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Perineoplasty

After my deliveries, I had so many vaginal tears that never healed just right. I was always in so much vaginal pain and sex was impossible for over 4 years. After Dr. Cappiello operated on me I can honestly say that I feel great, the pain is gone and sex is enjoyable again.” -V. O.

The perineum is the space between the posterior opening of the vagina and the superior part of the anal canal. That space represents diffusion of the bulbocavernosus muscles as well as the transverse perineal muscles in the midline. These muscles provide the support for the posterior vagina and introitus, and also maintain the vaginal axis, which is posterior by a 30° angle towards the coccyx.

This angulation of the vagina is very important in maintaining sexual capabilities and structural integrity of the vagina. When these muscles are broken as during a vaginal delivery, episiotomy or the use of forceps the muscles move laterally and the support for the opening of the vagina is destroyed. The vagina is now gaping and becomes very large and can easily admit a golf ball without much difficulty. Because of the loss of the muscle integrity this facilitates the falling out of the vagina itself, uterus, bladder and rectum.

Obviously this has sexual implications. The musculature of the vagina can no longer function to contract. The friction necessary for the sexual activity is absent. The vaginal angle is also nonexistent. The repair is never complete without the surgical repair of the perineum (aka Perineorrhaphy). In order to have a truly sexual experience the repair of the perineum is critical.