Vaginoplasty (vaginal tightening) in Baku: who needs it and how it's done

The vagina is a muscular, elastic canal. It is supported from below by the pelvic floor muscles and, behind the vaginal opening, by the perineum, the muscular tissue between the vagina and the anus. During a vaginal birth, these tissues are stretched hard and sometimes tear. After healing, the canal may stay wider than before, the muscles may remain separated, and the opening may stay gaping.

Many people also search for this operation as “vaginal tightening” or “vagina tightening surgery.” Vaginoplasty restores weakened, overstretched tissues and usually has three parts:

• posterior colporrhaphy — excess, stretched lining (mucosa) on the back wall of the vagina is removed and the wall is reinforced;
• levatorplasty — the separated pelvic floor muscles (the levator muscles) are brought back together and stitched;
• perineoplasty, or repair of the perineum — the tissue behind the vaginal opening is rebuilt, and scars from old birth tears and episiotomy cuts are corrected.

In other words, this operation is not simply “tightening”: it rebuilds a weakened support system.

Women often keep these complaints to themselves for years. Yet they are very common after childbirth:

• a feeling of looseness or “emptiness” during intercourse, and reduced sensation;
• air escaping from the vagina with a sound during intercourse, exercise or heavy lifting;
• a vaginal opening that stays open, a feeling that something inside is “out of place”;
• pulling or pain at an old birth tear or episiotomy scar;
• loss of self-confidence because of these changes, and avoiding intimacy.

These symptoms can be confused with other problems. A bulge or a feeling of heaviness in the vagina, difficulty with bowel movements and urine leakage are often signs of a rectocele, a prolapsed bladder or a prolapsed uterus. That is why the decision is made only after an examination.

The main cause is vaginal childbirth. The risk is especially high with:

• several births, a large baby, a long pushing stage;
• forceps or vacuum delivery, perineal tears, an episiotomy;
• a labor that started vaginally and ended in a cesarean section after long pushing.

Factors other than childbirth also play a role. With age and at menopause, estrogen levels fall and tissues lose their elasticity. Some women are born with weaker connective tissue, so laxity can occur even in a woman who has never given birth. Chronic constipation and straining, a long-lasting cough, heavy lifting and excess weight put constant pressure on the pelvic floor.

Vaginal laxity is not a woman's “fault.” It is the effect of childbirth and time on the tissues, and there is no reason at all to be ashamed of it.

These problems are often the result of the same births and can look alike. But each one involves a different part of the pelvic floor and is corrected with a different operation:

Posterior colporrhaphy is part of both rectocele repair and vaginoplasty, but the goal is different. In a rectocele, the main task is to eliminate the bulging of the rectum into the vagina; in vaginoplasty, it is to narrow the widened canal and restore the vaginal opening. Vaginoplasty alone does not treat urinary incontinence: stress urinary incontinence needs a separate operation, such as a TOT sling.

If the examination finds several problems at once and your general health allows it, they can be treated in the same session, under one anesthetic. This is called combined (“bouquet”) surgery. If the labia minora have also changed after childbirth, a labiaplasty can be added to the same session. For an overview of these topics, see our aesthetic proctology page.

The first visit starts with a conversation. We ask how many births you have had and how they went, whether you had tears or an episiotomy, and what bothers you. We also ask separately about bowel and bladder complaints, because they can change the surgical plan.

A female surgeon performs the examination on a gynecological chair, in private, and it usually takes a few minutes. She assesses the width of the canal, the muscle tone, the condition of the vaginal opening and any old scars. You may be asked to bear down or cough for a moment: this helps reveal a rectocele, a prolapsed bladder or urine leakage.

If surgery is decided on, you will have blood tests beforehand and an anesthesiologist will examine you. We also discuss your expectations openly. Vaginoplasty is performed only on adult women, and only at their own decision.

Conservative approach

If the laxity is mild or not much time has passed since the birth, pelvic floor (Kegel) exercises are recommended first. Regular exercise improves muscle tone and can reduce mild urine leakage. The difference is usually felt after a few months of training. Step-by-step instructions are in our article on intimate problems after childbirth.

However, exercises cannot put torn or overstretched tissues back in place or remove excess mucosa. In such cases, surgery is considered.

Surgical treatment: how is vaginoplasty performed?

1. Anesthesia. Spinal anesthesia (numbing the lower half of the body) or general anesthesia. The type is chosen individually together with the anesthesiologist, based on your health and the extent of the operation.
2. The operation. All the work is done through the vagina; there is no abdominal cut. Excess mucosa is removed, the separated muscles are brought together, the perineum is rebuilt and old scars are corrected.
3. Stitches. Self-dissolving cosmetic stitches are used, so they don't need to be removed.
4. Duration. Vaginoplasty on its own usually takes 30–45 minutes; combined with other procedures, it takes longer. You will be told the exact duration after the examination.
5. Going home. Usually the same day or the next day.

How much the canal will be narrowed is planned in advance. The goal is not a canal that is “as tight as possible” but one that is comfortable and functional, because over-tightening can cause pain.

The purpose of the operation is the woman's own comfort, the proper functioning of her body and her self-confidence. Many women say that after surgery the feeling of looseness, the air sounds and the scar-related discomfort have lessened. Still, it is important to be honest:

• vaginoplasty does not turn back the age of the tissues and does not promise a “pre-baby body”;
• the quality of your sex life does not depend on anatomy alone, and the operation by itself may not change it;
• later vaginal births and aging can change the tissues again;
• the suture line usually leaves a thin, barely noticeable mark, but the mark may not disappear completely.

As with any operation, complications are possible: bleeding, infection, slow healing of the stitches, temporary pain or a pulling sensation and, rarely, excessive narrowing. Complications are uncommon, and follow-up visits make it possible to spot them early.

Don't wait: call right away if you have a fever, worsening pain, increasing bleeding or foul-smelling discharge, or if you cannot urinate.

1. Keep doing pelvic floor exercises. Once your doctor allows it, regular exercise maintains muscle tone.
2. Avoid constipation. Drink enough water, eat high-fiber food, don't put off going to the toilet and don't strain. More: constipation and digestive problems.
3. Lift correctly. Lift heavy loads as little as possible, and don't hold your breath when you lift.
4. Keep your weight and any cough under control. Excess weight and a long-lasting cough put constant pressure on the pelvic floor. Smoking also worsens coughing and weakens the tissues.
5. Plan any future pregnancy. If you want to have more children, say so before the operation. If you become pregnant, be sure to tell your obstetrician-gynecologist about the surgery.

A patient in her late thirties who had given birth three times came to us with several complaints: constipation, needing finger pressure to empty the bowel, a feeling of looseness during intercourse, and air escaping from the vagina. The examination found vaginal laxity along with a prolapsed bladder and rectum (cystocele and rectocele). In one session, under one anesthetic, she had anterior and posterior colporrhaphy, levatorplasty and vaginoplasty. The operation took about 1 hour 15 minutes, and she stayed in the clinic for one day. Every patient's situation is individual.