Vaginal Rejuvenation

The Surgical Art of Looking Good and Feeling Better

Vaginal Relaxation - What Is It?

Vaginal relaxation refers to the stretching of the pelvic floor supports (connective tissue, ligaments and muscles) that takes place as a result of time, ageing, childbirth, genetics, lifestyle etc). Pregnancy and more importantly labour and vaginal delivery are the factors most often associated with the loss of sensation and damage to the female pelvic floor. It not only results in changes in sensation during intercourse but may have an adverse impact on urinary and lower bowel function (urinary incontinence and problems with emptying the bowels).

Many women suffer from their symptoms for many years before seeking help because the symptoms are often embarrassing and because there is a lack of information and discussion about the issues in a more public forum. Often, when women find the courage to seek help from doctors (male and female) they are often met with either a lack of interest or the attitude that it is 'all part of being a woman.' Such changes to function are, in Dr Onuma's views, about as normal or acceptable as an unresolved toothache, but he continues to see a large number of women who have been put off seeking help after their first attempts have been disparaged.

Different parts of the vagina can be affected to different degrees and each individual woman will have unique functional problems as a result such as lack of sensation during sex, the feeling that there is an obstruction within the vagina, stress urinary incontinence and difficulty passing motions (faecal trapping).
Vaginal relaxation can occur in the absence of significant pelvic organ (vagina, cervix, uterus) prolapse, but often both are seen to co-exist.

(*please refer to the section on ‘Female Pelvic Organ Prolapse')

For all practical purposes, definitive treatment is surgical correction of the specific defects.

Symptoms of Sexual Dysfunction

A departure from normal sensation and/or function experience by a woman during sexual activity.

  • Dyspareunia
    • Complaint of a persistent or recurrent pain or discomfort associated with attempted or complete vaginal penetration.
  • Superficial (introital) dyspareunia
    • Complaint of pain or discomfort on vaginal entry or at the vaginal introitus.
  • Deep dyspareunia
    • Complaint of pain or discomfort on deeper peneration (mid or upper vagina).
  • Vaginal laxity (relaxation)
    • Complaint of excessive vaginal laxity.

Laser Vaginal Rejuvenation

A Surgical Approach Aimed At Improving Vaginal And Pelvic Floor Function.

The concept of female pelvic floor medicine has been one that has been steadily developing and is often multidisciplinary. Depending on the pelvic floor problem, any individual patient might benefit from the imput of a gynaecological pelvic reconstrutive surgeon, a colorectal surgeon, urologist, pelvic floor physiotherapist, or an expert on female hormone or psychological function. There is still much to learn about female pelvic floor function and as we do, the likelihood is that certain aspects of these individual disciplines will work more cohesively for the benefit of women.

Laser Vaginal Rejuvenation for the enhancement of sexual function is reserved specifically for those women who complain that as a result of diminished vaginal sensation (due to vaginal wall relaxation) their enjoyment of sexual intercourse has been dimiinished. It can also be of significant value in women who, as a result of vaginal wall scarring (e.g. result of tears or episiotomy during childbirth or previous vaginal surgery) suffer from pain during intercourse or an overtight vagina where intromission has become painful or impossible.

LVR is unsuitable and unhelpful for women who have lost their libido (perhaps as a result of stress, depression, relationshiop dysfunction or are simply '"too tired" because they have responsibilities such as childcare). Women who have lost their libido need to seek appropriate assistance in resolving the lifestyle or medical issues that have caused their problem. Dr Onuma will not operate on women who he feels willl not benefit from surgery and this reflects the ethos of associates of the Laser Vaginal Rejuvenation Institute worldwide.

Where the cause of sexual dysfunction has a physical basis such as urinary incontinence, pelvic organ prolapse, vaginal relaxation resulting in diminished sensation, scarring of the vaginal walls from previous childbirth or surgery and labial entrapment during intercourse, surgical correction of the defect may result in significantly improved sexual function and enhancement of sexual gratification.

  • Laser Vaginal Rejuvenation &/or Designer Laser Vaginoplasty simultaneously combined with incontinence ± prolapse surgery will be, for many women, the key to improving their quality of life and enhancing their self-image and confidence.

Designer Laser Vaginoplasty®

Designer Laser Vaginoplasty® (DLV®) is the functional and aesthetic surgical enhancement of the vulvar structures:

  • labia minora, labia majora, mons pubis, perineum, introitus and hymen, (see figure).

Dr Onuma receive's numerous requests for 'before and after photographs' of surgeries performed. Dr Onuma does not usually provide these as a matter of patient confidentiality. Individual patients can, on request, be provided with digital images of themselves before and after surgery or, if relevant, de-identified images of previous surgeries.

The most common DLV procedures are as follows:

Laser Reduction Labioplasty can sculpture the elongated or unequal labial minora (small inner lips). Many women say that they do not want the small inner lips to project beyond the large outer lips. The most common reason for this is functional; infolding of the labia during intercourse causing discomfort, thickening and/or stretching of the labia as a result of chronic irritation from physical interaction with clothes or indeed the opposite labia, labial discomfort when wearing underwear such as a G-string and also discomfort when wearing tight trousers or simply sitting down. Some women are unsettled by the length of their labia, an aesthetic issue for which labioplasty is also effective. Labioplasty techniques can also reconstruct conditions that occur due as a result of the aging process, childbirth trauma, or injury.

Laser Perineoplasty can rejuvenate the relaxed or ageing perineum, providing support and increasing the lost distance between the entrance of the vagina and the anal margin. It can also enhance the sagging labia majora (large outer lips) and labia minora. Overall, the procedure can provide a more comfortable and aesthetic vulva.

Hymenoplasty (reconstruction of the hymen). The hymen can be damaged by sexual intercourse, use of tampons, digital manipulation of the vagina and spontaneously. The hymen can be repaired to look as if there had never been any damage to it. Dr Onuma is sensitive to the needs of women from all cultures that embrace these particular issues because of cultural, social, or religious reasons.

Combination of DLV with LVR. Most LVR and DLV can be performed in combination.

Dr Onuma does not combine LVR with hymenoplasty because of the risk of vaginal stenosis

They can also be performed with most cosmetic surgical procedures; the most popular of these are breast implants, breast reduction, tummy tuck, nose surgery, and eyelid surgery. (*these additional procedures would be carried out by an independent plastic surgeon who you would be expected to consult with before arrangements are made to carry out the required surgery under one anaesthetic).

The limitation to combining pelvic reconstructive surgery (functional and aesthetic) with general cosmetic procedures is the availability of surgeons as well as the risk-benefit analysis of one prolonged combined procedure compared with a two-stage procedure

Laser Vaginal Rejuvenation® for the Enhancement of Sexual Gratification

Laser Vaginal Rejuvenation® (LVR®) refers to a variety of surgical procedures designed with the aim of enhancing vaginal sensation during intercourse in women who have noted diminished sensation over time combined with clinically demonstrable pelvic organ prolapse.

LVR is the modification of gynaecological surgical procedures used for the treatment of female pelvic organ prolapse.

The laser techniques used result in gentle precision procedures with controlled accuracy. These techniques result in rapid healing and resumption of daily activities in a short period of time.

Laser Vaginal Rejuvenation® (LVR®) may effectively enhance vaginal muscle tone, strength, and control. This improvement will usually be amplified by attention to postsurgery pelvic floor retraining. Appropriate surgery may also effectively decrease the internal and external vaginal diameters as well as build up and strengthen the perineal body (see figure below).

In vaginal relaxation, the muscles are relaxed and have poor tone, strength, and control. The internal and external diameters increase. The muscles of the perineum are weak and poorly supported. Under these circumstances, the vagina is no longer at its optimum physiological state. As a result, the sensual side of sexual gratification is diminished. LVR was designed to enhance sexual gratification for women, who for whatever reason lack an overall optimum architectural integrity of the vagina.

It is important to note that reduced sensation during intercourse can be multifactorial (have many causes). Aside from issues such as those pertaining to psychosexual dysfunction a not uncommon cause of reduced sensation during intercourse is damage to the sensory nerves supplying the pelvic floor. The main nerve responsible is called the Pudendal nerve and this can undergo a crush or pressure type injury during vaginal delivery of a baby. This type of nerve damage has a higher incidence during 'instrumental' vaginal delivery such as forceps or ventouse ('suction') deliveries. Whilst there are complex test such Pudendal latency tests that can assess the function of the nerve, interpretation of the relationship between nerve damage and outcome on sexual function is not possible to gauge with any accuracy. Why is this important? It is important because physical reconstruction is no guarantee that full restoration of normal functon will result.

Empowering Women With Knowledge, Choice, And Alternatives

Dr Onuma encourages patients to participate in their healthcare and surgical options.

Pelvic floor surgeons with an interest in female sexual function have learned a tremendous amount from listening to women.

Many women who have sought Dr Onuma's help with problems related to urinary incontinence, pelvic organ prolapse and reduced sensation or pain during intercourse have been seeking help for 10 -15 years beforehand and report that they have often been ignored or told that their concerns are misplaced because they are simply consequences of being female! Few people find it easy to talk to strangers (doctors) or friends about leakage during exercise, the bulge that they have noticed protruding from their vagina or their labial discomfort or lack of vaginal sensation. These issues, however, need to be raised and explored in order to provide options for improving quality of life. Patients are becoming more informed and aware that there are solutions and doctors and other healthcare professionals are becoming better listeners and improving the range of options available.

In the same way that female urinary incontinence and faecal incontinence have been taboo subjects until the last few years, female sexual dysfunction (physical, hormomal, psychological) remains essentially an area where many health care professionals remain uneducated. Women come to Dr Onuma because they want knowledge, choice, and alternatives. Women want their gyanecologist to listen to them and provide viable solutions. Women throughout Australia have told Dr Onuma that whilst Kegels (pelvic floor exercises) provide some assistance, often they do not provide a definitive solution -but no one is listening. Women who have had children want a solution to rejuvenate the vagina and achieve the best sexual experience possible. No one wants to age or lose optimal function anywhere, and this includes the vaginal and vulvar structures.

Patients with involuntary loss of urine with coughing, sneezing, laughing, exercising, or sex can have their stress urinary incontinence corrected along with enhancement of sexual gratification.

 

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Quality Of Life

Vaginal relaxation is the loss of the optimum structural architect of the vagina. In the vaginal relaxation process, the vaginal muscles become relaxed with poor tone, strength, control and support. The internal and external vaginal diameters can greatly increase. The muscles of the perineum (the group of supporting muscles right outside the vaginal opening at the bottom) thin and separate in the midline producing a weakened, poorly supportive, thinned out perennial body.

Under these circumstances the vagina is no longer at its physiologically optimum sexual functioning state. In short, the sensual side of female sexual gratification is diminished. Thus, vaginal relaxation has a detrimental effect on sexual gratification because of the reduction of sexual feelings or pleasure.

How a woman feels about her sexuality is greatly influenced by her perception of her own wellbeing. Women who suffer from urinary incontinence or prolapse of the uterus &/or vaginal walls report high levels of sexual dysfunction. Embarrassment resulting from incontinence occurring during sexual intercourse or experiencing a sensation of a lump in the vagina can be distressing to the extent that it leads to avoidance of intimate contact with one’s partner.

Loss of libido that results from psychological or psychiatric dysfunction, chronic illness, debility or overt tiredness are generally best managed by treatment of the specific underlying cause.

Where the cause of sexual dysfunction has a physical basis such as urinary incontinence, pelvic organ prolapse, vaginal relaxation resulting in diminished sensation, scarring of the vaginal walls from previous childbirth or surgery and labial entrapment during intercourse, surgical correction of the defect may result in significantly improved sexual function and enhancement of sexual gratification.

Laser Vaginal Rejuvenation &/or Designer Laser Vaginoplasty simultaneously combined with incontinence ± prolapse surgery will be, for many women, the key to living life and not merely existing in the belief that it is normal to suffer from diminished sensation during intercourse, incontinence or pelvic organ prolapse.

What Can You Do?

Have courage! See your local doctor and engage them in a frank discussion about your perceptions about what your problems are. It is important to be frank and direct because not all doctors will know to discuss all the issues which are important to you. They will probably ask you about issues related to libido and try to exclude the presence of other causes of decreased sensation during intercourse. They may consider that referral to a counsellor may be appropriate.

If you feel that your problems have a physical basis such as lack of sensation or pain during intercourse, then you can ask for a referral to a specialist with an interest in the physical basis of female sexual dysfunction. Of course your local doctor is entitled not to make such a referral, however, you are entitled to consult another doctor in order to obtain the referral that you require.

Trust yourself and persist. It is NOT in your mind! Someone WILL listen to you and place you on the path to a better quality of life.

Frequently Asked Questions

Below are some of the commonly asked questions (and answers to) that we receive We also offer and encourage you to have a complimentary telephone conversation with our gynaecological surgeon, Dr Onuma, to address your issues and discuss our procedures. You can arrange a telephone conversation by scheduling one with our receptionist (Marianne or Jo) by calling +618 8344 6085 or you can make a request via E-mail (oseka@dronuma.com). Simply provide your telephone number and the best time to contact you. Our policy is to return your call or E-mail within 48 hours of receiving it. We are continuously updating our web site in order to provide you with a comprehensive and user friendly site that educates, describes, and explains our patient services. Our goal is to provide women with knowledge, choice, and alternatives.

Q: I am interested in having the procedure, can you explain more about it.
A: Because we offer numerous services it is hard to respond to a general question such as this. Dr Onuma would encourage you to make contact to determine your individual circumstances and the options available to you.

Q: I have had a child or a number of children and since, things just aren't the same vaginally. My vagina isn't like it was before I had children. Sex just isn't as gratifying as before. For me, having children resulted in vaginal enlargement, with loose, weak, vaginal muscles. My vaginal muscle tone is poor and the support outside the vagina at the bottom is poor also. I performed Kegals until I was blue in the face and they didn't help me at all. I didn't know about this procedure. But I am happy to know that something can be done. Please explain to me how Laser Vaginal Rejuvenation can correct my problems and enhance sexual gratification.
A: Many women have your exact same problem, share your self conscious concerns, and desire to enhance sexual gratification. Women are very concerned about their sexual health, sexual gratification, and procedures to enhance sexual gratification.

Laser vaginal rejuvenation for the enhancement of sexual gratification is a modification of a standard gynaecologicL surgical procedure. The laser is used to perform, precise surgical incisions. In brief surgery aims to tighten the vaginal muscles and support tissues, as well as reduce redundant vaginal mucosa (relaxed vaginal lining). The procedure will enhance vaginal muscle, tone, strength, and control. It will effectively decrease the internal and outer (introitus) vaginal diameters, as well as build up the perineal body (the area immediately outside the vaginal and above the anus).

Q: I have had several children. I have vaginal relaxation and I also lose urine when I laugh, cough, sneeze, or exercise. This problem has really impacted on my life, it is socially embarrassing and hygienically unacceptable. Can I correct my urinary problem and enhance sexual gratification all at once?
A: Your urinary problem is called stress urinary incontinence. It is caused by the vaginal relaxation of the top part of the vaginal wall. Laser vaginal rejuvenation can be combined with minimal access incontinence surgery such as the TVT procedure (Johnson & Johnson TVT and TVT O and American Medical Systems Monarch TVT procedure) or laparoscopic Burch colposuspension.

Q: How long does laser vaginal rejuvenation take?
A: The surgical time depends on the extent of the procedure. In general the procedure takes about one hour. Where there is significant vaginal wall or uterine prolapse correction of these will be undertaken at the same time and would increase the duration of surgery.

Q: Where is the procedure performed?
A: In a fully accredited hospital: St Andrew's Hospital, South Terrace, Adelaide.

Q: I have vaginal relaxation of the bottom floor of the vaginal and the perineal body. Can I have laser vaginal rejuvenation?
A: In this case we only need to repair the lower floor of the vagina and the perineal body (area immediately outside of the vagina). Usually in this case vaginal relaxation is less extensive. Laser vaginal rejuvenation may also enhance sexual gratification.

Q: I haven't had any children but I have some vaginal relaxation and I would like to enhance vaginal muscle tone and strength as well as decrease the vaginal diameter. Can I have the procedure?
A: Depending on your circumstances you can be a candidate for the laser vaginal rejuvenation. Such procedures primarily involve the bottom part of the vagina and the perineal body. It is important to note that a future pregnancy can alter the shape and sensation of the vagina.

Q: What types of anaesthesia are available?
A: You can be provided with your choice of anaesthesia by our anaesthetist. [local, nerve block, epidural, spinal, IV sedation, general]. Some types of anaesthesia are procedure dependent.

Q: When can I resume sex after laser vaginal rejuvenation?
A: We ask that you abstain from sexual intercourse for 6 weeks. Oral sex may be resumed much earlier.

Q: When can I return to work after laser vaginal rejuvenation?
A: In general returning to work is dependent on the type of work you do. Most patients can return within 2-3 weeks, particularly if the type of work done mainly involves sitting. If your work involves heavy lifting or spending long periods of time on your feet then you might benefit from a longer (4-6 week) recovery period. If LVR is combined with incontinence or pelvic organ prolapse surgery then the recovery time should be view as being between 3-6 weeks.

Q: I am from out of town. How long do I have to remain in Adelaide after laser vaginal rejuvenation?
A: You can return home in 4-5 days. If you are international visitor then you will need to remain in Adelaide for at least 7 days.

Q: How much discomfort will I have after laser vaginal rejuvenation?
A: With the technique of submucosal tumescence, pudendal block with long acting local anesthetic, most patients report mild to moderate discomfort which can be controlled by oral analgesia.

Q: How much does laser vaginal rejuvenation cost?
A: The fees depend on the type of the procedure and the extent. A quote can be provided once we know your particular needs. Quoted fees will provide a guide as to the fees raised by the surgeon, surgical assistant, anaesthetist and hospital.

Q: What are the surgical risks for laser vaginal rejuvenation?
A: Laser vaginal rejuvenation is a safe procedure with low risk. To put the risk in perspective, pregnancy is associated with far more risk than any of these procedures. Like any surgery the risks include haemorrhage and infection. These are less than 1%. If one requires work on both the upper and lower vagina then there is risk of injury to the bladder and the rectum. This is exceptionally rare. With any surgery one can encounter scarring. Over correction can potentially result in painful sex. Although rare there are anaesthetic risks which are dependent on the type of anaesthesia. Prior to any surgery a thorough discussion will take place not only about the operation technique and likely outcomes but also the specific risks associated with your particular plan of management.

Q: Can laser vaginal rejuvenation be combined with designer laser vaginoplasty?
A: Laser vaginal rejuvenation can be combined with perineal body reconstruction and labia minora and majora reduction.

Q: Can laser vaginal rejuvenation or designer laser vaginoplasty be combined with cosmetic surgical procedures?
A: Yes, Dr Onuma works in association with plastic and reconstructive surgeons so as to be able to combine laser vaginal rejuvenation or designer laser vaginoplasty with most cosmetic surgical procedures such as breast, nose, eye, or tummy tuck surgery. Some combination procedures may require a prolonged period of time in the operating theatre and Dr Onuma would weigh the potential risks associated with this compared to having to separte procedures.

Q: My inner vaginal lips (labia minora) are too long. Can I have them reduced?
A: The labia minora can be aesthetically sculptured to your specifications with reduction labioplasty. The principle revolves around function - making the labia less uncomfortable but the end result also encompasses the desire of many women to have smaller, neater labia.