Labiaplasty & Vulvo-Vaginal Repair: Gentle Guidance from Dr. Najeeb Layyous

In short: Female genital cosmetic surgery includes tightening of the vagina, reshaping of the labia, repair of pelvic laxity and other procedures. It is usually done after the vagina has been stretched by childbirth, or when tissues have slackened with age or weight loss. Vaginal tightening takes about an hour; light daily activities resume after about a week, intercourse after 4–6 weeks, and healing is complete within 3 months.

Labiaplasty - Plastic Surgery of the Vulva

Who May Consider Labiaplasty?

Labiaplasty may be suitable for women who notice elongation of the labia that leads to irritation, itching, redness, or discomfort — whether from wearing tight clothing or during intimacy. If you have been living with this discomfort, know that it is a common concern, and options exist to help you feel more comfortable in your body.

It is worth knowing that the size, shape and colour of the labia vary greatly between women, and in most cases what a woman notices is normal. Simple measures such as looser clothing and gentle skin care may help, and surgery is considered only after a careful discussion of the reasons and expectations. Labiaplasty is not performed on girls under 18 unless there is a medical need.

Goals of Vulva Plastic Surgery

1- Repair marks or deformity caused by a previous delivery.

2- Address vaginal widening, mainly resulting from vaginal delivery.

3- Restore symmetry to the labia minora.

4- Reduce excess fat distribution in this area.

The Labiaplasty Procedure

1- Performed under local or general anaesthesia.

2- Involves a small incision with minimal scarring.

3- Sensation is usually preserved in most cases.

4- No dressing needed, as absorbable stitches are used. 5- As with any operation, there are possible risks, including bleeding, infection, the wound opening, scarring, changes in sensation, pain during intercourse, and asymmetry or dissatisfaction with the result.

Recovering After Labiaplasty

1- Most patients can leave the hospital the same day as the operation.

2- You can typically return to daily activities and shower the next day, with intercourse advised to wait around 30 days.

Vaginal Tightening Surgery

• This procedure (perineoplasty or posterior repair) aims to repair the vaginal muscles and perineum, particularly after multiple vaginal deliveries. Some women report improved comfort and confidence, but good-quality evidence that it improves sexual satisfaction is limited, and pelvic floor exercises should usually be tried first.
• The procedure generally takes around one hour; most patients can walk and go home within about 24 hours, but full recovery takes several weeks, and heavy lifting and intercourse should be avoided for about six weeks.
• A follow-up visit is scheduled within two weeks; stitches usually dissolve naturally within 7–12 days after surgery.
• If pregnancy occurs after the operation, the mode of delivery should be discussed with your obstetrician; a caesarean section may be considered to protect the repair, but it is an individual decision.

Pelvic Floor Relaxation and Prolapse Repair

The pelvic floor is a group of muscles that support the bladder, abdomen, uterus, and vagina. When these muscles weaken over time, the area can become relaxed, which may lead to prolapse.

What Causes Pelvic Floor Relaxation and Prolapse?

1- Recurrent vaginal delivery.

2- Menopause and ageing, when declining estrogen levels can contribute to tissue relaxation. 3- Other factors that increase pressure on the pelvic floor, such as being overweight, chronic constipation, chronic cough and repeated heavy lifting, as well as an inherited tendency to weaker connective tissue.

Types of Prolapse

There are several types of prolapse, and sometimes more than one type can occur together:

1- Cystocele.

2- Cysto-urethrocele.

3- Rectocele, Enterocele.

4- Uterine prolapse.

Signs and Symptoms to Watch For

1- A feeling of heaviness or a sense of a mass coming down through the vagina.

2- Back pain.

3- Stress incontinence, especially when the bladder neck is weakened.

4- Difficulty with bowel movements, particularly if a rectocele or enterocele is present.

5- A wider vagina causing discomfort during intercourse.

6- Cervical erosion, infection, or bleeding if the cervix has prolapsed through the vaginal opening.

Treatment Options for Pelvic Floor Relaxation

Treatment depends on the type and degree of prolapse, and generally falls into two categories:

1- Conservative (non-surgical) therapy, which is suitable for mild prolapse and is also an option for women with more severe prolapse who prefer to avoid surgery, may include (together with weight loss and treating constipation or cough):

• a. Pelvic floor exercises.

b. A ring pessary, inserted by your doctor and replaced every 4–6 months.

2- Surgical treatment, chosen based on the type and severity of prolapse and whether stress incontinence is also present:

• a. Anterior repair.

b. Posterior repair.

c. Vaginal hysterectomy combined with anterior and posterior repair — used when the uterus and cervix have descended outside the vaginal opening; operations that support the uterus without removing it are also available and can be discussed.

If you are experiencing any of these symptoms and would like compassionate, professional guidance, Dr. Najeeb Layyous and his team welcome the opportunity to discuss your individual situation and the options available to you.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist