A Patient's Perspective
“Since having my daughter I have lost a lot of sensation during intercourse. At the time of her birth I had three different people saying to me, “you need stitches,” but I didn’t get any. Now I avoid intercourse because of that reason. It feels like everything is lower, feels like a prolapse, feels like everything is falling downwards. I can see a little lump at the entrance and I didn’t see that prior to having my daughter. There’s also a skin tear and tag at the entrance where it healed. I saw some doctors but I was told someone would care for me and love me for who I am. But I’m too embarrassed so how will I meet someone, and then it’s uncomfortable.”
What is Vaginoplasty?
Vaginoplasty is a simplistic blanket term for surgery to either construct or reconstruct a vagina
Vaginoplasty can be defined as:
- Reconstructive
- Plastic
- Cosmetic
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.
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.
What is Sexual Function Surgery?
Surgery for sexual dysfunction must aim to improve sexual dysfunction disorders that have their root in a physically identifiable cause. In order to achieve this, the principle of surgery is to restore anatomy to as close to normal as possible.
Whilst the resolution of physical problems may result in psychological benefits, surgery is highly unlikely to be beneficial for women whose primary problem has a psychological, psychiatric, hormonal or endocrinological aetiology.
