A Tight Fit

Standfirst:
Vaginoplasty, a surgery done to tighten the vagina, has made medicine cross over to the realm of aesthetics in recent years. Dr Christopher Chong gives you an insight on this trend. I'm certainly seeing more patients requesting for vaginoplasty these days.

Some of them do it for themselves, while others do it for their partners. Understandably, if sex reaches the "no fun" stage, their relationship can be affected. Many of these patients have prolapsed pelvic organ.

Let me share with you an interesting finding: a search on "vaginal cosmetic surgery" on internet portals Yahoo and Google revealed hundreds of websites dedicated to this topic. Yet, a similar search on Medline – for online medical journals and research – turned up none. This may simply be a matter of different terminologies, but the objective and outcome are likely to be the same.

Before you learn how vaginoplasty is done, you need to know what drives it. The pelvic floor muscles in women control the three organ systems – namely the bladder, womb and bowel, which are lined up in this order. When one organ system is damaged, it's likely that the neighbouring organs are affected as well. The three main culprits behind damaged pelvis floor muscles are pregnancy /childbirth, menopause and obesity. On the other hand, some women are born with weak collagen muscle tissues and have a lax vagina even at a young age and without having gone through childbirth.

Culprit:

Childbirth The usual damage is, of course, from pregnancy and childbirth. The baby's head going through the vagina can cause overstretching and tearing of the pelvic floor muscles. It's even worse for patients who do not do Kegel's exercise during pregnancy and post delivery. Many women are unaware that this exercise can reduce or prevent pelvic floor damage. To find out if damage has been done, a doctor may put an index finger into the vagina and a thumb into the anus, and pinch them together. If there's a hollow in between, it's likely to be due to the damage in the pelvic floor muscles and in the "perineal body" tissue located in the region. This is a common problem caused by poorly healed or poorly cut (episiotomy) vagina after childbirth. It gives that open vulva/vagina feeling to the patient and her partner, which is why complaints like "looseness", "no strength", "no sensation" and "no fun" are often heard.

Relatively safe In Vaginoplasty, I repair the perineal body tissue and join the pelvic floor muscles with sutures. The vaginal skin will be fashioned according to preferred tightness of the pelvic floor muscles. This surgery can be done as a day procedure, with minimal pain and complications, and with a good success rate under skilled hands.

Generally, I do not cut away vaginal skin unless it's excessive, because the complication that comes after it is that of painful intercourse. Any prolapsed problem must be corrected at the same time. This is an attempt at achieving "a tight fit" to improve stimulation of the vulval and vaginal tissues. It's not far fetched to get her partner to go for "fitting", but very often, he's not willing to do so. Vaginoplasty can be done with or without the use of laser but the principles of surgery remain the same. Complications like bleeding and infection are rare. Some women may get scarred, and coupled with the over tightening or cutting of the vaginal skin, sex can end up becoming a nightmare instead of a pleasure.

Measuring success

The success of vaginoplasty is personal and subjective – to the surgeon, the patient or her partner. The true measure of success would be the three parties are happy. I always abide by my teacher's wisdom of treating a patient as "a whole, not a hole". It's important to be sensitive to the psychological and emotional aspects of the patient and her partner. It helps manage expectations and improve the chances of a successful outcome. The majority of my patients, who have sought vaginoplasty, are in the pre-menopausal stage and a significant number is in their 30s. They have certainly reported better sexual satisfaction – and relationship – after the surgery.

But the greatest sex organ is truly what's between the ears – the brain. Stimulation of the clitoris and vulva, which can be achieved through foreplay, sends positive signals to the brain, which in turn gives sexual satisfaction. However, a satisfactory vulval/vaginal stimulation still requires a "good fit". While vaginoplasty is not the one-size-fits-all solution to enhancing sex life, it cannot be denied that a proper fit does matter in bed.