Giving birth to a child brings a lot of joy in one’s life. Additionally it also brings concern for damaged perineum and loose vagina. Vaginal tissue is stretched and muscles separated. If the size of introitus has increased, the feeling of friction is lost and results in sexual dysfunction. Females who delivered vaginally often get an episiotomy at the perineum to facilitate delivery of the baby. This episiotomy heals up and often causes scarring which can result in fibrosis. Resuming their sexual activity again can often result in dyspareunia. This all can in turn affect future pregnancies.
Hence, often this area needs re correction to eliminate the scarred tissue or tighten the loosen introitus. This is what perineoplasty is all about.
Let us understand the normal anatomy of perineum first.
Perineum is the localised area between the vaginal end and the anus. It contains muscles which support the pelvic floor organs.
Childbirth and pregnancy
Aging and menopause
Perineoplasty is the surgery to reshape and tighten the perineum. it narrows the genital hiatus length, removes redundant perineal skin and distal vaginal mucosa, and tightens the introitus with approximation of the muscles. This procedure is ideal for patients without complaints of vaginal laxity, but who are interested in improving the appearance and sexual function of a postpartum perineum.
For better sexual pleasures by treating looseness of perineal tissue.
To treat past chronic perineal tear during delivery.
To treat dyspareunia.
To treat anal sphincter detachment or incontinence.
Can be done to treat multiple warts, vulvar vestibulitis, lichen sclerosis.
Can be done in conjunction with other surgical procedures like vaginoplasty, hysterectomy etc
You are required to meet Dr Deepti Asthana, our gynae cosmetic surgeon.
Thorough history is taken and examination is done.
Decided plan of surgery is discussed in detail.
Preliminary blood investigations ordered.
Blood thinners to be stopped three days prior to date of surgery.
Preferred timing of surgery is usually immediate post menstrual.
Patient is allowed to come only with one attendant to avoid overcrowding.
Patient can have light meals and come, if the surgery is decided for local anaesthesia. However if the patient has opted for general anaesthesia, patient should be empty stomach , i.e. no food, liquids including water orally for atleast 8 hours prior to surgery.
There should not be any upper respiratory tract infection or any fever at the day of surgery or any other major contraindication.
Patient is asked to fill the consent form which also briefs about the possible complications.
It is preferable if pubic hair trimming is done 2 days prior to the surgery to avoid any fresh cuts.
Preoperative photograph is taken.
Local anaesthesia sensitivity testing is done.
Patient is asked to pass urine and proceed to OT room.
Perineoplasty is a daycare procedure of about 45- 60 minutes duration.
Patient is laid on operation table with legs apart.
It is generally done under local anesthesia. Additional oral or iv analgesic may be given if pain threshold is low.
Local anaesthesia is injected at the site of operation field.
A ‘V’ shaped incision is made to the posterior vaginal wall.
Scar tissue, bulges and extra skin tags are removed.
Perineal Muscles are identified and then resutured.
Skin and vaginal mucosa are closed.
Due care is taken to secure complete hemostasis.
In case anal sphincter is defective, its repair done at the same time.
Dressing done. Local ice pack kept.
Early complications include mild pain, bruising, oedema and bleeding which are managed by supportive medications.
Potential late complications include dyspareunia, vaginal dryness, vaginal and perineal restriction, and rarely, rectovaginal fistula.
Women with pelvic organ prolapse, rectocele,or cystocele
Urinary or neurological anal incontinence women
Patient is instructed to take rest atleast for 5 days post surgery.
A course of antibiotics and anti inflammatory drugs are prescribed.
Maintain strict local hygiene.
Maintain adequate hydration.
Eat healthy fiber rich diet to prevent constipatio.n
Avoid strenuous activity like bicycling, heavy weight lifting for 6 to 8 weeks.
Sexual intercourse or tampon insertion is to be avoided for 6 to 8 weeks.
Results are usually ever lasting. Healing is complete in 6 to 8 weeks. Outcome is excellent aesthetic appearance with a more petite look. Less gas noises with intercourse are observed. More frictional forces with sexual relations and improved intimacy are achieved.
But these results are affected if future pregnancy or obesity recurs. So, it is better to go for surgery once family is complete. However, if you are in pain or suffering extreme discomfort, there is no reason to wait for relief.
Team of highly qualified doctors- Dr Deepti Asthana is an internationally trained gynae cosmetic surgeon whereas Dr Ashish Khare is an experienced plastic and cosmetic surgeon.
Each patient gets individual personal attention and care.
Clinic set on high standards with great ambience.
Well trained staff.
Clinic equipped with latest state of the art technology and equipment.
Innumerable happy patients and great past results.
All safety measures for COVID 19 are being followed:
Clinic is being sanitized daily.
Screening of medical staff and patients at the entrance.
Social distancing being strictly followed.
Surgeons are equipped with recommended PPE kits.