Gynaecology

Vaginoplasty is a surgical procedure used for the surgical treatment of vaginal wall prolapse.

Pelvic Organ Prolapse

Pelvic organ prolapse refers to a condition in which an organ or organs in the pelvic area have shifted from their normal position and descended into or outside the vagina. More than half of women over the age of 50 experience some degree of pelvic organ prolapse. By the age of 80, one in ten women has undergone surgery due to prolapse.

Factors that contribute to pelvic organ prolapse include age, menopause, trauma from childbirth, previous gynecological surgeries, genetic predisposition, chronic diseases, overweight and obesity, heavy lifting, and chronic constipation.

The accompanying symptoms vary depending on the location and extent of the prolapse. Common complaints include a feeling of heaviness and pressure in the lower abdomen and vagina, lower abdominal pain, urinary disturbances, bowel movement difficulties, urinary incontinence, gas and fecal incontinence, and uncomfortable or painful intercourse.

Vaginoplasty

Vaginoplasty is a surgical procedure primarily used for vaginal wall prolapse. Anterior vaginal wall prolapse, also known as cystocele or bladder prolapse, refers to the bulging of the bladder through the anterior vaginal wall into the vagina or, in severe cases, outside the vagina. Posterior vaginal wall prolapse, also known as rectocele or rectal prolapse, involves the bulging of the rectum through the posterior vaginal wall into the vagina or, in severe cases, outside the vagina.

During vaginoplasty, supportive sutures are placed in the vaginal wall connective tissue. The procedure can be performed under general or spinal anesthesia, and it is done through the vagina. The surgery typically lasts 20-40 minutes. A catheter is inserted into the bladder during the operation, and a vaginal tampon is often placed.

Postoperative Period

After vaginoplasty, you can usually go home on the same or following day. Prior to discharge, the bladder catheter and vaginal tampon are removed. Your doctor will provide you with specific instructions for your postoperative care based on the course of the operation. Typically, within 1-2 months after surgery, you should avoid lifting heavy weights over 5 kg, swimming, and taking baths. Sexual intercourse, strenuous activities, and straining should be avoided. It is normal to have a bloody discharge for 1-3 weeks, and the use of vaginal tampons is not allowed during this time.

Possible Complications

There is always a risk of complications with surgical treatment. The more common complications include:

• Bleeding
• Postoperative pain
• Infection at the surgical site
• Injury to adjacent organs (urethra, bladder, intestines)
• Thrombosis
• Anesthesia-related complications, which are usually associated with drug allergies

To reduce the risk of potential complications, inform your surgeon about any existing medical conditions, medications you are taking, and any known drug allergies. If the surgery is performed under general anesthesia, you must refrain from eating for at least 6 hours and drinking for 4 hours prior to the operation.

Vaginoplasty does not guarantee the complete resolution of problems associated with vaginal wall prolapse, but it typically improves the patient’s quality of life. However, there is a risk of recurrence even after surgery. According to the literature, the risk of recurrence is up to 50%. Recurrent prolapse after surgery can involve both the supported organs and other pelvic organs. Patients who have persistent risk factors after surgery, such as obesity, chronic constipation, and regular heavy lifting, have a higher risk of recurrent prolapse.