Perineoplasty

Perineoplasty (also perineorrhaphy) denotes the plastic surgery procedures used to correct clinical conditions (damage, defect, deformity) of the vagina and the anus. Among the vagino-anal conditions resolved by perineoplasty are vaginal looseness, vaginal itching, damaged perineum, incontinence, genital warts, dyspareunia, vaginal stenosis, vaginismus, vulvar vestibulitis, and decreased sexual sensation. Depending upon the vagino-anal condition to be treated, there are two variants of the perineoplasty procedure: the first, to tighten the perineal muscles and the vagina; the second, to loosen the perineal muscles. Perineoplasty (also perineorrhaphy) denotes the plastic surgery procedures used to correct clinical conditions (damage, defect, deformity) of the vagina and the anus. Among the vagino-anal conditions resolved by perineoplasty are vaginal looseness, vaginal itching, damaged perineum, incontinence, genital warts, dyspareunia, vaginal stenosis, vaginismus, vulvar vestibulitis, and decreased sexual sensation. Depending upon the vagino-anal condition to be treated, there are two variants of the perineoplasty procedure: the first, to tighten the perineal muscles and the vagina; the second, to loosen the perineal muscles. A perineoplasty procedure repairs damage to the perineum and damage to the Vulva that a woman might experience as a result of: Clinically, the woman reports a feeling of physical looseness in her vulvo-vaginal area, which might be associated with decreased sexual satisfaction when compared to the degree of her sexual satisfaction before the incidence of the perineal damage. The indications can include detachment of the anal sphincter muscle, and the collapse of her rectum (rectocele). Perineoplasty is occasionally associated with posterior colporrhaphy, and can be performed in conjunction with the procedure. A perineoplasty procedure first involves a V-shaped incision to the posterior wall of the vagina. Incisions atop the V-incision can be flat, curved, or angled upwards, which incision is applied is determined by the degree of vaginal tightening to be achieved. Once the incision is made, any existing scar tissue and abnormal tissue fixations that resulted from previous injury or surgery or injury are removed. Depending upon the degree of damage occurred to the perineum, the corrections can include the: Stitching of the muscles is carefully performed to avoid creating transverse ridges, and so produce a ridged interior surface in the vagina. The Woman who experiences painful sexual intercourse (dyspareunia), or who is afflicted with vaginismus (involuntary contraction of the puboccygeus muscles) can be treated with a variant perineoplasty procedure that loosens the over-tight vaginal introitus (entry). Some surgeons use a simple surface incision at the fourchette for such loosening, but generally is not the most effectively corrective surgical approach. To perform loosening perineoplasty, a triangle of skin is excised from below the vulvar vestibule with its base near the vestibule and its apex near the anus. This allows the removal of genital warts and the adjustment of musculature necessary to increase the size of the vagina. In this procedure, it is desirable to maintain the vaginal mucosa as much as possible. Recovery typically requires 4–6 weeks. Perineoplasty is generally considered effective for treatment of dyspareunia, including that caused by lichen sclerosus, and vaginismus. It is also considered an effective treatment for vulvar vestibulitis, although it is generally recommended following the failure of nonsurgical methods.