I have seen many women who, after either childbirth or menopause were concerned about whether their vaginas were “too loose” and needed something done. There are many ads on the internet touting “vaginal rejuvenation” procedures purporting to restore tone and improve sexual enjoyment, among other things. One of the things I try to help my patients understand is the relationship between the overall health of the vaginal tissues, including muscles, mucosa (inner skin) and connective tissue, and proper function. A healthy vagina should have adequate moisture and elasticity, with good muscle tone and strength. I am skeptical of surgeries purported to achieve this in the absence of a visible and measurable structural defect. Undoubtedly childbirth can affect the vaginal muscles and damage some of the supporting structures. Sufficient damage can lead to a condition called prolapse, or dropping of the organs which results in a protrusion of tissue from the vaginal opening. That, however, is a different matter from “tightening” the vagina. While it is much better to have good muscle tone in the pelvis, as this leads to better functioning of the bladder, bowels, and appropriate blood flow in the vagina and more enjoyable sexual experience, the risk of a vaginal “tightening” surgery in the absence of an obvious structural defect includes painful intercourse as well as potential complications from the procedure, depending upon what is done. With aging and menopause, the vagina may become drier and less elastic, the muscles may become weakened or develop abnormal spasm leading to painful intercourse as well as pelvic or abdominal pain. A surgical rejuvenation procedure is not going to treat those problems.
Often, pelvic floor physical therapy can restore not only proper bladder and bowel function, but it can improve vaginal function and reduce pain. When the tissues have become thin and dry, they may respond to vaginal estrogen creams, tablets or rings, an oral preparation called Osphena ®, or vaginal laser therapy with the MonaLisa Touch®. Laser therapy is not “rejuvenation’ but rather a revitalization of the tissue, with effects similar to vaginal estrogen therapy but without the hormones. The objective is to promote proper blood supply, encourage new, proper collagen and elastin deposits to form, leading to better tissue strength and function. The combination of treating the pelvic floor muscles and the vaginal tissues provides the desired “rejuvenation” without a surgical procedure. Of course, if there is a problem related to torn or damaged tissue, surgical repair is sometimes appropriate. Restoring proper anatomy can be an important part of promoting vaginal health. However, it should not be taken lightly nor, in my opinion, should it be a “cosmetic” procedure.