Female Genital Tract Surgery
Although these procedures are available on the NHS, reconstructive genital tract surgery is not yet well established as a service, and patients may not automatically be offered the treatment options outlined in this section. If you or a family member requires treatment for a genital tract condition, you may need to make enquires and pursue these routes yourself.
What conditions might affect a patient in this area?
Conditions that most commonly require reconstructive female genital tract surgery include:
• Vulval, cervical and anal cancer/pre-cancer
• Birth trauma
• Congenital problems
About a third of all gynaecological reconstructive work carried out by plastic surgeons involves the treatment of birth trauma. There can be a great deal of cutting and tearing during childbirth. These tears can involve the labia, which sometimes split in two; they can also reach as far as the rectum and often affect the sphincter.
The surgical procedure to repair birth-related tears, known as an episiotomy, can often leave scarring at the entrance of the vagina, and is sometimes done too tightly. These conditions can cause acute discomfort and pain during sexual intercourse. In these cases, plastic surgeons will be required to unpick the episiotomy stitches and repair the damage that has been done. Surgeons will also work to tidy up the perineum following tear-related sphincter surgery.
What should I expect as a patient?
Birth trauma surgery can be complex and risky, often requiring more than one procedure. Once surgery is complete, however, the recovery period can be quite quick, with patients resuming normal sexual and other functions within about six weeks.
One of the main problems is getting patients referred to the appropriate specialist units. GPs and midwives can be slow to make the right referrals, so if patients are experiencing problems in this area they should seek a second opinion.
Some female babies are born with rare vaginal abnormalities. In some cases, these abnormalities are relatively minor, requiring only small-scale surgical interventions. For example, in cases where a patient’s hymen has not opened properly, there are straightforward surgical procedures to correct the problem. Likewise, congenital vaginal stenosis (constriction or blockage) is usually quite simple to resolve. In other cases, the extent of the congenital abnormality can be severe – as with female babies who are born without a vagina. In this instance, a vaginal dilator is often used to create the missing vagina in the pit of the perineum, with a view to enabling the patient to achieve full sexual function and fertility in later life. Sometimes a more complex reconstruction is needed.
Cosmetic surgery is also available to reduce, enlarge and tighten certain parts of the vagina. While these operations are often requested on purely aesthetic grounds, they may also relate to sexual dysfunction and general discomfort and can, on this basis, be requested on the NHS. However, vaginal surgery carried out for no other reason than to enhance appearance is only available privately.
A labiaplasty is a surgical procedure to reduce the size of the inner lips of the vagina, known as the labia minora. This operation is often requested on cosmetic grounds, but also for functional reasons. Some women find that oversized or elongated labia can prolapse into the vagina during sexual intercourse, while others report discomfort in certain articles of clothing.
During the operation, a surgeon will remove a wedge from the labia minora and use a local tissue flap to repair the wound that is created. It is a relatively straightforward procedure that usually yields good results. Most patients find that the area is well healed after two weeks, and is fully back to normal after six weeks.
Following childbirth some women find that their vagina has loosened, in some cases becoming so lax and splayed as to cause major sexual dysfunction. Women may request vaginal tightening with the aim of restoring their genital area to functional and visual normality. In such cases, surgeons carry out a procedure known as posterior repair, whereby the vagina is separated from the rectum and the muscles pulled together to tighten the vaginal structures.
Augmentation of the labia majora
In cases where the outer lips of the vagina (labia majora) are considered to be too small, surgeons can augment this area using fat transfers, grafts and injections into the labia.
Hitching and recontouring of the mons pubis
In women of a certain age, the mons pubis (the mound about the vagina) can drop, causing what some patients find to be an aesthetically unappealing bulge. This can be treated by a surgical hitching up of the loose abdominal skin around the mons pubis.
Royal College of Obstetricians and Gynaecologists
National Childbirth Trust
Nursing and Midwifery Council