Vaginoplasty: how I perform vaginal tightening and rejuvenation

What is vaginoplasty?

Vaginoplasty, also called colpoplasty or vaginal rejuvenation, is a surgical procedure aimed at tightening the vaginal canal and restoring the tone of the perineal muscles. Over the years — and especially after vaginal births — the tissues and muscles in this area can stretch, causing laxity and reduced sensitivity during sexual intercourse.

The procedure involves the removal of excess vaginal mucosa and the plication (approximation) of the pelvic floor muscles, particularly the levator ani muscle and the bulbospongiosus muscles. The result is a firmer vaginal canal, with better muscle tone and increased sensitivity.

Difference between vaginoplasty and perineoplasty

There is often confusion between these two procedures. Perineoplasty specifically addresses the perineal region — the area between the vagina and the anus — correcting episiotomy scars and restoring perineal anatomy. Vaginoplasty, on the other hand, encompasses the tightening of the entire vaginal canal. In my practice, I often combine both procedures, as the complete treatment offers far superior results.

A team approach

In the vaginoplasty I perform, I work in partnership with Dr Fabio Minotti. While he takes care of the internal reconstruction of the vaginal canal — the colporrhaphy and the plication of the deep muscles — I focus on the external aesthetic part: harmonisation of the labia, perineal rejuvenation, and correction of vulvar asymmetries. This team approach ensures that each stage of the procedure is carried out by a specialist in the area, providing the best possible result.

Pre-operative Vaginoplasty

The Consultation

In the consultation for vaginoplasty, I listen to your concerns and assess your intimate area thoroughly. I analyse the pelvic floor musculature, vaginal tone, the condition of the perineum, and the entire vulvar region. During the physical examination, I also check if there is a need for complementary procedures — such as labiaplasty or pubic liposuction — so that the surgical plan is as comprehensive and individualised as possible.

In this consultation, I also introduce Dr Fabio Minotti and we explain how our surgical partnership works. You will have the opportunity to ask all your questions to both professionals.

Pre-operative Tests

For vaginoplasty, I usually request the following tests:

• Complete blood count;
• PAT with INR + APTT;
• Urea;
• Creatinine;
• Fasting blood glucose;
• Total proteins and fractions;
• Vitamin D;
• Vitamin C;
• Urine I;
• Updated Pap smear;
• Electrocardiogram;
• Surgical risk assessment, which consists of evaluation with the cardiologist.

Anaesthesia

Vaginoplasty is performed under general anaesthesia or spinal anaesthesia, depending on the extent of the procedure and the anaesthetist's assessment. In most cases, we opt for spinal anaesthesia, which provides complete sensitivity blockage in the pelvic region with excellent pain control in the immediate postoperative period. In cases of more extensive procedures -- when we combine various intimate surgeries -- total intravenous general anaesthesia may be more appropriate.

Post-operative Vaginoplasty

The post-operative period of vaginoplasty requires some specific care, but recovery is more straightforward than most patients imagine. Pain is usually mild to moderate and is well controlled with common analgesics.

First Days

In the first days after surgery, it is normal to experience swelling and sensitivity in the area. I recommend relative rest, avoiding physical exertion and long walks. Local hygiene should be careful, and I prescribe silver sulfadiazine ointment to prevent infections, as it is a moist area. Sitz baths with warm water may be recommended for relief of discomfort.

Suture Threads

The threads used in vaginoplasty are absorbable — both internally and externally. This means they dissolve naturally in the following weeks, without the need for removal. This provides much more comfort to the patient during recovery.

Return to Activities

The majority of patients return to light activities — such as office work — in five to seven days. I recommend waiting at least four weeks to resume intense physical activities and a minimum of six to eight weeks for sexual relations. These timelines are individualised according to each patient's progress.

Final Result

In the first days and weeks, swelling is expected and will gradually decrease. After two to three months, it is already possible to perceive the tightening and functional improvement. I consider the final result of vaginoplasty to be between six months and a year, when the healing is completely mature and the definitive muscle tone is established.

Vaginoplasty and Quality of Life

Vaginoplasty is much more than an aesthetic surgery. For many women, vaginal tightening represents a true recovery of intimate quality of life. After pregnancies and vaginal births, it is natural for the tissues and muscles of the pelvic region to undergo distension. This can directly impact self-esteem, marital relationships, and emotional well-being.

In my experience, patients who undergo vaginoplasty report significant improvement in sexual satisfaction — both their own and their partner's. The recovery of muscle firmness and vaginal tone provides greater sensitivity and friction during intercourse, restoring sensations that had diminished over time.

In addition to the sexual aspect, vaginoplasty can also correct functional problems such as a feeling of pelvic heaviness, mild urinary incontinence (when associated with pelvic floor strengthening exercises), and discomfort when using tampons or during physical activities.

The Importance of Pelvic Physiotherapy

I recommend that my patients undergo pelvic physiotherapy sessions before and after vaginoplasty. In the pre-operative phase, physiotherapy helps the patient recognise and strengthen the pelvic floor musculature, which contributes to better recovery. In the post-operative phase, guided exercises assist in maintaining the surgical result in the long term, strengthening the muscles that were plicated during the surgery.

Laser vaginoplasty: a non-surgical alternative?

It is very common for patients to ask about laser treatments for vaginal rejuvenation. There are various technologies on the market that promise vaginal tightening without surgery — such as fractional CO₂ laser and radiofrequency. Although these treatments may offer some improvement in mild cases of laxity, it is important to have realistic expectations.

In my experience, laser treatments are indicated for early cases of vaginal laxity, as a complement to pelvic physiotherapy. For moderate to severe cases — especially after multiple vaginal deliveries — surgical vaginoplasty remains the gold standard, with far superior and longer-lasting results.

It is possible to use laser as a complementary treatment in the postoperative period of vaginoplasty, to optimise the quality of the vaginal mucosa and assist in maintaining long-term results. I assess each case individually and guide the patient on the best approach.

Frequently asked questions about vaginoplasty

Is vaginoplasty painful?

The surgery is performed under anaesthesia, so the patient does not feel pain during the procedure. In the postoperative period, discomfort is mild to moderate and well controlled with common analgesics. In my experience, most patients report less pain than they expected. The first 48 to 72 hours are usually the most uncomfortable, with progressive improvement in the following days.

How long does vaginoplasty surgery take?

Vaginoplasty takes an average of one to two hours. When we associate other procedures — such as labiaplasty, perineoplasty, or pubic liposuction — the total time may be longer, but each case is evaluated individually.

When can I resume sexual relations after vaginoplasty?

I recommend waiting at least six to eight weeks after surgery to resume sexual relations. This period is necessary for the healing to be sufficiently mature and the tissues to have regained their strength. Each case is evaluated individually during follow-up consultations.

Does vaginoplasty improve sensitivity during intercourse?

Yes. The tightening of the vaginal canal and the restoration of muscle tone provide greater sensitivity and friction during sexual relations. In my experience, the vast majority of patients report significant improvement in sexual satisfaction after complete recovery.

Can I become pregnant after vaginoplasty?

Although vaginoplasty does not prevent future pregnancy, I recommend that the patient has completed her family before undergoing the procedure. A new pregnancy and vaginal delivery can significantly compromise the surgical result.

Does vaginoplasty leave a scar?

The incisions are made internally, in the vaginal mucosa, and in the perineal area. The scars are located in naturally hidden areas and become practically imperceptible with complete healing. Internally, the vaginal mucosa has an excellent healing capacity.

What is the difference between vaginoplasty and perineoplasty?

Perineoplasty specifically addresses the perineal area — between the vagina and the anus — correcting scars and restoring perineal musculature. Vaginoplasty is more comprehensive, treating the tightening of the entire vaginal canal. In my practice, I often combine both procedures for a more complete result.

Why is vaginoplasty performed in partnership with another doctor?

In the vaginoplasty I perform, I work in partnership with Dr Fabio Minotti. He is responsible for the internal functional part — tightening of the vaginal canal and muscle plication — while I take care of the external aesthetic part — harmonisation of the vulva, perineal rejuvenation, and correction of asymmetries. This partnership allows each step to be performed by a specialist in the area, ensuring the best possible result.

Do I need to do pelvic physiotherapy before vaginoplasty?

I strongly recommend that my patients undergo pelvic physiotherapy sessions both before and after surgery. In the preoperative period, physiotherapy helps the patient recognise the pelvic floor musculature, which contributes to better recovery. In the postoperative period, the exercises assist in maintaining the long-term result.

Can vaginoplasty be performed alongside other intimate surgeries?

Yes, and this is very common. In my practice, I often combine vaginoplasty with labiaplasty, perineoplasty, reduction of labia majora, pubic liposuction, and other procedures. I specialise in intimate surgery and assess the entire region to offer a complete and harmonious treatment.

Is the result of vaginoplasty permanent?

The result is long-lasting, especially when the patient does not have new pregnancies with vaginal delivery. Natural ageing of the tissues occurs, but at a much slower rate. Regular pelvic floor exercises (Kegel exercises) and periodic sessions of pelvic physiotherapy help maintain the result for many years.

How do I choose a surgeon for vaginoplasty?

It is essential that vaginoplasty is performed by professionals with training and experience in the area. Look for a plastic surgeon who is a member of the Brazilian Society of Plastic Surgery (SBCP) and who has proven experience in intimate surgery. In my practice, I have over 20 years of experience and more than 8,000 surgeries performed, with training from the Ivo Pitanguy Institute and specialisation in intimate surgery.