Intimate plastic surgery is an operative alteration of the genital organs, during which their appearance or functionality can be improved. Many sexual problems arise from people’s dissatisfaction with their genitals because of real or perceived defects. There is intimate plastic surgery to correct them.
The association of aesthetic plastic surgeons, for example, writes in a press release that around 2,800 operations were performed on female genital areas in Germany in 2018, compared to 3,400 in 2019, an increase of 17 percent.
Female Genital Surgery
The following interventions are most popular with the fair sex:
- Labioplasty (alteration of the labia, or vulva lips).
- Vaginoplasty (vaginal surgery).
- Hymenoplasty (reconstruction of the hymen).
- Surgical defloration (destruction of the hymen, if it is difficult for certain reasons to do this in a normal way).
- Clitoroplasty.
- Pubic area plasty.
Male Genital Surgery
For men, genitalia functionality is in the first place, so the operations are divided into:
- Aesthetic (alteration of the appearance and size of the penis),
- andrological (restoration of impaired ability to have sexual intercourse).
Intimate plastic surgery helps to restore self-confidence, preserve mental health and ensure the possibility of a full perception of life.
Labioplasty ‒ Vulva Lips Plasty
Labioplasty is the area in the female intimate plastic surgery which deals with the correction of the labia size and shape. The surgery is usually performed at the patient’s request which is due to aesthetic reasons, but interventions are also possible for medical reasons.
A woman always strives to be beautiful in everything, and the intimate area is no exception. The conventional aesthetic standard is considered to be symmetrical inner lips which almost do not protrude beyond the edges of the outer lips (this corresponds to a length of 5 cm). In this case, there is often a situation when the harmony of the external genitalia proportions is disturbed. The reasons for this may be congenital or acquired. The most frequent of them are as follows:
- An individual peculiarity ‒ elongated vulva lips.
- Severe weight loss.
- Injuries (including childbirth).
- Excessive production of testosterone (it occurs in a variety of hormonal disorders, during puberty and pregnancy).
- Age-related changes.
- Inflammatory processes in the genital area.
Most often (approximately one in ten) women suffer from too large and asymmetrical inner lips. In this case, a woman may feel uneasy during sexual intercourse, when visiting public baths and during a medical examination. Enlarged labia cause problems with the choice of underwear. They can be jammed and become a source of pain when walking and cycling. Constant friction, skin irritation and tension lead not only to physical, but also to psychological discomfort. These women often develop neurotic conditions, since self-doubt causes difficulties when communicating with the opposite sex, leading to irritability, isolation and reduced quality of life. In such a situation, labia minora plasty can completely eliminate the problem.
Women often ask a question about how labioplasty influences the quality of sexual life. There is an opinion that during surgery the integrity of the nerve trunks suffers, as a result of which the sensitivity of the vulva is disturbed. Another reason for women’s fears is such undesirable consequences as scars.
The above problems are to a considerable degree farfetched. When marking and making incisions, the doctor takes into account the location of the most sensitive areas and bypasses them. Moreover, the removal of excess tissue makes the erogenous areas more open and accessible for stimulation. In addition, the discomfort caused by the elongated labia which, during coitus, can tuck in and cause pain, disappears. Slight numbness, sometimes occurring after surgery, is owing to oedema and it quickly passes.
As for the scars, like after most intimate plastic surgery, they are almost imperceptible even with a gynaecological examination. This is achieved by properly performing incisions and subsequently inserting cosmetic mini sutures.
Besides, the performed labioplasty has no negative effect on the course of pregnancy and childbirth.
Indications for Labioplasty
This plastic surgery can be performed in the following circumstances:
- A pronounced increase in the length of the inner lips and their protrusion beyond the edges of the outer lips.
- Asymmetry (a considerable difference in size between the right and the left vulva lips). It should be noted that ideal symmetry is not found in nature (which is considered an aesthetic standard) and it is almost impossible to achieve it even through the use of surgery.
- Loss of elasticity (usually due to age-related changes in the tissue).
- A marked increase in pigmentation.
- Tears, deformity and scarring (the result of injuries and inflammation).
Labioplasty usually involves the reduction of the labia. Surgery to make them larger is much less in demand.
Contraindications
Labioplasty is contraindicated in individuals having certain diseases and conditions, the most frequent of which are:
- Acute infections.
- Severe pathologies of internal organs (cardiovascular and respiratory systems, kidneys, liver).
- Decompensated diabetes.
- Problems with blood coagulation.
- Oncological diseases.
- Endocrine pathologies.
- Venereal diseases.
- Any inflammatory processes in the area of the internal (endometritis, colpitis) and external genital organs (bartbolinitis, furunculosis, herpes, candidiasis).
- Mental illnesses.
- Menstrual period.
Labia Minora Reduction Surgery (Reduction Labioplasty)
The essence of the intervention is the excision of excess skin, due to which the inner lips are reduced, hiding behind the outer lips, and become almost symmetrical. Two main surgery techniques are applied:
- V-shaped incisions with subsequent excision of skin grafts. In this case, the natural folding and pigmentation of the edges of the lips are preserved.
- Linear incisions which are used to alter the size and to eliminate excessive folding and hyperpigmentation.
The doctor can use both a scalpel and a medical laser (laser labioplasty). In the latter case, the operative bleeding is practically absent.
Labia Minora Enlargement Surgery
It is performed by introducing biopolymer gel into the base of the skin folds, which visually pushes them forward.
Labia Majora Reduction Surgery
This procedure may be necessary in case of an excessive volume of lips, which is eliminated by local liposuction. If there is sagging and deformation at the same time, it may be necessary to excise excess tissue.
Labia Majora Enlargement Surgery
Sometimes objectively “normal” inner lips seem to be excessively elongated due to the insufficient size of the outer lips, which stop covering them (this can happen after a sever weight loss). In this case, it is possible to enlarge the latter due to the introduction of various fillers ‒ the patient’s own adipose tissue, biopolymers or hyaluronic acid.
Any of these procedures lasts up to 1 hour, after which a bandage is applied and the patient leaves the clinic on the same day. As sutures from absorbable materials are usually used, their removal is not required.
Recovery Period
For several days, the woman should not wear tight underwear, sit for a long time, have thermal procedures, drink alcohol and have sexual intercourse. It is also recommended to avoid physical loads. It will be possible to estimate the result of the surgery in about three months.
Sometimes there are unpleasant phenomena: pain in the surgical area, oedema, irritation, impaired sensitivity. Such discomfort disappears over time. If necessary, the doctor prescribes analgesics and other corrective drugs.
Labioplasty is a technique that gives a woman the opportunity to feel beautiful and desired in any situation.
Vaginoplasty ‒ Vaginal Plastic Surgery
Vaginoplasty is a surgical restoration of the anatomical and functional integrity of the vagina. The surgery can be performed at a woman’s request, or for medical reasons.
The vagina is a multifunctional organ. Its destination is to take a penis during coitus and expel a mature fetus during natural childbirth. Both processes impose high and difficultly compatible requirements on the hollow muscular mass which is the vagina (Latin vagina). On the one hand, it should be dense enough for the quality performance of sexual intercourse. On the other hand, it should be wide enough to make it possible for a mature fetus to leave the mother’s genital tract without problems. This contradiction results in such a common obstetric pathology as tears of the vagina and perineum, and sometimes in the prolapse of the uterus.
Overstretching of the vaginal tissues adversely affects both the woman’s well-being and the quality of her sex life. Over time, age-related changes inevitably add to birth trauma ‒ a decrease in tissue elasticity, a decrease in gland secretion and in vaginal sensitivity. These problems can considerably worsen the quality of the woman’s life and lead to personal and social conflicts.
There is also a purely medical aspect concerning the state of the vagina. Stretched vaginal muscles inevitably lead to a weakening of the perineum and pelvic floor, which may bring about such unpleasant phenomena as urinary and fecal incontinence (owing to the weakening of the anal sphincter). This leads to social maladjustment and can cause neurosis and depression.
Modern medicine can almost completely solve this problem. Vaginoplasty is the surgery that restores the lost positive feeling to a woman and resolves a lot of problematic situations.
Vaginoplasty and Sex Life
In the “anthropogenic” XXI century, the importance of sex life is often underestimated. Modern people do not have so many “niches” that are free from socialization, and the most important of them is sexual relations. Everything connected with this aspect of human activity always attracts specialists’ attention for studying and making corrections.
Intimate plastic surgery is aimed at changing the quality of life for the better through the use of surgery. Plastic surgery of the vaginal walls is a relatively simple and at the same time effective manipulation that can eliminate a lot of problems in sexual relationships.
The purpose of the surgical procedure is to strengthen the muscles of the vagina, to narrow it, to eliminate the consequences of ruptures and scarring. Even such an unpleasant “trifle” as the “sound accompaniment” of coition, which is caused by a decrease in muscle tone and accumulation of air in the vagina, is eliminated. After childbirth and trauma, vaginal plastic surgery permits a woman to get back the joys of life ‒ the ability to have normal relationships with a man and physiological comfort.
Types of Surgery
There are several types of vaginoplasty.
Colporrhaphy (Colpoplasty)
Anterior colporrhaphy is a type of surgery for prolapse of the anterior wall of the vagina. As a rule, it is combined with simultaneous restoration of the integrity of the perineum by strengthening the musculo-fascial layer.
Anterior colporrhaphy can be performed under general and local anaesthesia. The patient is given a position used in all transvaginal techniques.
According to generally accepted rules, the surgical area is prepared; the uterine cervix is exposed by means of mirrors and an elevator, fixed with special forceps and brought down. Then, from the front wall of the stretched vagina with fully stretched folds an oval-shaped flap is raised so that its most pointed end will start at a distance of 1-2 cm from the external opening of the urethra, and the other one will extend to the site where the mucous membrane goes from the anterior vaginal fornix to the cervix. The circumferential incision of the vagina wall should be made so that the wound edges will be 0.5-1 cm apart, that is, with the dissection of the underlying loose connective tissue layer up to the fascia under it. Otherwise, the separation of this delineated flap will require additional effort and be accompanied by severe bleeding.
If the incision is too deep, bladder injury may occur. In addition, in order not to narrow the vagina too much or, on the contrary, not to make the surgery absolutely meaningless, having raised a too small flap, it is necessary to determine the width of the removed tissue section as accurately as possible. In case of need, it is always possible to increase the area of the excised section intraoperatively by excising additional strips from the vaginal wall. The doctor begins this manipulation from the external opening of the urethra and advances to the cervix. Then, having raised this section, the doctor separates the edges of the vaginal wound leaving about 1 cm between them, and then carefully, without tying too tight, joins them with separate knotted catgut sutures, bearing in mind that these tissues are easily cut through. The outcome of the operation depends largely on how the edges of the incision are hold together.
At the end of the surgery the vagina is tightly tamponed for 12-24 hours so that it will get smoothed out well.
Vagina Opening Reduction
Reducing vagina opening is a surgical procedure in intimate surgery that is performed on women with enlarged internal vaginal size.
During pregnancy, the body prepares for childbirth, during which the vagina is stretched to the size of the baby’s head. Sometimes, after giving birth, by reason of hormonal disturbances, the size of the vagina may not restore. It should be noted that a baby’s head reaches tens of centimetres, and after childbirth, doctors suture vaginal tears, but this does not mean that its size will be fully restored and you will not have to perform plastic surgery of the vagina separately.
The walls of the vagina should completely encircle the partner’s penis, which does not happen, and getting pleasure from sex becomes impossible. And such a problem, in turn, can become a real obstacle to the continuation of a normal family life.
The main indications for surgery are:
- Dissatisfaction with the sexual life;
- discrepancies in the size of the vaginal opening and the partner’s penis.
Vagina opening reduction (as a type of surgery) makes it possible to restore the functionality of the female genital organ. Stretched vaginal tissues not only worsen the quality of sexual life, but also provoke the occurrence of problems of urinary incontinence, vaginal prolapse, as well as uterine prolapse. After examination and based on the results of vaginal examination, the surgery is scheduled. Vaginal examination is performed to examine and assess the condition of the walls of the vagina, only after this individual treatment is prescribed. The surgery is performed under general anaesthesia. The vagina opening is reduced by imposing a series of sutures on its vestibule. During the operation, only the upper layers of the vaginal ring are affected, and the scars that may have remained after childbirth are removed. During the first week of the rehabilitation period you will not be able to sit. It is also necessary to limit sex life for a period of about 1.5 to 2 months. There are also separate procedures for suturing the anterior or posterior walls of the vagina, which are called respectively the anterior or posterior colporrhaphy. During the operation, scar tissue is excised, vaginal walls and perineal muscles are sutured. For a long time after the procedure, heavy physical activity is prohibited, you should also limit exercise.
Vagina opening reduction is not performed:
- In the presence of inflammatory processes in the woman’s genital area,
- in the presence of sexually transmitted diseases.
Colpopoiesis
The absence of the vagina (atresia) is a congenital disease when the female genital organs are underdeveloped. At the same time, the ovaries develop normally, which maintains a sufficient hormonal level, therefore in outward appearance the woman looks completely normal. And the only sign that makes it possible to suspect this pathology and begin an examination is the absence of menstruation, which is usually the reason for consulting a gynaecologist.
The absence of the vagina, owing to a genetic defect, when the woman has developed ovaries and uterus, should be distinguished from Mayer-Rokitansky syndrome. In some cases, after a comprehensive examination, polycystic kidney disease is also detected in combination with the absence of the uterus and vagina.
In all these cases, women may be unaware of their disease until the first visit to the gynaecologist or until puberty, when they notice the absence of menstruation. And sometimes women can even have sexual intercourse with this pathology. In this case, the urethra is used for intercourse, which leads to its overstretching and, as a consequence, the development of cystitis or urinary incontinence ‒ the problems with which women turn to the urologist.
The absence of the vagina can be treated only surgically. The surgery is called colpopoiesis (formation of vagina) and can be open or laparoscopic. In the first case, a horizontal incision of 10 cm in length is made in the lower abdomen. In the second case, the surgery is performed through punctures in the anterior abdominal wall by means of special instruments.
Nowadays, laparoscopic colpopoiesis is more often performed, since this type of surgery is more easily tolerated, and the absence of a scar provides a cosmetic effect. During the operation, a neovagina is formed from a segment of the sigmoid colon, that is, a segment of the colon is excised, and the continuity of the intestinal tube is restored via anastomosis.
The surgery is performed under general anaesthesia as described above. After the surgery, you will need to spend 1 week in hospital so that your sate of health in the postoperative period will be carefully monitored, despite the fact that the surgery is tolerated fairly easily.
During the first two days you should be in a horizontal position. A tampon will be inserted in the neovagina, which will also be removed in the first days after the operation. Subsequently, the vagina will be irrigated with antiseptic solutions. You will also be recommended to “exercise” the neovagina, that is, to perform bouginage.
The surgery is an effective method of treatment in the absence of the vagina, since the woman gets the opportunity to live a normal sex life, which fully rehabilitates her in the sexual sphere, which is an important component of a person’s life.
Vaginal Fornix Prolapse
Vaginal fornix prolapse is a common disease, most often it is diagnosed in aging patients. Vaginal fornix prolapse is a frequent complication of surgery to remove the uterus. After surgery, the upper part of the vagina weakens and begins to sag in its lumen. This is because of the loss of the supporting function that was provided by the removed uterus.
Every fourth patient aged 30-40 suffers from this disease. After the age of 50, every second woman faces vaginal prolapse. However, young women are also in danger of getting this disease, but less often: only every 10th patient comes to see a doctor with this problem.
Vaginal prolapse is associated with muscle weakening in the pelvic and abdominal areas. In addition, the causes of the disease may be an increase in abdominal pressure associated with overload, frequent constipation, weight lifting, difficult childbirth, obesity and old age. Estrogen deficiency can lead to vaginal fornix prolapse.
Clinical symptoms of vaginal prolapse are a sensation of a foreign body in the vagina, pain in the abdomen, feeling of heaviness in the abdomen, pain in the sacrum or lower back, aggravated by weight lifting, walking, coughing and sneezing.
The disease is conventionally divided into several stages:
- Mild form ‒ ptosis of the vaginal walls.
- Partial vaginal prolapse.
- Complete vaginal prolapse.
In this case, the disease is accompanied by uterine prolapse. In the early stages, vaginal fornix prolapse is often impossible to detect, since the disease may be asymptomatic.
The disease is usually treated surgically, although at the onset of the disease special exercises can help (conservative management of patients with the prescription of exercise therapy). The diagnosis is made after a gynaecological examination and palpation. A rectal examination is also required to assess the state of the rectal sphincter.
Indications
Strengthening the muscles of the vagina (vaginoplasty) is indicated in the following cases:
- Multiple childbirth.
- Birth injuries and obstetric surgery.
- Age-related changes.
- Anorgasmia (absence of orgasm or difficulty in attaining it).
- Unaesthetic (gaping, etc.) pudendal fissure caused by childbirth, surgery and other reasons.
- Inherited problems in the intimate area.
- Medical indications (vaginal prolapse, uterine prolapse, urinary incontinence, etc.).
Contraindications
Vaginoplasty is contraindicated in the following cases:
- Severe diseases of internal organs (kidney, liver, respiratory and cardiovascular systems).
- Decompensated diabetes.
- Blood clotting disorders.
- Genital infections (colpitis, herpes, candidiasis, trichomoniasis, etc.).
- Mental disorders.
- The menstrual period (in this case, the surgery is postponed).
- Acute condition of infectious diseases.
- Tendency to form large (keloid) scars.
- Allergy to drugs used for local or general anaesthesia.
Surgery and Recovery Period
Vaginoplasty, depending on the specific case and the chosen technique, can last up to two hours. Anaesthesia is almost always general (narcosis).
After surgery, the woman stays in the clinic for a period of 2 to 8 days. The doctor can prescribe confinement to bed for several days, a slag-free (completely liquid) diet to prevent complications associated with defecation, as well as a course of antibiotic therapy.
Suture removal is performed approximately 7 days after surgery (in some cases, when an absorbable material is used, this is not necessary). Within two weeks, the patient should not sit and lift weights, since this may result in partial or complete dehiscence of the knots, which will considerably worsen the effect of the surgery. Additional contraindications include visiting solariums, saunas, baths and swimming pools. Sex intercourse is allowed in about a month.
Complications
Problems appear quite rarely and are usually associated with failure to keep the regimen and follow other medical recommendations. This may be infection of sutures or their dehiscence. The inconveniences are usually easily eliminated.
Vaginoplasty permits a woman to feel desired at any age and live a rich and satisfying life.
Clitoroplasty
Clitoroplasty is surgical intervention in the area of the clitoris, aimed at changing its size and shape, as well as eliminating congenital or acquired defects. The surgery can be performed for aesthetic and medical reasons. In the latter case, it is about improving the quality of sex life and restoring the fullness of sensations in the presence of sexual problems.
Women’s Sexual Life, the Clitoris and its Importance
It is almost impossible to overestimate the importance of intimate relationships for a woman. Their effect on the physiological and psychological status has long been proven. Satisfying and regular sex life contributes to blood flow to the pelvic organs, improves the body’s resistance to infections by increasing immunity, improves self-esteem and is a strong anti-depressant. On the contrary, sexual problems lead to stagnation in the genital area, which can provoke the occurrence of various pathologies (inflammation of the uterine appendages, fibromyoma, etc.). They also negatively affect the emotional background, cause neurosis, social maladjustment and deterioration in the quality of life.
The clitoris is considered to be the centre of sexual sensations. Most women are able to experience both vaginal and clitoral orgasms, which harmoniously complement each other, but direct stimulation of the clitoris is an indispensable condition for obtaining satisfaction for most of them (according to various estimates, there are approximately 87% of such women). In the event of any problems with the clitoris, the subtle process of excitation, conduction and summation of sexual impulses can be disturbed, and with it the occurrence of orgasm.
Clitoris ‒ Main Problems and Their Causes
The clitoris is a peculiar analogue of the penis. It also consists of the cavernous bodies which are filled with blood and increase the size of the organ when excited. It also has glans, frenulum and miniature foreskin ‒ a fold of skin, otherwise called the clitoral hood.
On average, the size of the clitoris is from 2 to 4 cm, but it is not the size that is decisive, but the distance from it to the vagina opening. With a considerable distance (more than 2.5 cm), its stimulation during intercourse becomes insufficient, which makes it difficult to achieve orgasm.
In some cases, the clitoris becomes “covered” by an excessively enlarged skin fold or scars. This can occur when the tissues of the intimate area are weakened and slip down (perineal descent). This condition arises by reason of age-related changes, weight fluctuations, past pregnancies and childbirth, obstetric (and other) injuries and operations. At a young age, with overweight, the clitoris can be “hidden” in the fat mass. Sometimes over the years, the opposite problem appears ‒ the loss of subcutaneous tissue, the gradual atrophy of the labia minora and the clitoris itself, leading to its reduction and decrease in sensitivity. In these cases, clitoroplasty can provide a positive result.
There are congenital and acquired conditions in which the clitoris is too large. Most often this is a consequence of endocrine problems, for example, the excess production of male sex hormones by the adrenal glands, therefore, at the same time, there is almost always a menstrual disorder and infertility. Normalization of hormonal background is usually achieved in the course of treatment prescribed by an endocrinologist and a gynaecologist. However, macroclitoris does not disappear thereafter. Sometimes a woman has no complaints about the quality of intimate life, but the excessively large clitoris causes aesthetic discomfort during intercourse with a partner or if there is a need to strip naked (in a public bath, during a medical examination, etc.). These may be the reasons for surgical correction of its size.
Clitoral surgery is performed in order to enlarge, reduce (then it is aesthetic) or to “free” from skin folds or cicatricial adhesions (in this case, the intervention is functional). The woman who has decided to take such a step should know that a reduction in the size of the organ can lead to trauma to its nerve endings and a sharp decrease in sensitivity, up to its complete disappearance (this is fraught with a loss of ability to achieve orgasm). In such a case, instead of eliminating the problem, it will result in its aggravation. If the clitoris is “exposed,” the surgery will improve access to it, which will provide good conditions for stimulation, but will not increase sensitivity ‒ if the excitability is initially low, it will remain so even after the surgeon’s actions.
Indications for Surgery
Clitoroplasty has the following indications:
- A small size of the organ, usually as a result of age or pathological atrophy.
- The excessively large clitoris (owing to congenital or acquired hormonal disorders, as well as genetically determined structural peculiarities).
- The clitoris, “hidden” among the surrounding tissues (hypertrophied foreskin, scars and skin folds), which makes intimate stimulation and achieving orgasm difficult.
Contraindications
The reason to refuse the surgery to a patient can be:
- Decompensated diabetes.
- Severe pathology of internal organs.
- Blood clotting disorders.
- Genital and other infections.
- Mental illnesses.
- Oncological processes.
- Pregnancy and lactation.
Surgery Technique
Taking into consideration the high sensitivity of the organ, clitoral surgery is often performed under general anaesthesia or by using a combination of general and local anaesthesia. In addition to surgery, there are non-surgical methods of clitoroplasty.
Clitoral Enlargement Surgery
The doctor incises the tissues surrounding the clitoris and impeding access to it. These are usually skin folds or scars. The excess of the clitoral hood can be removed. After the organ is “set free”, the incisions are sutured with thin threads, the surgical area is covered with a sterile dressing. The approximate duration of the intervention is about 1 hour.
Clitoral Reduction Surgery
To reduce the size of the clitoris, its mucous membrane is incised and partial excision (removal) of the cavernous bodies is performed. Since the organ is abundantly supplied with blood, this surgery is fraught with the occurrence of severe bleeding, which requires extreme caution when performing all manipulations. The wound is carefully sutured with catgut threads, a self-absorbable material. This eliminates the need for subsequent suture removal.
Non-Surgical Clitoroplasty
In some cases, the conservative technique of clitoral enlargement is used, which makes it possible to avoid incisions and anaesthesia, reduces the duration of the recovery period and the likelihood of complications. The essence of the procedure is the introduction of a filler (hyaluronic acid gel, the patient’s adipose tissue, etc.) into the glans of the clitoris, due to which the size of the organ increases. The manipulation is performed by using a fine needle, under local anaesthesia and takes about 30 minutes. Sometimes there is a need for repeated procedures. The result is not persistent, since any filler gradually resolves.
Rehabilitation Period
After the intervention, the woman should carefully maintain intimate hygiene using local antiseptics prescribed by the doctor. For a period of up to three weeks, a ban is imposed on sex life and the use of intimate gels. Thermal procedures and physical exertion are limited. If the conservative method was used, the rehabilitation period is reduced to several days.
Possible Complications
In some cases, clitoroplasty can be complicated by the following problems:
- Infection of the surgery area.
- Bleeding.
- Urinary disorder (difficulty with flow or, on the contrary, urinary incontinence).
- Decreased sensitivity of the clitoris owing to the damage to the nerve trunks.
Some complications pass on their own, others are solved through additional corrective interventions.
Clitoroplasty is a prompt or minimally invasive elimination of defects of this organ for aesthetic or functional indications. The procedure makes it possible to improve the quality of the woman’s intimate life and to normalize her psychological state.
Hymenoplasty ‒ Reconstruction of Virginity
Hymenoplasty is the surgery to restore the hymen (virginal membrane), which is performed at the patient’s request. There are no medical indications for this procedure.
People’s attitude to the integrity of the hymen is very different depending on the historical period, nationality, cultural and religious beliefs prevailing in the area and among the round of the woman’s relations. To a large extent, these differences persist today.
Many men have a calm attitude towards premarital relations, but for Muslims the loss of virginity in a potential bride and wife can lead to conflict and a reason to end the relationship. In this there is an element of discrimination in relation to a woman, since a man has no analogue of the hymen, from which one can judge about his previous relationships. In addition, the integrity of the hymen can be broken for reasons unrelated to sex: injuries, sports (horse polo, bicycle), medical manipulations, careless use of vaginal tampons, etc.
To prevent difficulties in relations with the opposite sex, a modern woman can resort to such a procedure as the reconstruction of virginity.
Indications for Hymenoplasty
Most interventions take place shortly before marriage. Sometimes married women also resort to the procedure in order to introduce an element of novelty in the marital relationship.
After the restoration of the hymen, the distinction between the natural and the reconstructed hymen can be seen only by a specialist ‒ a gynaecologist or a surgeon with a thorough examination, and not in all cases. Sensations of both men and women during subsequent sexual intercourse will become indistinguishable from those during natural defloration, all signs of which (resistance to penis insertion, bleeding) will be completely “natural”. The reconstructed hymen will not have any negative effect on menstruation, sex life, the process of conception, pregnancy and childbirth.
Contraindications
Hymenoplasty has the following contraindications:
- Decompensated diabetes.
- Genital infections in the vagina and vulva: chlamydia, gonorrhea, herpes, vaginal candidiasis, etc. Chronic inflammation of the uterus and appendages without exacerbation is not a contraindication.
- Oncological diseases.
- Blood clotting disorders.
- Severe pathologies of internal organs (liver, kidney, endocrine, respiratory and cardiovascular systems).
- Infectious diseases.
- Mental problems.
Types of Hymenoplasty
Surgery to reconstruct virginity, depending on the technical peculiarities, makes it possible to get short-term or long-term results.
Short-Term Hymenoplasty
This type of intervention is performed in cases when the result will be claimed in the next few days (it can be saved for up to 1 month, but without a medical guarantee).
For a short-term reconstruction, the preserved fragments of the hymen are freshened and sutured together with a thin thread from an absorbable material. The surgery is usually performed under local anaesthesia on an outpatient basis (the patient can leave the clinic on the same day). To obtain a good result, you need to have a sufficient number of sections of the hymen. Since their true fusion does not occur, the reconstructed hymen is preserved due to the sutures for the time required for their degradation (resorption). The severity of bleeding during defloration will depend on the degree of blood supply to the mucous membrane. If you need a more lasting effect, resort to the following (long-term) method.
Long-Term Hymenoplasty
Other names for this surgery technique are triple or three-layer hymenoplasty. In this case, the reconstruction of the hymen is performed at the expense of the vaginal opening mucous membrane, which is sutured in three layers. With this type of intervention, in fact, not only the destroyed hymen is restored, but a new, artificial one is being formed. Sections of the mucous membrane are removed to the area of the vestibule of the vagina, after which they are successively fixed with vicryl or polysorb sutures. The result can be preserved for a long time ‒ from two years to a virtually unlimited period. Taking into consideration the high density of the tissues, bleeding during defloration will be more pronounced than in other cases.
Any of the procedures can be performed under local or general anaesthesia. Its duration usually does not exceed one hour. It is recommended to resort to it about 5 days before the next menstruation, which reduces the likelihood of infectious complications.
Recovery Period
The healing process after a short-term intervention is a few days, after surgery with a long-term effect, it is extended to a month.
For several weeks after the operation, the woman should avoid physical exertion and some gymnastic exercises (deep squats, doing splits, etc.). It is recommended to take a shower instead of a bath, give up visiting public baths, saunas and swimming pools (places with a high probability of infection in the genital tract). For the prevention of constipation, which has a negative effect on healing, you should eat dairy products, fruits and vegetables. If necessary (after consulting a doctor) take a mild laxative. If sexual life is not planned in the near future, you should stop using vaginal tampons (replace them with sanitary towels).
Complications are rare. Minor irritation and inflammation of the vulva is usually easily eliminated by prescribing solutions for irrigation and a short course of antibiotic therapy.
Hymenoplasty is the surgery that gives a modern woman the opportunity to avoid many of the difficulties associated with religious, social and cultural conventions.
Perineoplasty
One of the most popular intimate plastic surgery is perineoplasty. Thanks to this procedure, you can alter the area of the perineum and the vagina. The surgery can be both aesthetic and reconstructive.
During this surgery, not only the skin, but also muscles with fascia are affected. Thanks to this integrated approach, it is possible to get the perfect result.
Indications
Most often, women turn to an aesthetic surgeon after childbirth. During delivery, perineal and vaginal tears may occur, which are sutured in the delivery room without keeping in mind aesthetics. In addition, in a number of cases during delivery the use of an episiotomy (incision of tissues in order to prevent their rupture) is justified. After injuries during childbirth, the perineum and the vaginal opening are deformed, leaving rough scars. An expert in intimate plastic surgery can cope with this problem.
Another reason for perineoplasty is age-related changes. The elasticity of the tissue is considerably reduced. There is a large vaginal opening (gaping). During surgery, you can eliminate the problems associated with age and changes in hormonal levels.
Some women are not satisfied with the appearance of their perineum and experience moral discomfort during intimacy. As a result, they come to the clinic for aesthetic medicine. Intimate plastic surgery of the perineum can be performed both for purely aesthetic reasons and to eliminate the discomfort caused by the acquired deformities. Some women after perineal ruptures experience unpleasant sensations while walking, suffer from frequent inflammatory processes in the intimate area, and face difficulties during sexual intercourse. To eliminate the defects means to solve all these problems.
Contraindications
Before perineoplasty you need to undergo a comprehensive examination. This will exclude the presence of conditions that can cause complications during the intervention and in the postoperative period.
Severe cardiovascular diseases, diabetes, oncology, inflammatory and infectious diseases, rash in the genital area, severe mental disorders are contraindications for this surgical correction.
Surgery Characteristics
Tactics for each patient is selected individually. It is necessary to estimate how physiologically the internal genital organs are located. If their deviation from the normal position is considerable, surgical correction is required.
After childbirth, as well as owing to age-related changes, the vaginal muscles stretch and do not return to their original position. As a result, the vaginal opening gapes. The surgeon eliminates this problem by tightening certain muscle groups. Self-absorbable sutures are used, so there is no need to take the stitches out.
As a result of ruptures, the perineum and labia are often deformed, and rough scars are formed. The deformed areas are excised, the necessary configuration of the perineum is formed and fixation with sutures is performed. The surgery lasts an average of 1-2 hours. Narcosis or epidural anaesthesia may be used.
Rehabilitation
The result of the surgery can be assessed 2 months after it. In order to avoid complications and to get an excellent result, after the intervention you need to avoid physical exertion and intimacy, as well as visiting baths and saunas. In the first days you should not be in a sitting position.
At first, there may be pain syndrome. If it is considerable, the doctor will recommend painkillers. After a few days the discomfort disappears. A slight oedema of the external genital organs after intimate plastic surgery is a variant of the norm. This unpleasant phenomenon passes on its own.
The cost for a perineoplasty depends on the amount of intervention. If only correction of the external genital organs is required, it will be much cheaper than correcting such problems as descent of the internal genital organs and uterine prolapse.
If the state of the perineum causes moral or physical discomfort, the surgeon of intimate plastic surgery, thoroughly familiar with perineoplasty technique, will eliminate these problems forever.
Phalloplasty ‒ Penis Enlargement and Thickening Surgery
Phalloplasty is penis plastic surgery, including changes in its size (enlargement and thickening), correction of congenital or acquired defects (curvature, fractures, partial or complete amputation, etc.), as well as the elimination of erectile dysfunction. Interventions can be performed at the patient’s request and for medical reasons.
In addition to a purely physiological role, for a man the penis has an important psychological significance, being the personification of courage and sexual viability. Any deviations from the conventional standard (real or imaginary) often become the source of the development of neuroses and depressions. A rare youth does not worry about the “too small” genital organ. This complex usually passes with age, but it can persist for a long time. Penis enlargement is the most common surgery of all the male intimate plastic surgeries. Just a few extra centimetres of length can have enormous psychological significance and dramatically increase men’s self-esteem.
Other issues relating to the penis are more serious. With congenital malformations, diseases and injuries of the organ, not only sexual life is disturbed, but also urination. Therefore, phalloplasty includes not only penis lengthening and thickening, but also the correction of malformations and acquired defects. These include such problems as an excessively short frenulum, ectopia (abnormal positioning) of the opening of the urethra or the organ itself, fractures, deformities and injuries (up to the complete amputation of the penis). A special group of interventions is aimed at eliminating erectile dysfunction.
The Influence of Phalloplasty on Men’s Sexual Life
Any type of surgical correction of penis size or its function, performed professionally, has a positive effect on the patient’s sex life. Even in the case when all the concerns about the small size of the reproductive organ were not objective and were the result of suspiciousness, the man gains confidence after surgery. Since many of the problems in the bedroom arise from a lack of self-esteem, being calm and having no fear of possible failure often radically fix the problem.
If the man was completely deprived of the possibility of sexual contact due to a serious pathology or injury, phalloprosthetics can give the joy of a valid sexual relationship with a woman.
Indications for Phalloplasty
The following conditions can be the cause for penis plastic surgery:
- Congenital anomalies of the penis (hypospadias, epispadias, hypoplasia, ectopia, etc.).
- Consequences of tears, fractures, burns and other injuries.
- Severe deformity caused by certain diseases (for example, Peyronie’s disease).
- Mechanical urinary obstruction.
- Tumours of the organ (benign or malignant).
- The need to remove the foreskin.
- Excessively short frenulum.
- Complete loss of the organ in case of injury or surgery.
- The man’s desire to increase the length or thickness of the penis.
- Erectile dysfunction (impaired sexual potency).
Contraindications
Phalloplasty is contraindicated with certain diseases, which include:
- Decompensated diabetes.
- Severe pathologies of internal organs (heart, liver, kidneys, lungs).
- Blood clotting disorders.
- Mental illnesses.
- Autoimmune pathology.
- Genital infections (gonorrhea, trichomoniasis, chlamydia, herpes, etc.).
- Pustular diseases of the groin area (furunculosis and other types of pyoderma).
Penis Enlargement Surgery
Penis enlargement can be performed in several ways. Dissecting and removing the ligament located in the pubic area, which supports the penis, leads to its extension and visual enlargement of several centimetres. In most cases, this is enough. If there are considerable fatty deposits in the pubic area, their removal by means of local liposuction enhances the effect of the surgery.
Thickening of the penis is achieved by lipofilling ‒ the doctor introduces under the skin of the organ the patient’s own fat, taken from the areas of its deposit (abdomen or buttocks). The disadvantage of the method is the gradual resorption of such filler; therefore, the insertion (implantation) of artificial matrices from biocollagen or synthetic materials is used. Another way to increase the diameter of the penis is to place a rectus abdominal flap in the form of a cuff onto its body. This is a more complicated surgical procedure, after which there is a scar on the anterior abdominal wall.
Phalloprosthetics
Phalloprosthetics can be divided into several types.
When the organ is reconstructed after a complete or partial loss, lengthening of the remaining stump of the penis by dissecting and removing the ligaments, skin and muscle flaps from the abdomen, scrotum, forearm, back, etc. is used.
When there is erectile dysfunction which is not eliminated by conservative methods, the following prosthetic implants are used:
- Rigid which provide a constant artificial erection;
- flexible, with mechanical memory;
- inflatable which simulate an erection if necessary.
Rehabilitation and Complications
The duration of the recovery period and its course depend on the scope of the surgery. The man is usually in the clinic for the first few days. He can start working again in a few weeks. Sex life becomes possible in about two months.
The complications include:
- Narrowing of the opening of the urethra due to scarring.
- Suppuration.
- Transplant rejection.
- Impaired sensitivity and erection.
- Penile deformity.
In such situations, corrective surgery is usually required.
Phalloplasty is surgical correction of male problems, which in most cases make it possible for the patient to live a full life again.
Testicular Prosthesis Surgery
Testicular prosthesis surgery is a fairly common andrological intervention which makes it possible to obtain a satisfactory aesthetic result in the absence of one or both testicles in the scrotum.
The testicles (testes) perform two main functions ‒ incretory and secretory. As endocrine glands, they synthesize testosterone, a hormone that provides most of the external male characters and forms the corresponding behaviour. Sperm production also occurs in the testes. Infertility, sexual problems, loss of muscle and bone mass, and other serious metabolic disorders can result from a decrease in the normal function of the testicles or their loss for any reason.
In addition to a purely physiological role, the testicles have a great psychological significance, being one of the symbols of masculinity. Even in the case of complete objective well-being, a man with such an anatomical defect as the absence of a testicle will always experience discomfort during sexual intercourse. The emptiness in the scrotum or its asymmetry is easily detected by the partner, after which there may be unpleasant questions and tension in the relationship. The most sensitive in this regard contingent are teenagers. A young man who, for various reasons, possesses only one testicle, often does not have sufficient psychological protection. An inexperienced man can get a serious emotional trauma during the first sexual intercourse. A young partner is not always able to show the necessary tact. Negative experience can be fixed in the mind and subsequently cause habitual failures and lead to psychogenic impotence.
A testicular prosthesis that completely simulates the shape and consistency of the organ saves a representative of the stronger sex from many unpleasant moments and restores confidence in himself. Of course, the surgery pursues only an aesthetic goal, since a testicular prosthesis is simulation; it is not functional ‒ it does not produce testosterone and is not capable of spermatogenesis. Modern products are made of durable and biologically inert material (one polymer or their combination); they do not cause reactions of inflammation or rejection and are available in several sizes. The most popular modification is a dense polymer shell with a smooth external surface filled with a viscous gel.
Indications for Surgery
The indication for which testicular prosthesis surgery is performed is the absence of a testicle for any of the following reasons:
- Surgical removal owing to a malignant tumour, severe injury with a complete crush of the organ, twisting of the spermatic cord, purulent melting or some specific infectious processes (for example, tuberculosis).
- Surgical castration as part of the combination therapy for prostate cancer.
- Congenital organ defect: unilateral (monorchism) or bilateral (anorchism).
- Testicular atrophy owing to impaired blood supply, in which it has reduced size and inadequate functioning.
- Cryptorchidism ‒ a condition with which an existing testicle is in an unusual place (it is retained in the abdominal cavity or in the lumen of the inguinal canal).
A patient suffering from cryptorchidism is first of all offered surgical descent (artificial descent) of the testicle into the scrotum. In case of failure of the surgery, testicular prosthesis surgery is recommended.
Preoperative Examination and Preparation
Before the operation, the andrologist examines the patient to determine the capacity of the scrotum and select a testicular prosthesis that best suits all parameters. If there is another (normal) testicle, it is important to ensure symmetry ‒ the implant should be as similar to the existing organ in size, shape and texture as possible. The specialist needs to assess whether the skin is sufficiently tensile for the free placement of the implant. Inadequately small capacity of the scrotum can cause excessive tension and squeezing of soft tissues with subsequent local blood circulation disturbance, necrosis, suppuration and rejection of the prosthesis. If the patient has previously undergone surgery or injury to the scrotum, there may be severe scars or defects that restrict the surgeon’s abilities. In such cases, skin plastic surgery is performed, and the main stage of the operation is performed after all the tissues have completely healed (usually six months after the previous one).
Intervention in children and adolescents has its own peculiarities. The placement of the prosthesis helps to avoid psychological stress and injury to the child, and in the future, due to the growth of the body, it is necessary to perform the second stage of the surgery and replace the implant with a larger one. Early placement of an artificial testicle makes it possible to achieve a gradual stretching of the skin of the scrotum and obtain a cavity sufficient for the subsequent introduction of a prosthesis of an “adult” size.
Contraindications to surgery are silicone intolerance, acute infectious diseases, local skin problems (furunculosis, herpes, mycosis). On the eve of the surgery it is necessary to remove (shave) hair in the groin area.
Performing Surgery
The intervention is usually performed on an outpatient basis under local anaesthesia. General anaesthesia is used if there are appropriate indications (for example, childhood) or at the patient’s request. After the standard preparation of the surgical area with antiseptic solutions, a skin incision is made along the natural inguinoscrotal fold (to obtain a minimally noticeable scar). By means of the instrument, a pouch is created in the soft tissues into which the selected implant is placed. The wound is sutured in layers and covered with a sterile dressing. The duration of the operation is from 30 to 60 minutes.
In the postoperative period, prophylactic antibiotic therapy is prescribed. The patient is recommended to refrain from serious physical exertion and running for three days. The stitches are usually removed on the tenth day, after which it is allowed to resume sexual activity. Physical restrictions are completely excluded for about a month after the intervention.
Testicular prosthesis surgery is an aesthetic intervention aimed at improving the quality of a man’s life and increasing his psychological comfort.
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