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Central Florida UroGynecology

Marja Sprock, M.D.

Vaginoplasty and the “Designer Vagina”

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The marketing terms used to describe vaginas are amazing. A “designer vagina” is a very catchy term, but will probably mean something different for different women and possibly their partners. A vaginoplasty is a reconstructive surgery of the vaginal canal. It is a procedure which aims to tighten up a vagina which has become slack or loose from vaginal childbirth. It is also used to describe the creation of a vagina in either women born without one or in transgender surgeries.

The vaginoplasty we will focus on is the one related to the “designer vagina.” Vaginal tissues can stretch and sometimes overstretch and not return to their previous tightness. Laxity of muscles can often be corrected with correctly performed pelvic floor or “Kegel” exercises. A stretched out vagina however can’t be fixed by a “Kegel marathon.” Compare someone who has lost a large amount of weight, the abdominal, arm and leg skin will often hang and no muscle training will completely tighten it. It often requires removal. Even though I am a firm believer in pelvic floor exercises, it can’t correct an overstretched vagina to the level where there is a nice tight fit, like “how it used to be”. Nowadays a lot of women choose to have the vagina corrected instead of feeling shortchanged on vaginal sensation.

Vaginoplasty is considered cosmetic surgery, unless you have prolapse in addition. Prolapse or descent of organs in the vagina, like the bladder, rectum, bowel, uterus or cuff (area after hysterectomy). Once prolapse is corrected, the vagina is often tighter and could also give the idea of having had a vaginoplasty. Surgery for prolapse is usually insurance covered, vaginoplasty for cosmetic reasons is self-pay.

If the bladder is prolapsed it is often difficult to empty with urination and may keep you up at night, when emptying is usually easier. Reconstructive surgery, like an anterior colporrhaphy would improve the function. Cosmetic surgery vaginoplasty changes the aesthetics of essentially normal anatomy. Obviously it is debatable if a stretched out vagina is normal, however it is not prolapsed. Vaginal rejuvenation is a term often used to describe labiaplasty and vaginoplasty: restore and enhance the function and cosmetic appearance of the vagina and vulva. Some women dislike the appearance of their labia, or they are in the way with performing sports and have them shaped smaller. The vaginoplasty is a different procedure and focuses on the vagina. It can make the labia look closer together, since it could tighten the vaginal opening. Some women like the vagina tighter, but not the opening, since their partner has some erectile dysfunction. If women have a partner it is important to know the approximate size of the partner’s penis, since they are not all built the same. Some women have requested to make it extra tight, since their partner is small, while others like to be prepared for an average or large size.

Vaginoplasty tightens the vaginal walls and reinforces the support and may tighten the vaginal opening if desired.

ACOG (American College of Obstetrics and Gynecology) warns that vaginoplasty is not a medically indicated procedure and the safety and effectiveness are not documented.

ACOG also states that women should be informed about the lack of data supporting the efficacy of these procedures and their potential complications, including infection, altered sensation, dyspareunia (pain with sex), adhesions and scarring. Even though ACOG makes a valid point regarding concerns about sexual gratification in it that sexual dysfunctions and exploration of non-surgical options need to be addressed; women know they can’t counsel their vagina tighter. In reality by fixing prolapse we have noticed for years the often welcoming side effect of a tighter vagina.

It is a little behind the times and not supportive of women who choose their own destiny to state vaginoplasty should be discouraged. If your vagina is stretched out and muscle training has not tightened it, there is no need to suffer for years. It may be a natural effect of childbirth, but that does not mean it has to interfere with an enjoyable sex life for the years after. Very few women present at the urging of their partner, most will do it to enhance their own pleasure as research has shown. A lot of women are fine with the size and shape of their vagina, but for those who experience a “stretched” out vagina, a vaginoplasty could be a great surgery.

Sexual pleasure is dependent on numerous factors and a better “fitting” vagina helps. Marja Sprock, M.D. has years of experience in vaginal surgery and is a board certified in female pelvic medicine and reconstructive surgery as well as obstetrics and gynecology.

published onFebruary 9, 2011