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Vaginal Tightening Facts & Questions

Procedure Overview

Operative Time:
Vaginal Rejuvenation 1 – 3 hours depending on the extent of damage

Anesthesia General:
Patients have the choice of general and epidural anesthesia. Most commonly patients will undergo general anesthesia allowing for the patient to have the ultimate relaxation during the surgical procedure.

Performed in Operating Room:
Vaginal rejuvenation can incorporate a number of various surgical procedures and approaches. Most patients require only a surgical approach through the vagina however it is possible that in severe cases the surgeon may also need to approach laparoscopically (ie miniature incisions through the abdomen). Here at Atlanta Urogynecology Associates we usually perform our surgeries in the operating room at Northside Hospital, the largest hospital system in the southeastern U.S.A.

Post Operative Pain:
Though there are no generalized statements about the pain you will feel after having a vaginal rejuvenation, anecdotally I feel comfortable making the following statements: 1) approximately 30% of the patients really have no or mild discomfort the following morning after surgery 2)70% are practically pain free the first week 3) 90% of patients are practically pain free after 2 weeks.

The majority of patients receive Toradal (ketorolac), a very potent anti-inflammatory and non narcotic pain reliever before getting off of the operating room table. This is repeated every 6 hours intravenously. This is coupled simultaneously with narcotics intravenously for the first 24 hours if the patient stays in the hospital. Upon discharge the patient remains on Toradol for 2 1/2 more days every 6 hours (oral medication) as well as using narcotics (Lortab, Percocet, Dilaudid) every 4-6 hours.

Recovery

24-48 hours
The first 24-48 hours the patient should use ice packs on her external vagina i.e. at the surgical site to reduce swelling. Often patients will purchase two or three bags of frozen peas and keep them in a freezer. The patient will use them as an ice pack on their labiaplasty site and should rotate them every 30-60 minutes. Rotating the ice packs assures the best chance to minimize swelling of the perineum postoperatively. You may do routine tasks the day after surgery as long as there is minimal irritation to the surgical site. Loose clothing is a must.

Up to 6 weeks
Resume most normal everyday activities that do not require physical exertion or much friction in the area of healing. We do not recommend riding motorcycles, horses, bicycles for the first 4 weeks after surgery. No heavy lifting of pushing or pulling. Anything that requires excessive straining on the pelvic floor with the exception of getting up out of bed or a chair, straining to have a bowel movement would be considered excessive. Minimize straining on the pelvic floor anything that creates excessive straining should be avoided.

How long will the sutures last?
The sutures are made of a delayed absorbable material called Vicryl or Monocryl. These sutures usually dissolve in 6 weeks, however we have seen them last anywhere from 3-12 weeks. At which point they dissolve and the ends of the sutures fall off. There is no reason to surgically remove the sutures. Sutures inside the vagina often create a fair amount of discharge. The discharge is yellow/white and is not a concern. If the patient has a fever (Temp > 101 F) with or without a yellow discharge might be cause for concern. Contact your surgeon at this time.

Resume Driving
You may resume driving when you are no longer using narcotics. For some patients this may be as soon as the first day after surgery. There is an exception and that is for cars and trucks where it requires a great amount of force to push on the clutch to shift gears. Most women do not drive manual transmission, that doesn't mean we don't have a few race car drivers in our patient mix.

Resume Work
Most patients can resume work in as soon as 1 week, however this is dependent upon the type of work that one does. Patients whose work requires heavy lifting, strenuous exercise, jumping etc. ...You can go back to work in 1-2 weeks with restrictions. Usually going back to work is based on a patient's ability to tolerate discomfort.

In many instances patients with desk jobs, especially those who run their own businesses want to get to work as soon as possible. If what you do is sit at a desk filling out paperwork, check the stocks on a computer or manage and delegate all day I recommend getting back to work whenever you feel ready. We have had many CEO, CFO and executives literally go back to work within 48 hours.

Resuming Intercourse
Resume intercourse with-in 6-12 weeks depending upon the surgery you might have had to do the vaginal rejuvenation. If you had all of your surgery done through the transvaginal approach (ie done through the opening of the vagina) you may resume intercourse at 6 weeks.

If part of your surgery was done laparoscopically (ie done through small incisions in the abdomen) you may resume intercourse in 12 weeks.

What should I expect when resuming intercourse?
The first time you engage in intercourse it will feel very similar to having intercourse after having a baby. General tenderness and tightness is usually noticeable. Edema (swelling) will still be present for a couple of month inside of the vagina. The tenderness/ tightness usually dissipates over a few months until you accommodate to the new sexual experience.

Can I take a shower / bath / go swimming?
You may shower the day after surgery, however you should not scrub the incision areas. They can be bathed gently using a soft washcloth, soap and water. No tub baths for 4 weeks including pools, oceans, hot tubs, etc.

*A detailed aftercare plan will be outlined by your surgeon and given to you during your surgical scheduling

Frequently Asked Questions

I have never had kids, but I really want to be "tighter" - am I a good candidate for Vaginal Rejuvenation?
Dr. Miklos & Moore are often presented with this question. Many patients and doctors do not believe that a patient can have a "loose vagina" if they never had a child. This is ABSOLUTELY NOT TRUE.

Women who have not experienced a pregnancy are less commonly afflicted with vaginal relaxation. However at times these women can be afflicted due to a number of reasons including: 1) genetics i.e. women born with weak pelvic floor muscles and supportive structures 2) excessive stress and strain on the pelvic floor from activities such as weight lifting, pushing, or heavy lifting 3) chronic stress and stress due to medical problems such as chronic cough, asthma, constipation, COPD. So it is possible to have vaginal relaxation due to just pure bad luck (i.e. genetics) or due to excessive strain on your pelvic floor (an situation similar to bearing down during bowel movements). The only way to know if you would benefit from vaginal rejuvenation is to have an experienced surgeon examine you and discuss your exam as well as your postoperative expectations.

When I cough, sneeze or laugh, I leak urine and it's really embarrassing. Will vaginal rejuvenation help with stress urinary incontinence?
Many websites and vaginal rejuvenation specialists will tell you that vaginal rejuvenation will effectively treat your stress urine incontinence. Dr Miklos and Moore are not only cosmetic vaginal surgeons but are fellowship trained urological gynecologists. They have been treated with the latest and greatest surgical techniques for the treatment of stress urine incontinence. The best operations ever developed are slings (TVT, TOT, mini, traditional slings), Burch procedures and MMK procedures. These operations have cure rates of:

90-95% at 1 year
85-90 % at 5 years
80-85% at 10 years

Vaginal rejuvenation procedures used to fix stress urine incontinence have cure rates of approx. 50% at 1-5 years. Drs' Miklos & Moore recommend coupling vaginal rejuvenation with a sling procedure at the same surgical setting to accomplish both vaginal tightening and stopping stress urine leakage.

The bottom floor of my vagina is "relaxed," and so is the perineal body. Can I undergo Vaginal Rejuvenation? Can it help me?
This is actually the most common complaint and finding in patients who feel they would like to pursue vaginal rejuvenation. The answer to this question is a resounding "YES". In fact this is the best case scenario, a patient who only needs to procedures, fixing the floor of the vagina and the perineum. These two procedures are the two most commonly utilized procedures for vaginal rejuvenation.

What is the success rate of vaginal rejuvenation surgery?
As of 2011 there exists only TWO PAPERS in the entire surgical medical literature that are dedicated to the concept of vaginal cosmetic surgery and the treatment of vaginal relaxation to improve friction during intercourse. These two papers are:

  1. Pardo
  2. Goodman

The success rate is 85% in both of these papers. Meaning that 8-9 patients out of 10 did feel their surgery was beneficial in improving friction during intercourse. Dr. Miklos and Moore will be the first to inform you that these are indeed the facts and that no operation carries 100% success rate. Dr. Miklos & Moore wish that every patient had perfect results but they don't for a number of reasons including:

  1. The surgery was just not tight enough for the patient
  2. The sutures of the surgery did not hold in the patients WEAK tissue , causing the tightness to relax before complete healing / scaring occurs
  3. The patient pelvic floor muscles are so rigid due to prolonged nerve damage it is impossible to approximate them during surgery to give the a dequate tightness

How long will my results from Vaginal Rejuvenation Surgery last?
This question cannot be answered using scientifically proven data or literature; the studies have not been done. Even if studies were performed it would be impossible to make generalized statements as to the actual longevity of the surgery because no two patient's problems, surgery or anatomy are identical.

However in theory we suspect that most patients will surgeries will last a lifetime, realizing that most vaginal damage is due to the trauma of vaginal deliveries. If a patient never has another vaginal delivery this should minimize trauma to the pelvic floor and allow the vaginal rejuvenation surgery to last until the natural process of aging takes over.

Example: If a patient gets a face lift at the age of 50 will her face lift still be working perfectly at age 60, 70 or 80 years of age? The answer is an obvious NO!! Aging and gravity have untoward effects on all of our muscle, connective tissue, tendons and ligaments. This doesn't mean the face lift is not working well enough to meet the needs of the patient, the same goes for vaginal rejuvenation surgery.

Click here to view Before and After Photos


Vaginal Relaxation Before and After Photos

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