Any woman who has given vaginal birth knows that her vagina is not the same. Vaginal birth causes an incredible amount of stress and damage to the birth canal and surrounding tissue. It is especially difficult for white women. It is estimated that 65% of all white women that gave birth vaginally, have some sort of pelvic dysfunction and pelvic trauma. It is also estimated that if the baby weighs greater than 8 pounds we add 5% to the 65%. And if the woman was subject to an episiotomy or forceps, we would add 5% respectively for a total of another 10% risk to the pelvis. We estimate that 30% of women who gave birth vaginally will also have rectal dysfunction and or fecal loss. With these statistics it is no wonder that women seek help in restoring not only the vaginal function and anatomy but also their sexuality.
The most common problem is pelvic floor dysfunction which can lead to urinary incontinence, pelvic prolapse, fecal incontinence, severe pain with sexual activity, loss of orgasmic response, non-gratifying sexual act, not to mention the loss of anatomy and distortion of the vagina and surrounding area. The vagina has become lax, bulging and gaping. The perineum which is the area between the vagina and the rectum has become smaller and therefore approximating the vagina to the rectum. This is a very important area where the bulbocavernosus muscles and the transverse perineal muscles are able to contract the vagina and therefore reduce its caliber. When these muscles are broken the vaginal axis is destroyed and sexual activity is not gratifying. Around the vagina, sexual activity usually causes pain because of the scar tissue. This is also known as vestibulitis which is a very common and debilitating condition that affects many women.
With aging, the outer lips of the vagina oral labia majora become hollow and shrunken which is not attractive but more importantly can cause introital pain. The labia minora is also responsible for pain because it is frequently torn during vaginal birth. The labia minora is also enlarged and can be disfiguring as well as painful. Many times tears during childbirth may extend anteriorly and tear the tissue around the clitoris which can cause severe pain and loss of orgasmic response. Of course bladder hernias or cystoceles, along with hernias of the rectum called rectoceles, are also important to correct in order to restore the vagina to a pre-delivery state. In summary, cosmetic surgery is for almost all women.
The trauma to the pelvic structures is very real. The American College of OB/GYN has declared a new subspecialty called female pelvic health and pelvic reconstruction. I have been performing pelvic reconstruction for over 20 years and I train other physicians to learn the new techniques in not only cosmetic surgery but also reconstructive surgery.