In brief
Aesthetic vaginoplasty, or surgical vaginal tightening, is a procedure that corrects laxity of the vaginal canal by reconstructing the muscles and supporting tissues of the posterior wall and perineum, and removing excess mucosa. It is indicated mainly after one or more vaginal births. It is a true surgical procedure: different from laser or radiofrequency treatments, which act on the mucosa and not on the muscular structure.
What vaginoplasty is
The term refers to a procedure that narrows the diameter of the vaginal canal, especially in its lower third, near the entrance. The surgeon brings back together the muscles and fasciae that have separated or loosened, reconstructs the perineal body (the fibromuscular "knot" between the vagina and anus) and removes excess mucosa. It is often combined with a perineoplasty, which also reconstructs the external part of the perineum.
When it is indicated
Vaginal laxity is a loss of tone and support of the tissues of the vaginal canal. The most frequent causes are:
- Vaginal births, especially if numerous, with large babies or assisted with instruments: the pelvic floor muscles and the perineal body can stretch or separate.
- Ageing and menopause: the drop in oestrogen makes the tissues thinner and less elastic.
- Individual predisposition: a constitution with looser connective tissues.
Patients often describe a feeling of a "wider" vagina, less friction and reduced sensation during intercourse, sometimes for the partner too, with an impact on intimate life.
How the procedure is carried out
Vaginoplasty techniques, or colpoperineoplasty, vary according to where the laxity is (deep canal, entrance or both) and the presence of associated defects, such as a rectocele or the after-effects of childbirth tears. The aim is not simply to "tighten" the entrance, but to restore the muscular and fascial support of the pelvic floor, with a functional and aesthetic result.
I perform the procedure under local anaesthesia with sedation or under general anaesthesia, depending on the technique chosen and the patient's cooperation; it takes one to two hours.
1. Posterior colporrhaphy (myorrhaphy of the levator ani muscles)
This is the cornerstone technique for deep laxity of the vaginal canal.
Indication. Laxity of the middle and upper third of the vagina, often after several vaginal births or because of a progressive loss of muscle tone.
How it is performed. The posterior vaginal wall is incised lengthwise and the mucosa is separated from the underlying fascia. The bundles of the levator ani muscle (puborectalis and pubococcygeus) are brought together in the midline with slowly absorbable stitches; finally the excess mucosa is removed and sutured.
2. Perineoplasty (reconstruction of the perineal body)
It is indicated when the problem mainly concerns the vaginal entrance and the distance between the vulva and anus.
Indication. A "gaping" vaginal entrance, that is, one that stays open, after-effects of episiotomy or of badly healed childbirth tears, separation of the superficial muscles of the perineum.
How it is performed. A wedge-shaped or "V"-shaped area is removed at the level of the posterior commissure and the perineal body. The perineal body is reconstructed by bringing the bulbocavernosus and transverse perineal muscles back together, and mucosa and skin are rebuilt with a "Y"-shaped or inverted "T"-shaped plasty, for a toned and well-closed entrance.
3. Mucosal reshaping (diamond-shaped resection)
It is used when excess mucosa predominates over muscle damage.
Indication. Redundant mucosa and lax vaginal walls, without significant damage to the underlying fascia.
How it is performed. One or more diamond-shaped pieces of mucosa are removed, generally on the posterior wall or on the lateral walls, and a superficial plication of the fascia is performed before suturing. It reduces the diameter of the canal while limiting the risk of excessive or rigid narrowing.
4. Combined techniques
Laxity is often accompanied by other anatomical problems that can be corrected in the same session:
- Correction of rectocele: if the wall of the rectum bulges into the vagina, posterior colporrhaphy repairs the rectocele and, at the same time, tightens the canal.
- Labiaplasty: reduction of the labia minora can be performed together with tightening of the entrance, for a harmonious reshaping of the whole vulva (see the page on labiaplasty).
| Technique | Structure treated | Aim |
|---|---|---|
| Posterior colporrhaphy | Levator ani muscles and pelvic fascia | Tightening of the deep vaginal canal |
| Perineoplasty | Perineal body and bulbocavernosus muscle | Closure and support of the entrance |
| Mucosal reshaping | Vaginal mucosa and submucosa | Reduction of superficial laxity and folds |
How much to tighten
This is the most delicate point. Excessive tightening can make intercourse painful, and the tissue removed cannot be recovered. For this reason the degree of correction is decided together, at the consultation, considering the patient's real sex life and not a "catalogue" result.
Surgical vaginoplasty, laser and radiofrequency: the differences
Vaginoplasty is a surgical procedure that reconstructs the muscles and supporting structures of the pelvic floor. Non-surgical intimate rejuvenation treatments, with CO2 laser, Erbium laser or radiofrequency, act instead only on the mucosa, with heat. In my practice I use the fractional CO2 laser.
- Mechanism. Surgery brings back together and sutures the separated or stretched muscles, in particular the levator ani and the perineal body. Laser and radiofrequency cause controlled thermal micro-damage to the mucosa, which stimulates new collagen and elastin and improves blood supply and hydration, but they cannot bring the muscles back together or repair them.
- Duration. The surgical result is long-lasting because it changes the structure; that of energy-based treatments tends to fade over 6–12 months and requires maintenance courses.
- Indications. Surgery is the choice for true muscular laxity, the sensation of an "open canal" and the after-effects of childbirth tears. Laser and radiofrequency are indicated mainly in genitourinary syndrome of menopause (dryness, mild atrophy, burning), when the aim is to improve hydration and elasticity of the mucosa rather than to tighten.
| Parameter | Surgical vaginoplasty | Laser and radiofrequency |
|---|---|---|
| Nature | Intimate surgery: a surgical procedure | Intimate medicine: outpatient treatment without a scalpel |
| Aim | Muscular and fascial reconstruction and reduction of the vaginal diameter | Trophism of the mucosa and mild stimulation of superficial collagen |
| Action | Suture of the levator muscles (myorrhaphy) and resection of the mucosa | Heating of the connective tissue beneath the mucosa |
| Ideal indication | True vaginal laxity, after childbirth or because of loss of muscle tone | Mild vulvovaginal atrophy, dryness, early laxity |
| Duration of effect | Long-lasting, but may diminish with further births and with age | Temporary, with top-up sessions generally every year |
| Anaesthesia | Local with sedation, or general | None, or anaesthetic cream |
| Recovery | Work after 7–10 days; intercourse after 6–8 weeks | No time off work; intercourse after 3–7 days |
| Evidence and warnings | Mostly retrospective case series; according to ACOG (the American College of Obstetricians and Gynecologists) safety and efficacy for cosmetic purposes have not yet been demonstrated | In 2018 the FDA warned that no device is approved for "vaginal rejuvenation", reporting burns, scarring and pain |
I say this with the same frankness for both options: neither has large randomised studies behind it. Surgery corrects a structural problem that laser cannot correct, but it is an operation, with the risks of an operation.
What the literature says, honestly
The American College of Obstetricians and Gynecologists (ACOG) considers female genital surgery performed for cosmetic reasons or to improve sexual function not medically indicated and stresses that safety and efficacy have not yet been demonstrated by solid studies. It recommends giving full information about complications and assessing before surgery for any body image disorder.
The surgical case series available nonetheless report encouraging results. In a Canadian series of 30 women who underwent posterior vaginoplasty with perineoplasty (Austin, 2019), all reported an improvement in symptoms, no post-operative complications were recorded and 2 patients would have wished for greater tightening. These are useful data, but on small numbers and without a control group.
Prima comprendere («Understand first»): the consultation
At the first consultation, which lasts from half an hour to an hour, I first ask what has changed and since when, what bothers you in everyday life and during intercourse, and whether you have urinary or prolapse symptoms. Then we assess together the tone of the tissues and the perineum. If the problem is a prolapse, or if expectations are not realistic, I prefer to tell you openly and direct you to the most suitable pathway.
Risks and complications
General risks, common to any surgery
- Bleeding or haematoma
- Infection, wound dehiscence (partial reopening of the wound)
- Complications related to anaesthesia or sedation
Specific risks
- Pain during intercourse (dyspareunia), generally temporary; more rarely persistent, especially if the tightening is excessive.
- Insufficient or excessive correction, which may require a touch-up.
- Changes in sensation or painful scars at the vaginal entrance.
- Rectal injury and fistulas: rare, but possible, because the posterior wall of the vagina is in contact with the rectum.
- Dissatisfaction with the result, especially when expectations were not clarified beforehand.
Recovery
Vaginoplasty involves both the mucosa and the deep muscles of the pelvic floor: respecting healing times is important for a stable result. The timings I give my patients are approximate and are confirmed at the consultation.
First 2–3 days
Acute phase
- A feeling of heaviness or deep pain, similar to strong period pain, controlled with painkillers and anti-inflammatories at regular times.
- Gentle intimate washing after each urination, drying by patting, without rubbing.
- Rest in bed or in a semi-seated position, so as not to load the perineal stitches.
First and second week
Return to daily activities
- Household activities and non-strenuous office work after 7–10 days.
- The stitches are absorbable: they dissolve on their own in 2–3 weeks, with no need to remove them.
- Small amounts of blood or serous fluid are normal in the first two weeks.
Third and fourth week
Light activity
- Walking and moderate physical activity (for example an exercise bike or upper-body exercises), without intense effort or weights.
- The mucosa has healed on the surface, but the deep muscles are still scarring.
Sixth to eighth week
Complete healing
- Gradual resumption of penetrative intercourse, which must be avoided for 6–8 weeks; a water-based lubricant is useful for the first few times.
- Green light for intense sport (running, weights, horse riding).
What to do and what to avoid
| Area | What to do | What to avoid |
|---|---|---|
| Hygiene | Gentle, pH-neutral intimate cleansers; dry with cool air or by patting | Internal sanitary products (tampons) for 6–8 weeks: use external pads only |
| Bathing | Quick showers with lukewarm water from the third day | Bath, hot tub, sauna and swimming pool for at least 4–6 weeks |
| Clothing | White cotton underwear, comfortable, soft clothes | Tight clothing, synthetic fabrics or tight jeans, which rub and trap moisture |
| Lifestyle | A high-fibre diet and plenty of water, to prevent constipation | Straining during bowel movements; lifting weights over 5 kg in the first few weeks |
Complementary treatments
In selected cases, from the sixth week, I may recommend:
- Graduated vaginal dilators, to promote tissue elasticity in the final phase of healing.
- Pelvic floor physiotherapy, with guided exercises (for example Kegel) to improve muscle control and tone.
- Electromagnetic stimulation of the pelvic floor (EMS): a chair that, with a focused electromagnetic field, causes repeated contractions of the pelvic muscles, without a scalpel and without undressing. It can be used alongside physiotherapy to recover tone; it does not replace surgery when the laxity is structural. I discuss it on the page about electromagnetic stimulation of the pelvic floor and on giuliomaggi.com.
Frequently asked questions
What is aesthetic vaginoplasty?
It is a female intimate surgery procedure that tightens the vaginal canal by reconstructing the muscles and supporting tissues of the posterior wall and perineum and removing excess mucosa. It is indicated mainly for vaginal laxity after childbirth.
Is vaginoplasty painful?
Not during the procedure, because it is performed under anaesthesia. In the first 2–3 days a feeling of heaviness and a deep ache, similar to strong period pain, are normal and can be controlled with painkillers.
How soon can sexual intercourse be resumed?
After 6–8 weeks, when the deep muscles have also healed, gradually and with a water-based lubricant for the first few times.
When can I return to work and sport?
To non-strenuous office work after 7–10 days; to light activities such as walking from the third to fourth week; to intense sport after 6–8 weeks.
What anaesthesia is used and how long does the procedure take?
Local anaesthesia with sedation or general anaesthesia, depending on the technique and the patient's cooperation; the procedure takes one to two hours.
Can a rectocele also be corrected?
Yes. If the wall of the rectum bulges into the vagina, posterior colporrhaphy repairs the rectocele and tightens the canal in the same procedure.
Will there be visible scars?
The incisions are inside the vagina and, if the perineum is also reconstructed, at the entrance. With healing they generally become barely visible, but a scar always remains and, rarely, may be painful.
Is the result permanent?
It is long-lasting, but not unchangeable: further vaginal births and ageing of the tissues can reduce it over time. For this reason, if you want more pregnancies, it is usually best to postpone the procedure.
What is the difference from vaginal laser?
Vaginoplasty surgically corrects the muscles and supporting tissues; laser and radiofrequency stimulate the mucosa with heat and have a temporary effect. In 2018 the FDA, the American agency that approves drugs and medical devices, warned that no energy-based device is approved for "vaginal rejuvenation".
What is the difference from labiaplasty?
Vaginoplasty works inside the vaginal canal and on the muscles; labiaplasty reduces and reshapes the labia minora, on the outside. The two procedures can be performed in the same session.
What are the main risks?
Bleeding, infection, pain during intercourse, insufficient or excessive correction and, rarely, injury to the rectum. We discuss all of these before deciding.
Scientific bibliography
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American College of Obstetricians and Gynecologists – Elective female genital cosmetic surgery (Committee Opinion n. 795)
Source: Obstetrics & Gynecology, 2020 – ACOG
What it covers: the position of American gynaecologists on cosmetic genital surgery: procedures not medically indicated, with safety and efficacy not yet demonstrated, to be approached with fully informed consent and with attention to body image.
Why it matters: it is the most authoritative source on the limits of the evidence and on the complications to be discussed before surgery.
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U.S. Food and Drug Administration – FDA warns against use of energy-based devices to perform vaginal "rejuvenation" or vaginal cosmetic procedures
Source: FDA Safety Communication, July 2018 – FDA
What it covers: the American agency warns that the safety and efficacy of laser and radiofrequency devices for "vaginal rejuvenation" have not been established and reports burns, scarring, pain during intercourse and chronic pain.
Why it matters: it is the basis for the comparison between surgery and energy-based treatments on this page.
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Furnas HJ, Canales FL – Vaginoplasty and perineoplasty
Source: Plastic and Reconstructive Surgery – Global Open, 2017 – PubMed Central
What it covers: review of the anatomy, indications and techniques of aesthetic vaginoplasty and perineoplasty.
Why it matters: it is one of the main references for plastic surgeons who perform these procedures.
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Austin RE, Lista F, Vastis PG, Ahmad J – Posterior vaginoplasty with perineoplasty: a Canadian experience with vaginal tightening surgery
Source: Aesthetic Surgery Journal Open Forum, 2019 – Oxford Academic
What it covers: 30 women who underwent posterior vaginoplasty with perineoplasty, mostly after several births: improvement in symptoms in all, no post-operative complications, 2 patients wishing for greater tightening.
Why it matters: it shows concrete results of a technique similar to the one described here, but in a small case series without a control group.
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Triana L – Aesthetic vaginal plastic surgery: a practical guide
Source: Springer, 2020 – Springer
What it covers: a manual of aesthetic vaginal plastic surgery, with chapters devoted to vaginoplasty and perineoplasty.
Why it matters: it is a reference text for surgeons working in this field.
For a deeper look at the whole field of female intimate surgery:
Medically reviewed by Dr Giulio Maria Maggi, Plastic Surgeon — last review:
Article written by
Dr Giulio Maria Maggi
Aesthetic Plastic Surgeon — Turin, Asti and Alessandria
Medical Director — Aesthetic Clinic (Turin)
Registered with the Turin Medical Council (Ordine dei Medici di Torino) no. 20595
Full Member of AICPE (Italian Association of Aesthetic Plastic Surgery) (verify)
Expertise and fields of interest
Dr Maggi gained specific training in intimate medicine and surgery by working for 12 years alongside Prof. Renato Marten Perolino, urologist and plastic surgeon, at Villa Maria Pia Hospital and, privately, at Clinica Fornaca and Clinica Cellini in Turin. From him he learned male-to-female gender-affirming surgery and he was first operator in breast augmentation procedures on Prof. Perolino's patients undergoing gender transition. He also trained internationally with Prof. José Guerrero Santos in Guadalajara and with Prof. Andrew A. Jacono in New York, for the Deep Plane Facelift technique.
He is particularly dedicated to:
- Functional and aesthetic intimate surgery, male and female
- Deep Plane facelift
- Blepharoplasty
- Liposculpture and fat grafting (lipofilling)
- Breast surgery
- Body contouring
Clinical approach: «Prima comprendere» ("Understand first"). No promises of results: indications, risks and limits explained frankly, so that every patient can make a truly informed choice.
