Perineoplasty
What is Perine?
The perineum is the name for the genital area located between the vagina and the anus. Perineoplasty, or "perineum aesthetics," refers to the correction of suture scars from childbirth and the enhancement of the aesthetic appearance of this region. However, it can also be performed on women who have not given birth, addressing skin folds, excess skin, and wrinkles in the perineal area.
What is Perineoplasty?
Perineoplasty, or childbirth scar aesthetics, is performed to restore and repair the vaginal areas of women who have had a normal delivery. The perineal area is located between the lower part of the vagina and the anus. It is normal for women who deliver babies weighing over 1.5 kg to experience widening and wear of the vagina.
The muscles in the vaginal area, which are quite delicate, can become deformed after a normal delivery. To tighten these muscles and restore them to their pre-delivery state, perineoplasty is a suitable choice. It is relatively easy to erase the traces of normal delivery from the genital area, achieving the desired attractive appearance and sexual life.
During normal delivery, an incision is made on the right side of the perineal area with scissors to allow the baby's head to pass through comfortably and to prevent irregular tears. This incision, made to facilitate delivery, is referred to as an "episiotomy" or "birth incision."
Poor healing or subsequent infections of episiotomy scars can lead to numerous psychological and physical discomforts for women. Correcting the stitch scars left from normal delivery through genital aesthetics and cleaning skin folds between the vagina and anus to give the genital area an aesthetically pleasing appearance is known as perineoplasty. Perineum aesthetics are most commonly performed simultaneously with vaginal tightening surgeries. In some cases, labiaplasty and clitoral aesthetic surgeries may also be combined.
Why Does the Perineal Area Deform?
The perineal area—the region between the vagina and the anus—becomes lax due to the effects of normal childbirth. This deformation is more pronounced in women who have given birth multiple times or who have delivered large babies. Additionally, the excessive stretching of pelvic floor muscles during delivery can lead to the loosening of the perineal area. With increased births, the elasticity of the pelvic muscles decreases, causing the vagina to sag more. The widening of the perineal area results in less pleasure during sexual intercourse.
This loosening can lead to stress and dissatisfaction during sexual activity. Kegel exercises are recommended to tighten the perineal area. These exercises should be guided by a doctor. The muscles around the urethra, vagina, and anus can be tightened through Kegel exercises. However, despite regular Kegel exercises, they do not provide results as effective and rapid as surgery.
How is the Perineoplasty Procedure Performed?
Perineal childbirth scar aesthetics occur during normal delivery. It is observed that the perineal area tears towards the anus, especially during home births with a midwife present. Some tears during delivery can be severe and extend into the vagina. It is known that fewer tears occur during hospital births.
The perineal childbirth scars that arise during delivery are closed and sutured aesthetically after birth. Women who desire a tighter vaginal entrance can undergo vaginal tightening surgery a year after childbirth. Vaginal tightening surgery ensures that women's vaginal areas are tighter, thereby increasing pleasure during intercourse.
Mild pain lasting a few days after perineoplasty is considered normal. Spotting and leakage can be seen as complications of the procedure. Cold compresses may be applied to the treated area using ice post-operation. Patients can return to their intimate life after one week.
Common Issues Resolved by Perineoplasty
- Loose vaginal structure
- Vaginal itching
- Damaged perineum (possibly after childbirth)
- Incontinence
- Genital warts
- Painful intercourse
- Introital narrowing
- Vaginismus
- Vulvar vestibulitis
- Decreased sexual sensation
Types of Perineoplasty Procedure
There are two types of perineoplasty. The first tightens the perineal muscles and vagina, while the second relaxes them. The choice of which to perform depends on the individual's body structure and the doctor's preference.
Reasons for Tightening Perineal Muscles and the Vagina
- Childbirth: A woman who has given birth may experience stretching and tearing of vaginal tissue, which can heal improperly if not properly sutured.
- Obesity: Obese women may stretch excessively, damaging the perineum and causing stress to the perineal muscles.
- Sexual Penetration: Sexual activity, especially if there are abnormalities in the vagina, can lead to looseness in the perineum. This can involve separation of the anal muscles and possibly rectal prolapse.
Perineal Tightening Surgery
During the perineoplasty surgery, a V-shaped incision is made in the back wall of the vagina, depending on the required degree of tightening. Damaged tissue and excess scar tissue are removed. Muscles may be sutured together or separated from the perineal structure.
Perineoplasty for Painful Intercourse Caused by Vaginismus
Vaginismus (ineffective contraction of the pubococcygeus muscles) can be treated using perineoplasty to relax the vaginal entrance in some women. This involves a simple incision in the posterior four channels. This surgery is considered effective for dyspareunia caused by lichen sclerosus and vaginismus but should first be attempted with non-surgical methods.