Perineoplasty: Indications, Procedure & Recovery

Perineoplasty is a surgery used to repair and strengthen the pelvic floor muscles, which help support the bladder, uterus, and intestines. It is usually considered when the tissues and muscles in this area have been weakened or injured.

This procedure may be recommended to repair vaginal tears, especially after a vaginal birth, or to treat changes that affect how the area works, such as pelvic organ prolapse and urinary or fecal incontinence.

A gynecologist may recommend perineoplasty when other treatments, such as pelvic floor physical therapy, do not provide sufficient relief. During the consultation they will discuss options with the patient and decide on a treatment plan.

Main indications

Perineoplasty is indicated to:

• Prevent or treat pelvic organ prolapse

• Strengthen and restore pelvic floor support

• Improve urinary incontinence

• Improve bowel function

• Repair vaginal tears, especially after childbirth

It may also be done to improve sexual function by increasing comfort and the feeling of tightness in the area.

Perineoplasty is generally recommended after a vaginal birth, but it may also be needed in people who have not given birth because of vaginal laxity or changes in pelvic floor function.

Before recommending surgery, the doctor may suggest non-surgical treatments, such as exercises to strengthen the pelvic floor, pelvic physical therapy, and daily habit changes to improve symptoms.

According to the American College of Obstetricians and Gynecologists (ACOG), pelvic floor exercises may improve incontinence and may slow the progression of pelvic organ prolapse, and a physical therapist can help ensure the exercises are done correctly.

Preparing for surgery

Before perineoplasty, patients may need to fast if the procedure is performed under general anesthesia and may be advised to adjust or stop medications such as anticoagulants or anti-inflammatory drugs, which can increase bleeding risk during surgery.

Avoid sexual intercourse for a few days and follow the recommended vaginal hygiene instructions. According to ACOG, taking antibiotics before surgery is one of the measures used to help prevent infection after gynecologic procedures.

In some cases, imaging tests such as ultrasound may be used to evaluate pelvic anatomy and identify changes that can help with surgical planning.

Procedure steps

Perineoplasty is done in several steps, which include:

• Administering local or general anesthesia, depending on the case

• Making an incision in the perineum, usually in a curved shape along the edge of the vaginal opening

• Removing excess skin or scar tissue as needed

• Repairing and strengthening the perineal muscles to restore pelvic support and reduce the vaginal opening

• Closing the incision with absorbable stitches

Perineoplasty mainly focuses on the vaginal opening and the perineum. It does not change the vaginal canal or the inner part of the vagina, but it may improve the feeling of firmness and comfort at the vaginal opening.

Recovery time

In most cases, recovery from perineoplasty is quick, and patients can return to work within a few days.

During recovery, it is recommended to drink plenty of water and eat enough fiber to help prevent constipation, get about one week of rest, and avoid sexual activity for approximately six weeks.

Some bleeding is common, and a sanitary pad should be used. The stitches are usually absorbed within about two weeks.

The doctor may also prescribe pain relievers to reduce discomfort during the first few days.

It is also important to watch for any symptoms that may appear, such as heavy bleeding, severe pain, fever, or foul-smelling vaginal discharge, as these may be signs of infection.

Does the procedure leave a scar?

Perineoplasty may leave a scar, but it is usually small and located in the area between the vagina and the anus. Over time, the scar tends to become less noticeable, and most people do not have cosmetic concerns.

Possible risks

Although perineoplasty is generally safe, there are some possible risks, such as:

• Infection

• Constipation

• Pain or discomfort

• Temporary changes in sensation in the perineal area

It is important to watch for signs of complications, such as fever, severe pain, foul-smelling discharge, or bleeding, and seek emergency care right away if any of these occur.

Is perineoplasty dangerous?

Perineoplasty is generally safe, but like any surgery, it involves some risks, such as infection, bleeding, pain, and temporary constipation. Still, when medical instructions are followed, most people recover without problems.

Contraindications for the procedure

Perineoplasty is generally not recommended for people with vaginas who have pelvic pain or pain during sex (dyspareunia), skin problems in the area, fecal incontinence, or mild prolapse. It is also not recommended for those younger than 18 years of age.

In addition, people with a history of previous surgeries in the area, active infections, severe pelvic disease, plans for a future pregnancy, or treatments such as radiotherapy may not be good candidates.