Vaginoplasty is a major surgical procedure used to narrow the vagina for which there are various medical indications. It may be performed to reverse the normal slight laxity that occurs to a varying extent in women who have given birth vaginally, as well as in older women. It is also used to correct congenital defects of the vagina, and acquired deformities due to cancers, tumors or trauma.
Congenital syndromes that require a vaginoplasty include:
- Vaginal agenesis, as in Rokitansky syndrome
- Vaginal atresia, as with a transverse vaginal band, imperforate hymen, or atresia of the lower one-third of the vagina
- Intersex conditions such as androgen insensitivity syndrome, congenital adrenal hyperplasia, and gonadal dysgenesis
Acquired conditions that may necessitate a vaginoplasty include:
- Extensive surgery for pelvic tumors or abscesses which required exenteration
- Other types of trauma
- Vaginal prolapse or other pelvic floor weakness
- Vaginal laxity following childbirth or trauma, or with aging
The procedures adopted for the various indications for a vaginoplasty may be classified as:
Procedures for Vaginal Atresia and Vaginal Agenesis
- When there is a vaginal dimple, various techniques are used to create a neovagina.
- One of the most popular is the Vechietti method in which continuous traction is applied from the abdominal wall on a silicone bead or ‘olive’ introduced into the vaginal dimple. The traction applied is sufficient to pull the olive inwards and upwards at a rate of about 1 cm a day. The threads leading from the olive are attached to the anterior abdominal wall via laparoscopy, and are tightened daily.
- Another method is balloon vaginoplasty in which balloon dilation is used to create a space in the rectovesical fascia for the neovagina.
- When there is no vaginal tissue at all, more radical techniques may be indicated such as:
- Intestinal vaginoplasty, which makes use of a segment of vascularized colon or ileum to replace the vagina. The intestine serves as a capacious and lubricated vagina. However, it is a highly invasive procedure, with many risks, and may lead to excessive mucus discharge.
- The McIndoe vaginoplasty, which consists of expanding the rectovesical potential space and inserting a split-thickness skin graft usually taken from the buttocks, to line the space.
- William’s vaginoplasty is a technique in which the labia minora are sutured together to create a pocket, which becomes the neovagina. Several modifications have been made as a result, including labial tissue to form a deeper pouch, which allows for more comfortable sexual intercourse.
- Buccal mucosa is also used as the lining of the new vagina, because of its superior healing properties, which leads to a short recovery time and minimal scarring.
- The Don flap uses labia minora or clitoral hood tissue to create a vagina. When labia minora tissue is used, cosmetic labial surgery to recreate the labia minora is required, along with cervical dilation to ensure that the vagina is large enough.
With the need to cater to transgender individuals, several new sex-conversion techniques evolved including the Wilson procedure, which uses a three-stage penile inversion technique to create female-appearing external genitalia.
The intestinal vaginoplasty technique is also used to create a vagina in congenital adrenal hyperplasia with ambiguous genitalia, or in androgen insensitivity syndrome.
Many women feel that a lax vagina is an inhibitor of sexual pleasure and make a request for vaginal tightening. Besides perineal surgery to approximate the perineal muscles and narrow the introitus and vaginal wall, there are modern techniques available such as laser tightening. This uses carbon dioxide laser beams to produce controlled injury and stimulate collagen synthesis. As a result, regeneration of new supporting tissue and tightening of the vaginal mucosa occurs.