"My doctor has told me that I need to have
vaginal reconstruction due to the problems childbirth
caused me. He is not pushy about it but says it is
my decision whether it would be worth it to have the
surgery. My problems are urinary incontinence, vaginal
dryness because I am "wide open", and intercourse
is not as pleasurable because of my muscles being
so weak and loose. I don't know if this is recommended
or is my problems just something I have to live with
since they are not a medical necessity?
Background: I am 36 and have had 2 children. I am
in overall good health and in good shape. I have had
a hysterectomy due to fibroids. I still have my ovaries,
and my estrogen level is fine. I have vaginal infections
quite often. I have been tested for diabetes, and
lupus.Negative. I think I have vaginal infections
often because of the dryness that is caused by being
exposed to air inside me. I know this sounds quite
weird. "
rj
This is not weird. It is just not expressed very
often by women but I suspect there are many more women
like you that have this problem. Basically the vaginal
opening has been stretched larger due to childbirth.
It sounds as if in your case the stress incontinence
is bad but the gaping of the perineal opening is of
the most concern.
What causes vaginal opening enlargement and decreased
pleasure with intercourse?
Many try to blame the use of episiotomy and forceps
during delivery of a child as the cause for perineal
enlargement and subsequent pelvic organ prolapse.
Perhaps the question of how much those factors contribute
rather than just the size of the baby relative to
the mothers vaginal and perineal size and tissue elasticity,
will never be fully answered. Large babies and long
difficult labors in the pushing stage can, in some
women, result in symptoms of incontinence, bladder
and rectal dropping and enlargement of the vaginal
opening called the genital hiatus.
It has been established that the genital opening
is indeed larger in women with pelvic prolapse (1).
In fact it can be 2 or even 3 times larger in the
increasing degrees of pelvic prolapse and even when
the prolapse is corrected, it may not go back to normal
size.
In addition to a permanent enlargement of the opening,
there is often injury to the nerve (pudendal) that
controls sensation and muscle contraction of that
muscle at the opening (2). It does not seem to be
the nerve injury that causes prolapse of the perineum
but rather that nerve injury also takes place with
the injury to support structures (3).
Are there non-surgical treatments for perineal relaxation?
The traditional non surgical treatment for relaxation
of the vaginal opening has been Kegel exercises. These
are isometric contractions of the muscle at the vaginal
opening that are held for a period of time (seconds)
and then repeated. They have been shown to help reduce
mild urinary stress incontinence but not moderate
and severe incontinence (4). Starting them during
pregnancy may even help (5). Other treatments such
as vaginal cones (6) may be as good or even more effective.
Pelvic floor therapy with microstimulation of the
vaginal musculature is also used to promote perineal
muscle strength (7). It can produce over a 50% long
term cure rate in stress incontinence 8).
What is the surgical treatment for repair of the
vaginal opening (perineum)?
Surgical therapy of this problem is called a perineorraphy.
It is a reconstruction of the muscles and tissues
at the open of the vagina. It is often performed with
other pelvic relaxation surgery such as rectocoele
repair. The procedure is very good at decreasing the
size of the vaginal opening but as with any surgery,
there can be further nerve damage to the muscles which
lessens the sensation at the opening. There also is
a slight risk of scarring of the skin right at the
opening which can make intercourse painful. Therefore
the surgery must not be undertaken lightly.
Most of the time women do not mention to the physician
how bothersome the looseness of the opening is. Doctors
do not automatically just perform surgery because
they think the opening is too loose. there needs to
be a concern expressed by the woman. Be sure to be
bold enough to discuss this problem with your doctor
before surgery so you will not be disappointed by
assuming something will change just because of the
other components of surgical repair surgery.
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