Before touching on Vaginoplasty (surgical operation to graft tissue on to the vagina), I must mention that I am seeing more patients requesting Labioplasty (reduction of the labia).

Some patients, especially those below 40 years of age, are very upset by their enlarged labia (fleshy folds at the edge of the vulva, a woman's external sexual organs, at the opening leading to the vagina).

Some complain that penetration was more difficult and they feel the pain when their partner search for the point of entry. Others feel depressed when their partners look at their vulva and there were complaints that the partners have been turned off by the sight.

Labioplasty is a simple surgery to cut away excess labia skin using a straight cut or a zig-zag interlocking cut. Stitching is done using very fine sutures and these are removed in about 1 week.

Labioplasty can be done as a day procedure with excellent results. The pelvic floor muscles in females control the bladder, womb and bowel. These 3 organ systems are lined one after another in the above order. When one organ system is damaged, it is likely that the neighbouring organs are involved as well.

The 3 main culprits for the pelvis floor muscles damaged are pregnancy/childbirth, menopause and obesity.

Some people are born with weak collagen muscle tissues and can have a lax vagina when young and even without childbirth. Certainly the main damage is from pregnancy and childbirth. The baby's head going through the vagina can cause over-stretching and tearing of the pelvic floor muscles.

This is even worse as patients often do not do pelvic floor (Kegel's) exercise when pregnant and after delivery of the baby. Many do not know that this exercise can reduce or prevent pelvic floor damage.

If a doctor were to put the index finger into the vagina and the thumb into the anus, pinching them together will often give the findings of a hollow between the thumb and finger. This is due to damage of the pelvic floor muscles and damage of the tissue in that region called the perineal body.

Not uncommonly it is due to poorly healed or poorly cut (episiotomy) from childbirth. This gives the lax or open vulva/vagina feeling to the patient and her partner.

This usual complaints are "looseness", "no strength", "no sensation" and "no fun". More patients are seeing me for Vaginoplasty these days.

In simple term - Vaginoplasty is the surgery to "tighten the vagina". Some do this for themselves; many do it for their partners.

Certainly if this situation reaches the "no fun" stage in intercourse, relationship can be affected. These patients often have a prolapse of the pelvic organ as well.

The greatest sex organ of the human is between the ears - the brain. The brain needs signals and feedback to function even better. Stimulation of the clitoris and vulva provide positive pleasurable feedback.

However for satisfactory vulval/vaginal stimulation, it often requires good fit at intercourse. This is the most common complaint from my patients - the problem with a "good fit".

It is important to understand the psychological and emotional aspects of the couple. This will certainly help in managing expectations and improving successful outcome. In Vaginoplasty, I repair the perineal body and join the pelvic floor muscles back with sutures.

The vaginal skin will be fashioned in accordance with the amount of tightness of the pelvic floor muscles. This surgery can be done as a day procedure, with minimal pain and complications, and with good success rates under skilled hands.

I generally do not cut away vaginal skin unless it is excessive, otherwise the complication will be that of painful intercourse. Any prolapse problem must be corrected at the same time.

This is an attempt in achieving "a tight fit" to improve stimulation of the vulval and vaginal tissues.

Vaginoplasty can be done with or without the use of laser and the principles of surgery are the same. Complications of bleeding and infection are uncommon. Some people scar badly and coupled with over-tightening or cutting away of too much vagina skin, can result in the nightmare of painful intercourse instead of more pleasurable sex.

Success of Vaginoplasty depends on to whom it concerns - the surgeon, the patient or the partner. The real success is when all 3 are happy.

Majority of my patients seeking this surgery are pre-menopausal and a good number are in their 30s. I am heartened that my patients have reported improved sexual satisfaction and relationship after Vaginoplasty.

The writer is a Consultant Obstetrician, Gynaecologist and Urogynaecologist of Chris Chong Women and Urogynae Clinic at Gleneagles Medical Centre in Singapore. [E-mail: [email protected]]