The Ultimate V


“I want you to, for a moment, close your eyes. Imagine that you are about to begin a journey somewhere way out of your comfort zone. Now, begin to see that journey with a guide who knows the route, the diversions, the potential traps, and pitfalls, who understands your fears and your desires. A guide who could place the very words that you are thinking in your mouth just as you struggle to get them out. That guide is me, Oseka Onuma, and I plan to hold your hand and steady your course on this, your personal journey.

The Ultimate V is a personalised, tailored programme, created by me, for you. It is unapologetic in its goal, to restore your pelvic floor anatomy and function using physical means available from surgery and medical therapies. I will treat and, with my assistance, you will maintain.”

Dr Onuma is the author of So, You Want A Labiaplasty and The Ultimate V. These books are unique and aimed at women considering their options for labial, vaginal and pelvic floor improvement.

My concept of The Ultimate V began developing many years ago when I received the 2 emails below:

‘Dear Dr Onuma

Firstly, I would like to thank you for providing such an excellent and informative website for your viewers. I have found much comfort in knowing that I am not alone, and that many women share the same problem that I have. Thank you for bringing this issue out in the open, because I have been through a period of anger and depression, and even resentment towards health professionals for not providing any information on the topic of female sexual gratification and for not informing women that problems like this can be corrected.

I am sad that so many women, including myself, have suffered in silence or accepted it as normal, at the expense of enjoying a fulfilling sex life once again.

I have two children, both, delivered vaginally. With my first child, six years ago, I was advised by friends to avoid a caesarean section at all costs, since it would weaken my abdominal muscles and I would never achieve a flat stomach again. So, I asked my midwife to let me push for as long as I could, and that a caesarean section should be the very last option. My labour lasted 15 hours, and I pushed for a good hour but got into difficulty as the baby was not descending. I went to theatre and baby was delivered by ventouse; with or without episiotomy, I am still not sure. My midwife told me I tore, but my delivery record says I had episiotomy. I had six stitches.

I never regained the vaginal tone, or pelvic floor strength that I had before, despite doing regular pelvic floor exercises. I immediately noticed a change in the appearance and the size of the vaginal opening, and this has really distressed me since. Most disturbingly, my enjoyment of sex has greatly diminished because of the lack of tone in my vaginal muscles. Of course, after having my second child nine months ago, my situation got worse. I am so disturbed by the appearance of my vagina that I don’t like my partner to look at me. Sex is even less fulfilling than before, and the whole situation has started to affect my self-esteem. I used to enjoy a very active sex life with my partner, but now, because I don’t enjoy sex as much, I don’t want sex as much. I feel very unattractive and unfeminine.

After having my second child I actually thought that what I was seeing was a bladder and/or bowel prolapse and became very depressed about it. I found it impossible to share my feelings with my partner, so I found a very good GP and we both went along to see her together. She examined me and told me that I do not have a bladder/bowel prolapse, but a minor prolapse of the vaginal wall.  She said it was normal for someone who has had two children, and that I should try pelvic wall exercises religiously for three months.  If after that, I found no improvement and was still distressed, she would refer me to a gynaecologist.

As I mentioned earlier, I went through a period of resentment towards the health profession, especially for not fully informing women of the trauma following childbirth and for not providing more options for the type of delivery to have. Whilst I have achieved only minimal improvement with pelvic floor exercises, I have yet to go back to my GP for referral to a gynaecologist. Partly, because I think a major source of my frustration was that I could not share this with my partner, but we have since worked through it and he is very supportive.  Also, I am frightened that the gynae will not be as understanding as my GP and give me more exercises to do. I’m sure you have heard this from other women Dr Onuma, but I have very little faith in these exercises to restore my body to even a fraction of what it was before.

My GP told me about a doctor here that does “Designer Vaginas”, but I just laughed it off.  I really didn’t think that real women had that sort of surgery, that it was only reserved for the rich or the weird. I actually didn’t know that it really existed, until a friend of mine told me that her sister had it done. So here I am, seriously considering having this procedure done myself. I want to feel attractive and feminine again, and to achieve a fulfilling sex life with my partner like before. Without those things I don’t even feel like me anymore, it really has affected my self-image.  So, I am asking for your help Dr Onuma. Once again, thank you so much for doing what you do, and for making what is such a sensitive topic easier to talk about.’


‘When I initially looked for a gynaecologist to help me with my concerns; when I told them, “Not only am I concerned about my rectocele, but my labia majora are sagging, my labia minora are too long and my vagina is quite loose.”  Their focus was on just repairing my rectocele and that was the end of it.

When I mentioned my other concerns, the look on their face made me feel rather foolish.  It was already an embarrassing problem, and it became even more embarrassing when I was made to feel silly. I actually had a doctor say to me, “Oh, you’ve just had two kids.  You should see women who have had four kids, it’s like you can drive a bus in.” So basically, it was like, “Be happy you didn’t have two more kids.”  Basically, you are left with the impression that it is something you just have to live with.’

Excellence in Form and Function. Prevent, Treat and Maintain.

Dr Oseka Onuma believes that expertise does not happen by accident, it requires thought, dedication, and hard work. This is his comfort zone. However, expertise is not enough. Empathy combined with experience forms the basis of his approach to pelvic floor medicine and surgery. When you are ready, we will be here for you.

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