Vaginoplasty
is the surgical tightening of the skin and muscles of the vaginal canal from the outside to the inside when they have become loose - a condition called vaginal laxity. It is the gold standard procedure for vaginal tightening. It provides the strongest and most durable results of all available treatments. Vaginoplasty fixes both the perineum and the vaginal canal.
Watch Dr. Marco Pelosi III's video on being recognized as the World's Leading Vaginoplasty Expert:
is the surgical tightening of the skin and muscles of the vaginal canal from the outside to the inside when they have become loose - a condition called vaginal laxity. It is the gold standard procedure for vaginal tightening. It provides the strongest and most durable results of all available treatments. Vaginoplasty fixes both the perineum and the vaginal canal.
Watch Dr. Marco Pelosi III's video on being recognized as the World's Leading Vaginoplasty Expert:
Surgical Vaginal Rejuvenation
is a term sometimes used interchangeably with vaginoplasty.
Laser vaginal rejuvenation is a specific type of vaginoplasty and we offer this type too. Regardless of the technique, the results of a vaginoplasty are dependent upon a well-supported and intact pelvic floor.
Pelvic Floor Reconstruction
is surgery to repair a pelvic floor that is damaged from childbirth, the repair of this damage is integral to a successful vaginoplasty result. We include any necessary pelvic floor reconstruction whenever we perform a vaginoplasty. If this is not done, the vaginoplasty will not work properly.
Watch Dr. Marco Pelosi III's video on vaginoplasty from World Congress of Cosmetic Gynecology:
is a term sometimes used interchangeably with vaginoplasty.
Laser vaginal rejuvenation is a specific type of vaginoplasty and we offer this type too. Regardless of the technique, the results of a vaginoplasty are dependent upon a well-supported and intact pelvic floor.
Pelvic Floor Reconstruction
is surgery to repair a pelvic floor that is damaged from childbirth, the repair of this damage is integral to a successful vaginoplasty result. We include any necessary pelvic floor reconstruction whenever we perform a vaginoplasty. If this is not done, the vaginoplasty will not work properly.
Watch Dr. Marco Pelosi III's video on vaginoplasty from World Congress of Cosmetic Gynecology:
Drs. Pelosi have extensive training, education and experience in all elements of these procedures and include any necessary pelvic floor reconstruction when they conduct vaginoplasty procedures to ensure you the best possible results. They have been doing these procedures for over twenty years and teach them to other surgeons all over the world.
Listen to Dr. Marco Pelosi III's podcast on vaginoplasty patient info:
The Perineum
The perineum is the bridge of tissue between the vagina (V) and the anus (A). Childbirth damage causes the muscle tissue inside the perineum to separate away from the center. This causes the perineum to thin out, shorten and loosen.
Reconstruction of the perineum (perineoplasty) is a part of all our vaginoplasty procedures. Perineoplasty makes the perineum thicker and longer. The middle line (before) and the top line (after) show the change in the bottom of the vaginal opening. This dramatically improves vaginal grip during sex and directs the penis toward the G-spot. If all you need is a reconstruction of the perineum, see our Perineoplasty page for complete details.
The Vaginal Muscles: The Outer Muscles of the perineum
The muscles of the perineum form a partial ring around the vaginal opening. The majority of this ring consists of the left and right bulbocavernosus muscles.
The center of this ring is a fusion point where the bulbocavernosus muscles connect with the transverse perineal muscles. This fusion point is called the perineal body.
The center of this ring is a fusion point where the bulbocavernosus muscles connect with the transverse perineal muscles. This fusion point is called the perineal body.
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The outer vaginal muscles are not the muscles involved in Kegel exercises and women are not usually able to tighten them at will. However, when they are intact and firm they generate a snug yet elastic sensation during intercourse. |
In the surgical photo below, Dr. Marco Pelosi III demonstrates the perineal muscles just before he sutures them during a perineoplasty:
The bulbocavernosus muscles (BCM) and the transverse perineal muscles (TPM) will be tightened
The Vaginal Muscles: The Inner Muscles
The inner layer of vaginal muscles responsible for vaginal tightening are called the levator ani muscles or simply the levator muscles.
The levator muscles form the floor of the pelvis and support the bladder, the vagina and the rectum during normal activity.
These muscles consist of one large sheet of muscle tissue that spans across the entire bony pelvis with an opening in the center called the levator hiatus or the genital hiatus.
This sheet of muscle is shaped like a bowl with the levator hiatus at its center.
The periphery of this bowl is attached to its surroundings by a tough layer of leather-like tissue called fascia.
The center is attached to the tailbone and the perineal body.
The Puborectalis Muscle
The central portion of the levator ani muscle group is called the puborectalis muscle (blue). This muscle loops around from front to back and forms a sling that tightens around the vagina, the bladder and the rectum.
When the puborectalis muscle contracts, the gap between the two sides constricts and the vagina tightens.
Vaginal childbirth can damage the puborectalis muscle by either damaging its nerve supply or by loosening its attachments. Once damaged, the muscle is unable to contract properly and the ability to tighten the vagina is lost or impaired.
The puborectalis muscle is the target of vaginal rejuvenation tightening procedures and you can see the borders of this muscle that Dr. Marco Pelosi III has marked in blue ink in his surgical photo below:
Puborectalis (Kegel) muscles before tightening with levatorplasty stitching
Puborectalist (Kegel) muscles after levatorplasty stitching
Levatorplasty: Tightening of the Inner muscles
Levatorplasty is what makes the vaginal canal tight. It's the tightening of the Kegel muscles and nobody does it better. Dr. Pelosi III's world leading technique doesn't require huge bites of muscle tissue. It doesn't involve high tension. And it doesn't take place without the support of a first-class rectocele repair underneath to take the tension and stress off the sensitive muscle tissue. Most surgeons suture these muscles at only 4 points and leave 4 bulky knots that can sometimes be felt during sex. Dr. Pelosi sutures these muscles at 16-24 points and leaves no knots that can be felt during sex.
Pelvic floor reconstruction is integral to a successful vaginoplasty.
Pelvic and vaginal structural components are frequently broken, not merely loosened from childbirth. This can cause conditions known as cystocele, rectocele and enterocele. Pelvic floor reconstruction techniques restore essential support. Your clinical exam will determine whether your vaginplasty requires these techniques.
If you are seeking nonsurgical vaginal tightening, click here>
If you are seeking nonsurgical vaginal tightening, click here>
Cystocele
This is the technical name for a loose, sagging or dropped bladder. Urinary incontinence is frequently a side effect. The condition most commonly begins during vaginal childbirth when the fetal head stresses and tears the lateral attachments of the bladder to the surrounding musculature along the anterior vaginal wall. Corrective surgery may include sling procedures of the bladder neck and repair of the lateral bladder attachments (paravaginal repairs). See our Urinary Incontinence page for more information.
The line is where the bottom of a normal bladder would be
rectocele
The posterior vaginal wall is also prone to damage from the forces of childbirth. The most common consequence injury to this area is a bulging of the posterior vaginal wall and rectum into the vagina through damaged tissue planes (endopelvic fascia). In some women, bowel movements may be affected by this bulging and require digital pressure through the vagina for complete emptying.
Watch Dr. Marco Pelosi III demonstrate a rectocele as he fixes a vaginoplasty done somewhere else that wasn't tight enough:
Watch Dr. Marco Pelosi III demonstrate a rectocele as he fixes a vaginoplasty done somewhere else that wasn't tight enough:
Enterocele
Damage to the vaginal apex deep behind the cervix (the cul-de-sac) produces bulging of the vaginal wall and the internal pelvic lining (peritoneum). The appearance is similar to a rectocele, but originates deeper along the posterior vaginal wall. Low back pain is a common symptom of this condition.
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Q&A with dr. Marco Pelosi III
Do I have early prolapse? and what vaginal rejuvenation can I consider?
A: So you feel a little loose after three kids?
Looseness after childbirth is the result of damage to the vaginal muscles and to the vaginal supports. These are the same muscles that you use for kegel exercises and also the outer muscles of the vaginal opening (the perineum). The vaginal supports are the same supports that hold up the bladder, the uterus and the posterior vaginal wall.
Your photos show significant damage to the muscles of the perineum. The distance from the anus to the vaginal opening is very short as a result of this damage and the vaginal opening is gaping because the muscle tissue in the center ripped apart at childbirth and is now displaced off the to the sides. An exam would be needed to assess the amount of damage present on the inside, but there is a suggestion that you have looseness in the posterior vaginal wall called a rectocele.
You would need, at minimum, pelvic floor reconstruction of the posterior vaginal wall and a vaginoplasty with full tightening of the muscles of the vaginal canal (levatorplasty) and total reconstruction of the perineum (perineoplasty). This is expert level work that I conduct on a regular basis.
Looseness after childbirth is the result of damage to the vaginal muscles and to the vaginal supports. These are the same muscles that you use for kegel exercises and also the outer muscles of the vaginal opening (the perineum). The vaginal supports are the same supports that hold up the bladder, the uterus and the posterior vaginal wall.
Your photos show significant damage to the muscles of the perineum. The distance from the anus to the vaginal opening is very short as a result of this damage and the vaginal opening is gaping because the muscle tissue in the center ripped apart at childbirth and is now displaced off the to the sides. An exam would be needed to assess the amount of damage present on the inside, but there is a suggestion that you have looseness in the posterior vaginal wall called a rectocele.
You would need, at minimum, pelvic floor reconstruction of the posterior vaginal wall and a vaginoplasty with full tightening of the muscles of the vaginal canal (levatorplasty) and total reconstruction of the perineum (perineoplasty). This is expert level work that I conduct on a regular basis.
What kind of vaginal rejuvenation procedure would be best for me?
After kids, I have a tear on my right labia that I would like put back together. I would like my perineum tightened up and maybe my vagina overall tightened. I don’t know if you can have what appears to be remnant of my hymen cleaned up inside as well. Also wondering about labia majora plumping with fat at the same time. Thanks
After kids, I have a tear on my right labia that I would like put back together. I would like my perineum tightened up and maybe my vagina overall tightened. I don’t know if you can have what appears to be remnant of my hymen cleaned up inside as well. Also wondering about labia majora plumping with fat at the same time. Thanks
A: Vaginal rejuvenation customized just for you
You've got a variety of requests. Vaginoplasty with pelvic floor reconstruction will take care of the tightening and eliminate that hymenal tag that bothers you. Fat injections to labia majora will add fullness to the area and you are a perfect candidate - not too loose, not too wrinkled. The chronic tear on the right labium can be repaired at the same time. The biggest portion of this combo is the vaginal tightening surgery and will require a few days off from work and 8 weeks of abstinence.
You've got a variety of requests. Vaginoplasty with pelvic floor reconstruction will take care of the tightening and eliminate that hymenal tag that bothers you. Fat injections to labia majora will add fullness to the area and you are a perfect candidate - not too loose, not too wrinkled. The chronic tear on the right labium can be repaired at the same time. The biggest portion of this combo is the vaginal tightening surgery and will require a few days off from work and 8 weeks of abstinence.
How does vaginoplasty make the vagina narrower?
My vagina feels like there’s too much empty spacy. I can move my finger far from side to side as it’s way too wide. I understand an incision is made on the posterior wall but how will a vaginoplasty make the side walls closer together?
My vagina feels like there’s too much empty spacy. I can move my finger far from side to side as it’s way too wide. I understand an incision is made on the posterior wall but how will a vaginoplasty make the side walls closer together?
A: How does a vaginoplasty work?
Your vagina feels wide because the muscles inside the vagina are widely separated. If you place your fingers in the vagina deep and tighten, you might feel the muscles get tighter, but you won't feel them come together if you try to squeeze. This happens when the muscles are separated. Vaginoplasty brings these muscles together. When the muscles are brought together, you will be able to squeeze effectively like a champ! It has nothing to do with the skin.
Removing skin doesn't improve your ability to squeeze. I remove a small amount of skin simply to eliminate a lumpy vaginal wall when the muscles are tightened. Now, there's more to a vaginoplasty than muscle tightening. I also have to repair any damage to the supports of the vaginal wall around the muscles and this is called pelvic floor reconstruction and I include this with all of my vaginoplasty procedures.
Your vagina feels wide because the muscles inside the vagina are widely separated. If you place your fingers in the vagina deep and tighten, you might feel the muscles get tighter, but you won't feel them come together if you try to squeeze. This happens when the muscles are separated. Vaginoplasty brings these muscles together. When the muscles are brought together, you will be able to squeeze effectively like a champ! It has nothing to do with the skin.
Removing skin doesn't improve your ability to squeeze. I remove a small amount of skin simply to eliminate a lumpy vaginal wall when the muscles are tightened. Now, there's more to a vaginoplasty than muscle tightening. I also have to repair any damage to the supports of the vaginal wall around the muscles and this is called pelvic floor reconstruction and I include this with all of my vaginoplasty procedures.
