Vaginal rejuvenation and vaginal cosmetic surgery have been popularized and performed by several medical specialties – gynecology, uroginecology and plastic surgery.
However, the subject itself is debated more than the technique itself, the line between surgical and non-invasive procedures is the “gray area,” both of which are done for the same purpose.
Vaginal rejuvenation is a relatively new term that refers to repairing the vaginal canal and vaginal introitus to improve sexual function.
The concept refers to “vaginal rejuvenation,” “aesthetic surgery of the vagina,” “vaginoplasty,” “diminishing vaginal diameter,” “vaginal cosmetic surgery.”
The term vaginal rejuvenation has recently created controversy for both specialists and the public eye because of the wrong information about the procedures and the area where these procedures are performed.
One of the terms refers to vulvo-vaginal external surgery such as labyoplasty and hymenoplasty, another refers to surgical procedures that improve sexual function.
In the following, vaginal rejuvenation refers to the surgical procedures of the vaginal canal and introitus which are performed to repair vaginal relaxation by improving the sexual and sensory function of the vagina, and we reserve the term surgical genital surgery to the vulvar area.
Vaginal rejuvenation also refers to the term perineoplasty and vaginoplasty, which are procedures for diminishing the vaginal canal diameter and strengthening the perineal muscles.
The purpose of these procedures is not to correct the defects of the pelvic floor but involves reconstructive techniques for the anatomical reforming of the vaginal canal by decreasing its diameter while reconstructing the pelvic floor.
The reasons for this procedure are functional and aesthetic.
Aesthetically, patients complain about hypertrophy and asymmetry of small labia and unilateral or bilateral hypertrophy of the clitoral folds of the clitoris.
The purpose of the intervention is to get the symmetry as perfect as possible and to reduce it so that it is covered by the big labia.
Functional – Labial discomfort during sex. Most patients report that this symptom has been present for a long time but has increased after birth. Other patients report discomfort during sports activities, including during rides. Irritation accentuated by hypertrophied tissue folds or infection with bacteria or fungi occurs more frequently in adolescents where aesthetic surgery resolves these symptoms with great success. Also excessively large folds around the clitoris can lead to the decrease or absence of orgasm by decreasing clitoral stimulation. Excision of hypertrophic tissues around the clitoris leads to increased sexual stimulation.
Compared to aesthetic surgery on the breasts or face where small asymmetries are immediately reported by patients, external genitalia, small asymmetries even in patients who professionally expose this region in public do not pose any particular problems.
Fortunately, the genital area is very rich in vascularization, the healing process is faster and less complicated.
The most common complications quoted by the literature are edema and discomfort due to lack of rest which is mandatory for several weeks, which is hard to accept by patients – sexual rest is of 6 weeks.
Another problem is labia asymmetry that is well tolerated by patients and can be corrected by local anesthesia. Postoperative infection or bleeding is avoided by correct preparation of the intervention. A problem that we and other colleagues in the US and the UK face is the absence of postoperative imagery, as patients generally do not return to scheduled schedules, being satisfied with postoperative results.
However, the implication of our definition is to listen to women’s shortcomings in sexual function alteration of vaginal relaxation and the possibility of repairing the vaginal channel long before vaginal prolapse occurs.
As we will further discuss, many women complaining of vaginal relaxation actually have a higher or lower degree of vaginal prolapse.
Prolapse and vaginal relaxation occur after repeated births and this is not a new concept because it is already known that natural birth increases the risk for vaginal relaxation, prolapse and urinary incontinence.
Numerous studies have shown that after multiple births there are significant changes in levator muscles, nerves and pelvic floor support, with prolapse, faecal and urinary incontinence in women multiples when compared to non-naive women.
There is ample epidemiological evidence showing that natural birth is a strong risk factor for pelvic floor disorders.
Also, the birth-related disorders are related to sexual function disorders.
SEXUAL PROLAPSE AND FUNCTION
Female sexual dysfunction is defined as a disorder of sexual desire, sexual arousal, orgasm, and / or sexual pain contributing to the appearance of personal suffering.
Sexual dysfunction is a multifactorial, biological, psychosocial disorder plus anatomical changes of the pelvic floor with the onset of prolapse and incontinence.
The question now is: prolapse and vaginal relaxation cause sexual dysfunction and their repair improves
function and sexual sensation of the woman’s vagina?
The repair of the pelvic floor for many years has been an argument for improving the sexual function of women.
Many studies have shown the negative impact of prolapse on female sexual function compared to women who do not have prolapse.
Studies have also been conducted on sexual function at multipath and nulipation, demonstrating negative influence on multiparous sexual function. Correlations regarding urinary incontinence syndrome and sexual function were found in the sense that sexual function is greatly effected in those with urinary incontinence.
Recent studies have shown that improving sexual function 6 months after repairing prolapse and decreasing urinary incontinence
using the PISQ urinary incontinence questionnaire and the TSFI sexual function index.
Today it is known that the back wall of the anatomical vagina controls the diameter of the vaginal canal through the close relationship with the levatori muscle and the genital hiatus. Repairing this wall is the main procedure in vaginal rejuvenation. The postoperative rectocele evaluation showed a good correlation between vaginal caliber and sexual satisfaction.
Enlarged studies have shown that repairing genital prolapse in a woman enriches the sexual function of both the woman and the male.
Assessment of sexual function in women and their partners FSFI and BMSI (brill male sexual inventory) have shown significant improvement in sexual desire, excitement, lubrication and pain loss in women and improved satisfaction among partners
sexual in all respects remains unchanged erection, ejaculatory function and orgasm.