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Urogynecology, Vaginal Rejuvenation

Vaginal rejuvenation surgery has become a growing trend not only in the United States but worldwide. As women remain healthier and more youthful into later years, the negative effects on the pelvic anatomy as a result of childbirth, hormone deficiency, and aging are all challenges that can now be effectively addressed. In some cases it is necessary to revise prior surgical procedures or scars from bad episiotomies. In other cases and often concomitantly, vaginal rejuvenation surgery can be used to restore the proper caliber and tone to the vaginal canal that has become “loose” due to the reasons listed above. The field of vaginal rejuvenation is a highly specialized field with relatively few surgeons who are properly trained in performing these delicate procedures. Vaginal rejuvenation as a discipline includes a broad array of different approaches to reconstituting normal esthetic anatomy as well as function and support to the vagina and surrounding organs. Successful outcomes call for a combination of both surgical and nonsurgical approaches which may include physical therapy and biofeedback, hormone replacement along with specific corrective surgical procedures. When surgery is indicated, specific objectives are identified in a private consultation with physician and patient so that all related concerns and defects may be addressed simultaneously. Issues related to vaginal rejuvenation may include bladder and bowel dysfunction, and require a thorough evaluation, including computerized urodynamic studies, pelvic ultrasound or cystoscopy along with a thorough history and pelvic examination. Successful results include the correction of both the functional and cosmetic defects of the vagina and pelvic organs. When these clinical goals are addressed and met, the result is often a renewal of both self esteem and intimacy for affected women. Listed below are a number of related procedures along with a description of the defect and indications for corrective surgery.

Vaginal Relaxation Surgery

Pregnancy and vaginal childbirth often result in some form of relaxation of the vaginal supporting tissues. This can produce varying degrees of vaginal relaxation. A lax or “loose” vagina can often cause sexual dysfunction for both the woman and her male partner due to suboptimal contact during intercourse. Women can also develop significant loss of vaginal wall support leading to various degrees of vaginal prolapse. Most commonly they will experience the development of a cystocele (fallen bladder) which gives rise to urinary tract dysfunction including bladder infections and incontinence. They may develop a rectocele (rectum pushing into the vagina) which can lead to bowel dysfunction, including both constipation and, in some cases, loss of fecal control. In addition they may experience uterine prolapse (fallen uterus) which may actually protrude from the vagina while sitting or standing. In addition to causing urinary and fecal problems these vaginal prolapse conditions can also have a negative impact on sexual performance. Vaginal relaxation surgery may address both the tightening of the vaginal canal as well as the correction of the prolapse. In cases where the patient is also experiencing urinary incontinence, corrective procedures such as a pubo-vaginal sling are also performed in the same setting. These surgical procedures are performed using a combination of surgical tools including laser and electrocautery to minimize peri-operative bleeding and surgical trauma, and are most often performed on an outpatient basis.

Reductive Labiaplasty

This procedure will correct the function and appearance of the the inner lips (labia minora) of the vagina. The reasons women may consider reductive labiaplasty are related to the large or asymmetric appearance of the tissues in some cases that may cause discomfort in clothing during physical activities or intercourse. Not uncommonly, the large asymmetric appearance of the labia may also make some woman feel self-conscious which has the potential to adversely affect their sexual intimacy. The surgery consists of removing the excess skin with carefully planned surgical tailoring using combination of laser, fine surgical scalpel, and plastic surgical scissors.

Unhooding of the Clitoris

Normally the prepuce (clitoral hood) is anatomically designed to protect the clitoris against undue abrasion and overstimulation, and naturally retracts during intercourse thereby leaving the highly innervated surface of the clitoris exposed. Sometimes women either have a small clitoris or the preputial skin is thickened making it impossible for the clitoral glans to be exposed during intercourse. Often these women have difficulty in achieving orgasm. Corrective surgery involves the careful removal of the excessive skin overlying the clitoris.

Hymenoplasty

This procedure restores the delicate hymenal tissue to a virginal state. The surgery is very successful with minimal risk or discomfort.

Labia Majora Augmentation Surgery

Some women may have very thin outer vaginal lips and would feel more comfortable if they were fuller. This is easily achieved in a similar way that lips on the mouth are made to look fuller. The labia majora can be made to look fuller with bulking agents or the woman’s own fat obtained by liposuction from such areas as the mons pubis. The skin surrounding outer vagina and perineum can also be treated with combination injections of bulking agents and laser resurfacing to restore a more youthful appearance of the region.

A Word About Insurance and Medicare

Vaginal rejuvenation is multifaceted. It involves correction of both the cosmetic appearance of the vagina as well as the function of the vagina, bladder and rectum. Many of the procedures used for evaluating and correcting these defects are therefore covered by insurance and medicare while others are not. Once the initial consultation has been done, a list of necessary procedures is generated and a precertification specialist will contact your insurance to confirm your benefits and determine your out of pocket expenses.