Feel Young Again...All Over
Why vaginal rejuvenation?
Many women feel that after they have completed childbirth, things are "not the same" in the vaginal area. Considering the effects of pregnancy and childbirth on the pelvic floor, this is not surprising. (There's a reason women in Brazil and Italy request cesarean section over vaginal birth!) Many women feel stretched out, feel less friction during intercourse and other sexual activity, feel pressure in the vaginal area when they lift or strain, feel that the opening to the vagina feels larger than it originally was, and no longer feel they can squeeze the vagina as tightly as previously. For many, sex is less enjoyable for both women and for their partners. Some women have had lacerations during childbirth that may have been repaired hastily in the delivery suite under suboptimal operating conditions and have left the vaginal area anatomically distorted.
Vaginal rejuvenation procedures are designed to bring the vagina back to the state it was in prior to childbirth, or at least, a whole lot closer to it.
Sometimes women who have not had children have similar concerns, simply from sexual activity and general use of the vagina over time. Being overweight can also cause significant stretching of the vaginal tissue, and sometimes having genetically weak collagen, or an injury, or smoking.
What vaginal rejuvenation procedures are available?
Vaginoplasty is a cosmetic procedure to tighten the internal vagina and the soft tissues surrounding it. It is typically performed with a surgical techniques that use a precise microcautery as well as laser temperature and focus, and its purpose is to carefully design and tighten the lower third of the vagina such that it has a slightly smaller diameter, closer to what it was prior to childbirth. Care is taken not to make the vagina so tight that sex is uncomfortable. The goal is increased sexual pleasure and relief of the "loose feeling" that can follow childbirth and years of sexual activity. It can usually be done with conscious sedation anesthesia in the office in about 30 minutes. Recovery to normal activities varies from 1-4 weeks, and return to sexual activity should wait until 8 weeks post-operatively.
Labiaplasty is the reduction of the length of the inner lips of the vulva. This is also done with careful use of precise radiofrequency devices. Some women complain that the length of the labia minora (or "inner lips" of the vulva) are too long and rub on clothing and make love-making and exercise uncomfortable and at times embarrassing. Labiaplasty can be done in our office procedure room with conscious sedation in about 30 minutes. Recovery to normal activities varies from 1-4 weeks, and return to sexual activity should wait until 8 weeks post-operatively.
Before and After Labiaplasty
|Labia Minora Hypertrophy - Double
||Labia Minora Hypertrophy - Single Sided
||Normal Anatomy - After Labiaplasty
Combined labiaplasty/vaginoplasty are opted for by many women who have these procedures performed. They can also be done with any of the following procedures, or with medically indicated, insurance covered procedures for stress incontinence and true pelvic prolapsed, if present.
Radiofrequency Tightening is a non-invasive technique (no incisions!) that can be applied to the skin tissue surrounding the opening of the vagina to stimulate more collagen support to this tissue and moderately tighten and reduce the diameter of the lower vagina and opening to the vagina. The effects are more modest that vaginoplasty, but still a nice effect. It is a new technique, and favorable data on this technique is being presented this year at the American College of Obstetricians and Gynecologists Annual Clinical Meeting. This is also a procedure that can be done with only local anesthetic.
Radiofrequency tightening can be combined with any other aesthetic gynecology technique for a great effect. All work in different ways and locations and on different parts of the supporting tissue.
G - Spot Augmentation
Ah, the illusive G-spot, first described by Masters and Johnson. Some argue it doesn't exist as an area of increased sexual sensitivity, and others are convinced that it does. G-Spot Augmentation is a relatively painless injection of hyaluronic acid, a substance that is normally found in the skin and soft tissue that provides support and structure. This procedure is performed in our office under local anesthesia. It usually takes less than 10 seconds and the total time in the exam room is usually less than 10-15 minutes. The purified hyaluronic acid is placed directly into the G-spot after local anesthesia. The collagen augments and enlarges the G-spot to an area almost an inch in width and a few millimeters thick, which causes it to project further into the vagina. This effect can last for up to 4 months. In a pilot study, 87% of women surveyed experienced increased sexual gratification and arousal after their G-spot injection, but results do vary. G-spot Augmentation is an off-label use of hyaluronic acid. Hyaluronic acid is more commonly used as a dermal filler for wrinkles on the face, and to augment the tissue around the urethra to help with stress incontinence, and for injection into joints with arthritis, to better lubricate and support them. Complications of G-Spot augmentation are unusual but can occur. We advise a 15 minute consultation with the physician first.
What if I have real prolapse (cystocele, rectocele, uterine prolapse), or urinary stress incontinence?
Dr. Ravasia has extensive experience in pelvic floor reconstruction and advanced vaginal and urogynecologic surgery. At your consultation, the physician will perform an exam to see if you have purely a cosmetic /aesthetic problem, or whether a functional medical problem such as prolapse, cystocele, rectocele, enterocele, or urinary stress incontinence are present. If they are, they will either recommend an entirely medical procedure (such as an "A&P repair" and/or "suburethral mini-sling"), or an aesthetic and medical procedure combined. If this is the case, insurance may cover the medical portion of the procedure. We will do an estimate for you and find out ahead of time if this is the case.
What are the complications aesthetic vaginal surgery?
Aesthetic vaginal surgery is designed for be a minimally invasive procedure that allows you to return to work within a few days to weeks, and to normal (and improved) sexual relations within 6-10 weeks. As with any surgery, there is always a small risk of bleeding, infection, injury to surrounding organs, scar tissue with associated discomfort following the procedure, although these risks are not common with the techniques we use. About 6% of women are prone to pelvic floor spasm after any vaginal procedure, and can have some urgency, frequency and discomfort with intercourse for 1-6 months after the procedure if this happens. Usually it is mild and responds well to watchful waiting or physical therapy.
Will these techniques enhance my sensuality, arousal and sex life?
These techniques are all designed to improve anatomy such that sexual arousal and pleasure for both partners is improved. However, sexuality is complex, and there are a variety of factors involved. Sometimes there are other medical conditions such as weak pelvic floor muscles, pelvic muscle spasticity, bladder problems, endometriosis, and true pelvic organ prolapse, which must also be addressed in addition to aesthetics, for optimal results. Pain with intercourse is not normal, and aesthetic vaginal surgery is not advised if you have pain with intercourse. Please advise our physicians if this is the case, as this problem needs further investigation. Sometimes relationship issues need to be addressed simultaneously and marital and sexual counseling can be of value in addition to aesthetic procedures. Other times, aesthetic procedures are done purely "for fun" or increased sexual gratification in an already very satisfactory relationship. Almost always, optimizing hormones can help both with the health of the vagina itself and with energy and libido. Talk to one of our physicians about how best to do this in your situation.
Out of Town Clients
If you are coming from out-of-town, you will need to have someone to stay with you for 24 hours after the procedure if you are having a procedure that requires IV sedation. If you have a medical repair in addition to your aesthetic repair, we recommend that you stay in Spokane for 72 hours after the surgery.
Costs of the Vaginal Rejuvenation and Labiaplasty
If you have a medical indication for a vaginal repair / tightening (such as a pelvic floor prolapse, or bladder problems), and we are contracted with your insurance company, then the cost of a vaginoplasty is capped at whatever allowable price your insurance has set it at. This is determined by your insurance company, and we can give you more information after meeting with you and assessing the situation, and is billed through insurance, and capped by insurance, like any other medical procedure. We will pre-authorize through your insurance company like any other procedure.
If you have a medical indication for a labiaplasty (such as pain with intercourse, or hypertrophy /overgrowth or over stretching of the labia from birth injury), then insurance MIGHT cover your labiaplasty, if we are contracted with them. In this case, the cost of the labiaplasty is capped at whatever allowable price your insurance has set it at. This is determined by your insurance company, and we can give you more information after meeting with you and assessing the situation, and is billed through insurance, and capped by insurance, like any other medical procedure. We will pre-authorize through your insurance company like any other procedure.
If you don't have insurance coverage OR don't have a medical indication, or both, then the cost of the procedures is as follows:
Labiaplasty: $4200 (surgery cost)*
Vaginoplasty: $6000 (surgery costs)*
Combined Labiaplasty and Vaginoplasty: $9400 (surgery cost)*
*IV sedation is done by a separately contracted CRNA and is $150 per hour.
Radiofrequency Tightening $999 (never covered by insurance)
Initial G-spot augmentation (hyaluronic acid, lasts up to 4 months): $100 for initial 30 minute consultation, $850 for initial G-spot augmentation itself (never covered by insurance)
Follow-Up G-Spot Augmentations (hyaluronic acid, lasts up to 4 months): $600 each (never covered by insurance)
If you have pelvic discomfort, pressure, sexual concerns, urinary concerns, bowel concerns, pain with intercourse, discomfort with activity because labia are too long, or any other medical condition, and our practice accepts your insurance, then the initial visit will be for that reason and is typically handled through insurance. As you fill out the forms below, you will have a good idea if one of these is present. If you don't have insurance, and/or don't have any of those symptoms (ie the visit is for straightforward cosmetic reasons), then your initial visit is $300. This is due by credit card at the time of booking. Of this, $200 can be put toward the cost of the procedure or surgery, should you decide to proceed after a thorough evaluation and discussion.
Please fill out the following forms ahead of your visit: