginal wall or uterine prolapse correction of these will be undertaken at the same time and would increase the duration of surgery.
Q: I have vaginal relaxation of the bottom floor of the vaginal and the perineal body. Can I have laser vaginal rejuvenation?
A: In this case we only need to repair the lower floor of the vagina and the perineal body (area immediately outside of the vagina). Usually in this case vaginal relaxation is less extensive. Laser vaginal rejuvenation may also enhance sexual gratification.
Q: Where is the procedure performed?
A: In a fully accredited hospital: St Andrew’s Hospital, South Terrace, Adelaide.
Q: I haven’t had any children but I have some vaginal relaxation and I would like to enhance vaginal muscle tone and strength as well as decrease the vaginal diameter. Can I have the procedure?
A: Depending on your circumstances you can be a candidate for surgery. It is important to note that a future pregnancy can result in damage to any previous surgery. However, appropriately carried out surgery would not interfere with delivery of a baby in the future. You will need to be quite sure that the timing of surgery is correct for you and discussion with Dr Onuma will guide you comprehensively on risks and benefits of surgery.
Q: I have had several children. I have vaginal relaxation and I also lose urine when I laugh, cough, sneeze, or exercise. This problem has really impacted on my life, it is socially embarrassing and hygienically unacceptable. Can I correct my urinary problem and enhance sexual gratification all at once?
A: Your urinary problem is called stress urinary incontinence. Laser vaginal rejuvenation can be combined with minimal access incontinence surgery such as a sling (TVT ) procedure or laparoscopic Burch colposuspension.
Q: Having children resulted in vaginal enlargement, with loose, weak, vaginal muscles. Sex just isn’t as gratifying as before. I performed Kegals and they didn’t help me very much. Please explain to me how Laser Vaginal Rejuvenation can correct my problems and enhance sexual gratification.
A: The laser is used to perform, precise surgical incisions. Surgery aims to tighten the vaginal muscles and support tissues, as well as reduce redundant vaginal epithelium. The procedure will enhance vaginal muscle, tone, strength, and control. It will effectively decrease the internal and outer (introitus) vaginal diameters.
Q: What types of anaesthesia are available?
A: You will be provided with a choice of anaesthesia by our anaesthetist. [local, nerve block, epidural, spinal, IV sedation, general]. Some types of anaesthesia are procedure dependent.
Q: When can I resume sex after laser vaginal rejuvenation?
A: We ask that you abstain from sexual intercourse for 6 weeks. Oral sex may be resumed much earlier.
Q: When can I return to work after laser vaginal rejuvenation?
A: In general returning to work is dependent on the type of work you do. Most patients can return within 2-3 weeks, particularly if the type of work done mainly involves sitting. If your work involves heavy lifting or spending long periods of time on your feet then you might benefit from a longer (4-6 week) recovery period. If LVR is combined with incontinence or pelvic organ prolapse surgery then the recovery time should be viewed as being between 3-6 weeks.
Q: I am from out of town. How long do I have to remain in Adelaide after laser vaginal rejuvenation?
A: You can return home in 4-5 days if you are from interstate. If you are an international visitor then you will need to remain in Adelaide for at least 7 days.
Q: How much discomfort will I have after laser vaginal rejuvenation?
A: With the technique of submucosal tumescence, pudendal block with long acting local anesthetic, most patients report mild to moderate discomfort which can be controlled by oral analgesia.
Q: How much does laser vaginal rejuvenation cost?
A: The fees depend on the type of the procedure and the extent. A quote can be provided once we know your particular needs. Quoted fees will provide a guide as to the fees raised by the surgeon, surgical assistant, anaesthetist and hospital.
Q: Can laser vaginal rejuvenation be combined with designer laser vaginoplasty?
A: Laser vaginal rejuvenation can be combined with perineal body reconstruction and labia minora and majora reduction.
Q: Can laser vaginal rejuvenation or designer laser vaginoplasty be combined with cosmetic surgical procedures?
A: Yes. Dr Onuma works in association with plastic and reconstructive surgeons so as to be able to combine laser vaginal rejuvenation or designer laser vaginoplasty with most cosmetic surgical procedures such as breast, nose, eye, or tummy tuck surgery. Some combination procedures may require a prolonged period of time in the operating theatre and Dr Onuma would weigh the potential risks associated with this compared to having two separate procedures.
Q: What are the surgical risks for laser vaginal rejuvenation?
A: Laser vaginal rejuvenation is a safe procedure with low risk. Like any surgery, the risks include haemorrhage and infection. Injury to the bladder or the rectum is uncommon. With any surgery scarring can occur. Painful sex is a recognised risk. Although rare, there are anaesthetic risks that are dependent on the type of anaesthesia. Prior to any surgery a thorough discussion will take place not only about the operation technique and likely outcomes but also the specific risks associated with your particular plan of management.