Why is narrowing alone not enough?
The source text is clear: perineoplasty is not simply narrowing the vaginal entrance by cutting and stitching skin. That common approach creates an unnatural band of skin and leads to pain during intercourse.
Narrowing the entrance with sutures may also give a good result in terms of appearance; but it cannot rebuild the perineum — because it does not touch what actually matters, namely strengthening the muscles and the supporting structures.
What is actually repaired: the perineal body
The perineal muscles contract to protect the area when pressure inside the abdomen rises. But if that pressure stays above normal for a long time — pregnancy and vaginal birth are the typical examples — these muscles weaken, shift and descend.
The main aim of the operation is to rebuild the perineal body, the point where the perineal muscles and the anal sphincter meet.
An established misconception is corrected here: the perineal body was traditionally regarded as the "central tendon of the perineum". It has been shown that this is a misnomer — on tissue examination it is not a tendon but the meeting point of muscles.
A small perineal body is strongly associated with posterior compartment prolapse. It is therefore a measurable structure and is taken into account in the assessment.
When is it performed?
- As part of repairing posterior wall and perineal prolapse — this is where it is used most often.
- As a procedure on its own: to improve sexual function by narrowing and strengthening a lax vaginal entrance at the level of the muscle.
- To address concerns about appearance.
- To remove tender scars remaining after repair of the cut made at delivery (episiotomy) — this is a fairly common reason for the operation.
Who is it not performed on, or postponed for?
- It should be postponed in women planning a vaginal birth.
- Active infection and undiagnosed skin conditions of the external genital area must first be clarified and treated.
- Vulvodynia (persistent pain in the external genital area) is a relative contraindication — genital surgery may make it worse.
- If there are problems with bowel movements, the opinion of the relevant specialist should be obtained before surgery.
Assessment before surgery
The source stresses that this assessment must be thorough. Regardless of any expectation about appearance:
- A detailed medical and sexual history is taken.
- Whether there are problems with bladder, bowel and pelvic floor function is established.
- Open questions are asked about sexual life, orgasm, comfort, laxity and lubrication.
- The examination is carried out both gynaecologically and standing; the patient is asked to cough and to bear down — because the true degree of prolapse is only seen on straining.
- A rectal examination is performed and the nerve responses of the area are checked.
Using a mirror, a finger or a dilator, and taking photographs, helps you understand the situation and see the extent of the planned operation.
Patients are expected to be in good general health, and the planned procedure should be explained to you in language you understand. Legally, you must be given time to read and discuss the detailed consent document.
Surgery and recovery
- Operations on the external genital area can be done as day cases; local anaesthetic is usually the most suitable option, and even with a general anaesthetic an overnight stay is not needed.
- In an emergency you must always be able to reach your surgeon or the team on duty.
The golden rule of this surgery: the source notes that the carpenter's principle "measure twice, cut once" applies exactly here. If there is any doubt about how much tissue to remove, removing less is preferred — because over-narrowing leads to a tight introitus and pain during intercourse.
After the operation
- Medicine to prevent constipation is given.
- Follow-up: day 1 after surgery, then week 1, week 6 and month 3.
- The perineum should be rinsed gently with soap and water four times a day and after every visit to the toilet — keeping the area clean lowers the risk of infection and prevents crusting along the incision.
- Sitting baths are not recommended.
- Avoid heavy physical activity for 4 weeks.
- Avoid tampons and intercourse for 6 weeks.
Risks and complications
During surgery complications are extremely uncommon. Injury to the anus and rectum is easily avoided by the careful rectal examination carried out beforehand.
After surgery the most common are:
- Delayed healing and superficial separation: the most common. Superficial separation does not require surgical repair.
- Deep separation: the edges need to be refreshed and rejoined. If there is too much tension, letting the wound heal on its own is preferred.
- Swelling: easily settled with cold application; if it persists, low-dose medical treatment helps.
- A tight introitus: managed first with dilators and massage. If that is not enough, a small release procedure is needed, which can be done under local anaesthetic.
With any surgical procedure, results vary from person to person. You are advised to discuss the procedure with your doctor in detail beforehand.
Frequently Asked Questions
Is vaginoplasty just narrowing?
No — and the source explicitly criticises that idea. Narrowing simply by cutting and stitching skin creates an unnatural band of skin and leads to pain during intercourse. Narrowing with sutures may give a result in terms of appearance but cannot rebuild the perineum. The real aim is to repair the muscles and the supporting structures.
What exactly is repaired in the operation?
The main aim is to rebuild the perineal body — the point where the perineal muscles and the anal sphincter meet. Because pressure inside the abdomen stays high for a long time in pregnancy and vaginal birth, these muscles weaken, shift and descend; the operation aims to bring them back together.
Can it be done for a scar from childbirth?
Yes, this is a common reason. Removing tender scars remaining after repair of the cut made at delivery (episiotomy) is one of the defined uses of perineoplasty.
Who is it not performed on?
It is postponed in women planning a vaginal birth. Active infection and undiagnosed skin conditions of the external genital area must be treated first. Vulvodynia (persistent pain in the external genital area) is a relative contraindication — genital surgery may make it worse. If there are problems with bowel movements, the relevant specialist's opinion is obtained first.
Why is the examination so detailed?
Because the outcome depends on function, not only on appearance. Bladder, bowel and pelvic floor function are assessed; open questions are asked about sexual life, comfort, laxity and lubrication. The examination is done both gynaecologically and standing, with coughing and bearing down — because the true degree of prolapse is only seen on straining.
What happens if it is narrowed too much?
This is deliberately avoided. Over-narrowing leads to a tight introitus and pain during intercourse. The principle followed is "measure twice, cut once": if there is any doubt about how much tissue to remove, removing less is preferred. If a tight introitus does occur it is managed first with dilators and massage, and if that is not enough, with a small release procedure.
What should I be careful about while healing?
Rinse the perineum gently with soap and water four times a day and after every visit to the toilet; do not take sitting baths. Avoid heavy physical activity for 4 weeks, and tampons and intercourse for 6 weeks. Medicine to prevent constipation is given. Follow-up is at day 1, week 1, week 6 and month 3.
What if the wound separates?
Delayed healing and superficial separation are the most common and do not require surgical repair. With deep separation the edges need to be refreshed and rejoined; if there is too much tension, letting the wound heal on its own is preferred. Swelling settles with cold application.
Sources
- Perineoplasty. In: Bader A (Ed.), Aesthetic Gynecology Rejuvenation. CRC Press, 2023, Chapter 10. Anatomy of the perineum and the place of the perineal body, indications and contraindications, preoperative assessment, surgical principles, postoperative care and complications.
The information on this page is based on the national and international guidelines listed above. The page is reviewed whenever those guidelines are updated.
Practice and Contact Details
The information on this page is general. Please speak to your doctor about your own situation.
- DoctorOp. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology
- AddressOp. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya
- Telephone0505 351 77 88
- HoursMonday – Saturday 09:00 – 18:00 · Closed on Sunday