Surgical & Non-Surgical Vaginal Rejuvenation

As the first Baby Boomers hit the age of 50 comes a growing awareness of symptomatic pelvic prolapse with accompanying vaginal laxity or looseness.  More women visit their gynecologist complaining of pelvic pressure and fullness, a constant feeling of constipation, a visible pelvic bulge, worsening incontinence, and lack of sensation and friction.  With the advance to new technologies the new message to physicians and patients alike is this: patients can be helped with new minimally invasive and non-invasive procedures!  Instead of prolonged hospitalizations and days of an indwelling catheter, newer techniques allow outpatient and overnight stays without the need for open abdominal incisions.  The cystocele(fallen bladder), the rectocele(fallen rectum), the enterocele(fallen small bowel), the vaginal and uterine prolapse can be similarly viewed as hernias into and out of the vagina. Modern vaginal surgery can now help patients without the need for meshes and foreign bodies implanted into the pelvis.  Many of these surgeries, like posterior repair, vaginoplasty, perineoplasty, can be done in the office without IVs while the patient is awake and completely comfortable.

On a parallel note, one of the fastest growing segments of cosmetic surgery is female cosmetic genital surgery or “FCGM.”  There are now two mainstream textbooks on the subject published within the past two years.  Many phrases are used to describe what is surgically done and the catch-all phrase lay people have seen with increasing regularity is “vaginal rejuvenation.”  The branded name “Laser Vaginal Rejuvenation” has even gained national attention in print and television.  In reality, vaginal rejuvenation is a marketing term referring to vaginoplasty, or the surgical tightening, or narrowing, of the vaginal canal.  Birth trauma, tissue stretching, and improper surgical healing are the usual reasons for requesting vaginoplasty.  Vaginoplasty usually entails a modification of a standard gynecologic procedure called “posterior repair” along with rebuilding of the perineum (the space between the vagina and rectum).  More and more women are requesting vaginal tightening procedures to go along with the standard pelvic surgery. Gynecologists and urogynecologists have the most training performing these types of surgery.

Another surgery rapidly gaining social acceptance and widespread growth is labiaplasty or labioplasty.  This is when the labia minora (the “minor lips”) are sculpted to look more pleasing and less prominent.  The usual reasons for having this surgery done are complaints of large, uneven, and unappealing labia minora.  Many complain of pain, irritation, pulling, and rubbing when wearing tight clothing, horseback riding, sports, and sexual intercourse.  Teens and young women complain of the inability of wearing swimsuits for fear of severe embarrassment.  At times, the labia majora can also be altered by excision of excess tissue, resurfaced and shrunk with CO2 or Erbium lasers, or injected with fat to make it look more plump and appealing. More recently, the use of radiofrequency has made huge jumps in popularity for labia majora shrinkage and tissue improvement.  Visible changes in vulvar appearance and increased moisture and vaginal tightness have been pleasant effects reported by patients after radiofrequency vaginal treatments.  ThermiVa is the radiofrequency device that started this entire industry for internal and external radiofrequency treatments.  Labiaplasty and vaginoplasty have been referred to as a “vaginal face-lift.”  Radiofrequency treatments, cosmetic labiaplasty and vaginoplasty can be combined with pelvic prolapse repair at the same time.  Although health insurance typically does not cover vaginoplasty or labiaplasty many women are more than willing to pay for a feeling and look of being “21 Again.”

Non-surgical options for “vaginal rejuvenation” or “vaginal restoration” for shrinking the loose prolapsed tissues inside the vagina can also be achieved by using radiofrequency to improve tissue tone and quality.  The ThermiVa device, invented by Dr. Red Alinsod, was the first to provide full depth treatments for the vagina.  The vagina is made of dermatologic tissues and radiofrequency application has been found to be ideal and safe for multiple conditions such as loose skin, dry skin, and insensitive skin.  Reducing and eliminating symptoms can be obtained by the use of both radiofrequency and even with CO2 and Erbium lasers.  Stack therapies using both radiofrequency and lasers are being studied worldwide.

Perhaps the technology that is garnering the largest amount of press and media attention currently is the use of platelet rich plasma for genital conditions such as stress incontinence, overactive bladder, and orgasmic dysfunction indianpharmall.com.  It has also been used for dermatologic conditions such as Lichen Sclerosis and vulvar vestibulitis.  Also known as PRP or the O-Shot, the patient’s own blood is obtained, spun in a centrifuge, the amber “platelet rich plasma” portion collected, then this Growth Factor rich serum is reinjected into the inside walls of the vagina (specifically in the G-Spot area) and under the clitoral hood and into the clitoris itself.  Much research is ongoing in this field.  The combination of ThermiVa radiofrequency with PRP has been used extensively in Laguna Beach by Dr. Red Alinsod to aid many patients who are wary of surgery or drugs that have significant side effect profiles.  The more recent addition of pelvic floor physical therapy and EMSella (electromagnetic chair) have been used successfully to strengthen and improve coordination of muscles and reduce symptoms of leaky and overactive bladders.

In recent years reconstructive pelvic surgeons and urogynecologists, with specific training in pelvic and vaginal surgery, have popularized these aesthetic genital procedures and have helped provide it legitimacy.  It was only several years ago when cosmetic vaginal surgery was attacked vigorously by many medical practitioners as barbaric, unnecessary, and frivolous.  However, baby boomers drove the acceptance of these procedures and fueled the growth of this subspecialty.  Women did not want to live with unflattering, sagging, and large labias, nor did they want to live with gaping open vaginas and lack of sensation when having sexual relations.  Both young women wanting a sleeker appearance of their genitals and older women wanting to repair the ravages of childbirth and time are in the forefront of demand to look and feel young again.  Southern California became the birthplace of this movement.