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The vagina lift, also called vaginoplasty or posterior colpoperineorrhaphy, restores the anatomy of the vagina and perineum. Faced with a sagging or distension of their vagina, this operation helps restore a certain tone after childbirth or menopause. The patient can then find a harmonious sex life.

The perineum is a muscle that supports all the weight of the upper part of the body. Endowed with important elastic properties, this muscle plays a key role in female sexuality. Its ability to open and contract participates in sexuality during penetration. He is also in charge of continence and bladder control.

What does a vaginoplasty consist of?

Successive natural deliveries by vaginal route, menopause, overweight, a poorly closed episiotomy ... can cause  trauma to the vagina and perineum . It is especially during the first childbirth that the damage is the most important, especially as the weight of the baby is important. In extreme cases and in older women, this loss of tone of the perineum can cause the bladder, uterus and rectum to descend ( prolapse ).

In younger women, this loss of tone leads to significant sexual disorders  : the woman "no longer feels anything" , her partner has the impression of "floating" . Women can suffer from stress incontinence, vaginal dryness ... Faced with these taboo disorders, women do not always receive the necessary listening to their complaints.

The benefits are generally appreciated  3 months after the surgery . The benefits are of several types:

• The aesthetics of the vulva are improved;
• The sexuality of the woman finds a "normality"appreciated by the couple thanks to a vagina which has regained its tone;
• Incontinence problems(if they were present before the operation) are resolved.

What are the indications for a vaginoplasty?

Perineal surgery can help women who have sexual problems caused by vaginal distension and sagging perineum. It makes it possible to  reconstitute the muscular strap in the form of a sling which ensures the tone of the vagina and its contractility.

The operation will have to wait 6 months after childbirth. During this period, perineal rehabilitation could have solved the problems. But if no improvement occurs after 15 sessions, the lesions may be too severe and surgical repair may be necessary . This operation does not call into question future pregnancies, by discussing the modalities of the future childbirth (classic or cesarean). However, if the desire for a child foresees a near pregnancy, it is preferable to postpone the procedure after the birth. 

This surgery also concerns women who suffer from these disorders during menopause, because of a hormonal deficiency.

EXAMINATIONS DURING THE CONSULTATION

During the consultation, the surgeon will:

• An interrogation and a complete clinical examination. The discomfort felt, the impact on sex life, the possible occurrence of urinary disorders, stress incontinence will be discussed. Other questions will concern childbirth (number of children, birth weight, methods of childbirth assistance - episiotomy, forceps, tearing, etc.) and in postmenopausal women, the possible use of medication;
• The gynecological examination will assess the anatomical condition of the vulva, perineum and vagina. A vaginal examination will test voluntary contractions and loss of tone or even lesions;
• A blood test will also be requested.

EXPLANATION OF THE PLANNED SURGICAL PROCEDURE

Depending on the lesions observed, the surgeon will specify the surgical technique envisaged. In addition to vaginoplasty, other surgical procedures may be associated: placement of a suburethral band in case of stress incontinence. This is the time for the patient to ask all the questions she wishes about the technique, the consequences, etc. 

Documents and an estimate must be given to the patient who will have to benefit from a new consultation before the operation. The recommendations before the operation will also be specified.

Vaginoplasty: how is the procedure performed?

BEFORE THE OPERATION

Some recommendations should be observed before any operation:

• It is recommended to stop smoking at least one month before and after the surgery so as not to hamper healing;
• Aspirin intake is prohibited during the 10 days preceding the operation;
• Stopping oral contraception or hormonal treatment is required to limit the risk of phlebitis (in particular if other risk factors are present: obesity, poor venous condition, coagulation disorders);
• For the same reasons, the surgeon may ask you to buy compression stockings to wear on the day of the operation;
• It is recommended not to eat or drink anything 6 hours before the operation.

Preoperative consultation with the anesthetist must be scheduled at least 48 hours before the operation.

THE STAGES OF THE INTERVENTION

This operation is performed under general anesthesia , although peri-anesthesia is possible. The intervention lasts approximately between 1 hour and 1 hour 30 minutes. It can be performed on an outpatient basis (without hospitalization) or require an overnight stay with a discharge the day after the operation.

Several surgical procedures are performed, each with a different objective:

• To tighten the muscles of the perineum, the surgeon will bring them together and suture them together with absorbable thread to reconstitute the muscle strap.
• To tighten the entrance to the vagina, a vaginal plasty will close the vagina at the bottom to have a narrower opening and positioned higher.
• To rejuvenate the vagina and improve its sensitivity, a lipofilling(reinjection of fat taken in another area) can be carried out in the vagina and the labia majora;
• Other surgical procedures can be associated with this procedure : the placement of a sling against stress incontinence but also a nymphoplasty (reduction of the labia minora), amplification of the G-spot by lipomodelling (injection of fat), treatment an episiotomy scar.

Postoperative after vaginoplasty

The postoperative effects are normally not very painful and conventional analgesics are sufficient to calm them. Showers are authorized the day after the operation.  Local care and special instructions for personal hygiene will be specified by the surgeon. Their good respect is essential. A swelling of the vulva will be found, but it will quickly disappear. Scars are not normally visible.

A "perineum cushion" will provide more comfort for sitting. The patient can resume her normal activities 5 to 6 days after the procedure . A work stoppage of one week is generally prescribed. She will need to abstain from sex for 4-6 weeks . Wearing tampons is prohibited within 2 weeks of the operation. The physical efforts and the carrying of heavy loads are not recommended during the month following the operation.

The possible complications of a vaginaplasty

Recourse to a surgeon authorized for this type of intervention, registered with the council of the medical order and practicing in a truly surgical context, makes it possible to  limit the complications, and if necessary, to ensure an effective and personalized follow-up. If the outcome is usually satisfactory, the plastic surgeon should inform his patients of all possible complications, even the most exceptional.

The risks associated with this operation are very rare  :

• Thromboembolic accident(phlebitis, embolism);
• Skin necrosis especially in the event of heavy smoking, a hematoma, infection, healing disorders (keloid scars).

Contraindications to a vaginoplasty

The contraindications to vaginoplasty are those of any surgical intervention:

• A history of phlebitis or pulmonary embolism constitute formal contraindications to this operation;
• A short-term pregnancy plan is not an absolute contraindication but it is advisable to wait 6 months after the operation for pregnancy;
• Smoking increases the risk of skin necrosis,which can delay healing and delay healing. It is therefore recommended to stop smoking one to two months before the operation and as many after;
• Taking hormonal contraceptives or hormone therapy for menopause increases the risk of phlebitis. In case of other risk factors, it may be asked to stop it a month before the operation.

The cost of a vaginoplasty

It is exceptional that a care is granted for a vaginoplasty , however certain forms of significant relaxation of the muscles of the perineum can give rise to a care. For this, the surgeon will have to write a request for prior agreement that the patient will have to submit to her Social Security center. The medical adviser will then check the clinical elements and give his or her agreement or not.