Complications and Procedures of the Vagina

Vaginal problems include an array of issues, from minor odors, itchiness and discomfort to aesthetic and sexual health concerns, serious infections and diseases. Vaginal health should be an integral part of routine healthcare, but most women aren't aware of the magnitude of treatment options available to repair damage, fix problems and help restore self-confidence and satisfaction.

An overview of vaginal health

The definition of a healthy vagina is multifaceted and is maintained by a number of life choices. At the top of the list is practicing safe sex and protecting yourself from sexually transmitted diseases (STDs), followed by sticking to a routine of annual gynecological exams and other key screenings, like Pap smears. Next up is protecting vaginal pH by not douching and by seeking professional treatment for problems and infections (yeast infection, bacterial vaginosis, chlamydia) when they arise. Other smart practices include wearing breathable underwear and bottoms, and quickly changing out of sweaty clothes; avoiding dangerous products (non-body-safe sex toys, petroleum jelly, baby oil or tea tree oil); and following basic hygiene practices (wiping from front to back, showering, and changing menstrual cups, tampons and/or sanitary pads regularly).

Even with these precautions, vaginal problems can still arise, and some form of vaginal rejuvenation—whether a surgical procedure, minor procedure or alternative therapy—may be the best option.

Vaginal rejuvenation

A broad term covering a number of corrective treatments, vaginal rejuvenation includes multiple surgery options and energy-based processes. Though these procedures are often considered merely cosmetic, the reasons a woman might seek vaginal rejuvenation go beyond the desire to forestall the natural aging process.

Vaginal delivery of a child can cause extensive trauma to the pelvic and abdominal muscles. As a result, women commonly experience decreased vaginal tightness and stress urinary incontinence (sudden leakage of urine from the bladder caused by pressure from activities like laughing, sneezing or jumping).

And new mothers aren’t the only ones experiencing problems—a 2008 study from Obstetrics & Gynecology reported nearly half of women experience urinary incontinence. A 2018 study from the Journal of Sexual Medicine found 38 percent of more than 2,600 women self-reported vaginal laxity, which was significantly associated with decreased satisfaction with sex. After menopause, decreased estrogen in the body commonly results in vaginal dryness, which is uncomfortable and can make sex difficult or painful. Childbirth can contribute to vaginal dryness, too. Aging can contribute to sagging skin. Some of these issues (laxity, incontinence) may be corrected through less-invasive means, including pelvic floor exercises. When these methods are not possible or are unsuccessful, vaginal rejuvenation can be a life-changing option, making the most basic activities—such as laughing and sex—significantly more comfortable and enjoyable.

Vaginal rejuvenation surgeries cover a variety of areas, including the clitoris, the labia majora, mons pubis, vulva and vaginal canal.

• Clitoral hood reduction removes excess tissue around the clitoris, exposing more of the sensitive skin and improving sexual function.
• Labia majoraplasty involves the reduction and reshaping of the labia majora (the outer lips).
• Monsplasty removes excess skin in the mons pubis, the area just above the vulva, which may result from weight loss.
• Vaginoplasty reduces the size of the vaginal canal, increasing vaginal tightness.
• A vulvoplasty reshapes the entire vulva.

Patients can expect mild to moderate pain and swelling for several weeks after surgery. Discomfort can be reduced with a cold compress and pain medications such as ibuprofen. Itching is common for a week or two after surgery. Strenuous activities, including sex, should be avoided for three to four weeks, or until approved by a doctor. Sutures usually dissolve within a month, and most women are back to work within one to two weeks.

Energy-based procedures heat up vaginal tissue to stimulate collagen production, which firms sagging skin and muscles, and tightens the vagina and/or labia. They can be used inside the vaginal canal or on exterior vaginal structures.

• Radiofrequency (RF) treatments use electromagnetic waves and can treat vaginal laxity, drooping labia and urinary incontinence.
• Rejuvenation treatments with CO2 lasers involve inserting a rotating wand into the vagina, using a light beam to target vaginal tissue to stimulate collagen production.
• High-intensity focused ultrasound also uses energy waves to heat up tissue and stimulate collagen and elastin production.

All three procedures are performed in a clinician’s office and take about 10 to 30 minutes. A wand or handpiece is inserted into the vagina (or against the outer labia); the procedures are not painful and don’t require anesthesia or pain medication. They can treat vaginal complications, including vaginal prolapse, pelvic spasms, endometriosis, pelvic pain, pain with sex, stress urinary incontinence, vaginal laxity, vaginal dryness and decreased libido.

Results depend on collagen production, and noticeable tightening may take up to a month, though RF often produces immediate results. Patients can resume normal activity immediately after the procedure, although sex should be avoided for five days. Results are temporary and require subsequent treatment to maintain, typically every three months.

While less invasive than surgical procedures, nonsurgical options are newer and less studied. Talk to your doctor before pursuing any option, even before using home treatments, such as vaginal tightening creams and gels, which may not be FDA-approved and have serious risks or side effects.

For women considering rejuvenation for cosmetic reasons rather than physiological ones, it's important to consider the benefits versus risks of each treatment. A doctor can walk you through the pros and cons, and whether you may be a good candidate. Recognizing that no vagina is perfect or "normal," and that aging is a natural and sublime part of life, is also important. But for women who feel corrective treatments can improve their quality of life and body confidence, do your research and always seek care from a board-certified physician.

Labiaplasty

A procedure that reduces and/or reshapes a woman’s labia minora, the inner folds of skin that cover the vagina, labiaplasties increased by more than 50 percent in the U.S. between 2014 and 2018. The procedure can correct asymmetry and reduce length to treat problems (due to genetics, changes in puberty, childbirth), including painful twisting, chafing, irritation, difficulty or pain with exercising, urinary tract infections (UTIs), hygiene problems or negative impact on body confidence and sexual health.

The procedure is performed by a board-certified plastic surgeon at a hospital or plastic surgery center. Excess skin of the inner labia is trimmed and sutured to create smaller, symmetrical labia minora that are flush with the labia majora. The procedure takes around an hour. Patients can usually go home the same day and are back to most normal activities right away, although activities that apply pressure or friction to the area (riding a bike, running) should be avoided until approved by a doctor. Sex should be avoided for at least four weeks, and tight clothing and long showers are also discouraged.

Botox

Botox is not just for forehead wrinkles and crow's feet. It's also used to treat other, noncosmetic conditions, from chronic migraines to pelvic floor dysfunction. Patients experiencing the latter, which is also known as vaginismus or genito pelvic pain/penetration disorder, may get painful pelvic floor muscle spasms when the pelvic floor comes into contact with the bladder, vagina, rectum, pubic bone or coccyx. Other symptoms of pelvic floor dysfunction include pain, difficulty urinating or defecating and pain during sex.

A mild case of pelvic floor dysfunction can make everyday vaginal penetration (sex, inserting a tampon, pelvic exam) uncomfortable. In severe cases, it can be extremely painful, even impossible. Nonsurgical procedures (physical therapy, muscle relaxants) can be a less-invasive treatment, but when these methods are unsuccessful, vaginal Botox can temporarily freeze the muscles, providing relief.

Patients undergoing the procedure will get local anesthesia to numb the area, or mild sedation. A board-certified OB-GYN then injects the drug into the muscles. Patients can go home the same day, with minimal side effects. They may be asked to use massage or a dilator to help relax the muscles. Botox typically takes several days to a week to kick in, and lasts around three months for most individuals. If treatment is successful, patients may schedule their next treatment to kick in just as their old treatment is wearing off, to minimize recurrence of symptoms.

Vaginal health is an important part of a woman's normal wellness routine. When things go wrong, fortunate medical advancements enable a woman to treat both minor and major issues, restoring both physical well-being and body positivity.