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Vagina reconstruction or vaginoplasty after childbirth may be required in some women for various reasons, including sexual dysfunction. This can be related to women’s physical and psycho-emotional states, as well as their experiences. If necessary, vaginoplastia in postpartum women can be performed during a cesarean delivery or within 6 weeks after normal vaginal delivery. Performing an incision in the hymen, in postpartum vaginoplasty after childbirth, special reconstruction techniques allow restructuring as it is located at the midlevel of the vaginal introitus to provide vaginal narrowing and increased sexual satisfaction. The aim of this chapter is to describe the surgical techniques and postpartum vaginoplasty benefits in women.
The vagina changes superficially after childbirth, which is why increasing numbers of women demand surgical treatment. There is simply no data regarding human vaginal pressure over time corresponding to deliveries by orifice animals. The effect of restoring vaginal function after childbirth is more significant in 30-50% of multiestrous. The passage through the birth canal usually smooths itself in the correct orthogonal axis, but many lateral vaginal walls are visible. After a tiring vaginal childbirth, the vaginal wall will have a marked glycos role that will be outlined. Large suction cups are useful enough to contain the seal, but not forces. With the hand on the fetal head, muscles in the extremities of the introitus are torn.
Vaginoplasty is known as one of the changes observed after vaginal delivery. Vaginoplasty surgery includes reconstruction and reduction of the lateral vaginal canal walls to tighten the vaginal walls and the perineal body. Vaginoplasty techniques use a technique to change the lateral pressure, strength or volume to adjust the ventral-ventral position, which is the first step in that LAMM is based on the LFS and apply a full-thickness incision involving the vagina and perineum. Thus, this technique first forms the posterior wall of the vagina into a vertical manner. Nowadays, many advanced tools and techniques are available to overcome breast and facial volume, body girth and instead to be increased by applying volume fillers and prostheses. Although it can be fixed after the initial durable effect and surgical removal, it lacks long-term effectiveness and creates biological damage to the use of foreign bodies.
Vaginoplasty is mainly indicated for patients with postpartum vaginal surgery seeking to reconstruct the vaginal opening and tighten the vaginal canal, also known as a “Mommy Makeover”. The laxity and morphological changes in the vaginal tissue caused by restoring vaginal function after childbirth alter the tactile function, leading to anorgasmia, increased diameter of intra-canal proximal and middle vaginal originating from the lateral planes, uterine cervix protrusion in the vaginal lumen and loss of sensation on the lateral-vertical portion of the vaginal. Vaginal birth can result in loss of vaginal tissue and perineal muscles that support the paravaginal ligaments. It is possible through the rectovesical leap-vaginal muscles- obturator septum, which is responsible for the urethra extension for neuro-pudendal events and inspired the autonomic nervous system. Therefore, if the diagnosis is supported by the digitorectal exam to confirm hypotonia muscle as well as any androgenization of the patient, the withdrawal therapy of nandrolone may be combined with the reconstruction of the remaining bulbar muscles, the six dorsal muscles, and internal body gluteus muscles to increase spa amenity.
Postoperative care and recovery are extremely important segments of the vaginoplasty for new mother’s process; they dictate the manner in which women are going to heal from their surgery. Women have to take good care of themselves in the postoperative period, in order to lessen the risks of complications and to get the best possible results. Patients will feel some post-surgical discomfort when the anesthesia wears off. During this time, mothers may get some postsurgical medicinal therapy. The women are also educated to keep the procedure site very hygienic, which involves regular wound site cleaning, eosin-free gauze dressing, and regular use of water-containing bidet. They are also educated to be cautious with regard to their movement so that they can prevent accidental traumatic harms of their association site.
In conclusion, vaginoplasty after childbirth improves the functional and aesthetic nature of the scar that a patient gets after episiotomy or spontaneous wedge resection. A patient can return to her daily life with an activated sexual lifestyle after recovery from vaginoplasty for new mothers. The earliest possible is better. Mothers can return to work and take some medications to recover better. In the early postoperative period, alternating hot and cold treatments are required, mostly on the first day after the procedure and for 2 more days. Women are requested to abstain from heavy exercise for 2 weeks and to resume sexual associations 6 to 8 weeks after the procedure. Also, patients require to be gentle with anything and do not stay faithful during these periods. Mothers with high discomfort are instructed to stop the approach.
Therefore, they should be suggested to make regular vaginal dilators of increasing thickness. Any stress, distress, and other mood changes can be evaluated and treated accordingly.
Hay muchas técnicas diferentes de cirugía de rejuvenecimiento vaginal, pero los médicos siempre comenzarán con la construcción de la vulva. La cirugía generalmente se realiza bajo anestesia general en el quirófano de un hospital. La cirugía comienza con la extirpación del pene. A veces se utilizan escrotos para crear los labios externos. Los testículos se extraen del escroto y la piel escrotal se gira para formar los labios externos de la vagina. La piel del pene se pela quirúrgicamente y se utiliza para crear un canal vaginal. Los cirujanos a menudo usan la longitud del colon para revestir el canal vaginal, que se cubre con un colgajo de piel para crear los labios internos. Si tiene suficiente piel del pene, los cirujanos pueden invertirla para revestir el canal vaginal y reemplazar cualquiera de los revestimientos intestinales con la piel del escroto. Esto se llama "revestimiento intestinal o completo".
Antes de la cirugía, se le extraerá y congelará un poco de su propio líquido corporal (sangre o eyaculación) en caso de que desee tener hijos genéticamente relacionados en el futuro. Tendrá una herida entre las piernas que deberá limpiarse. Es posible que necesite un catéter durante una semana después de la cirugía.Los puntos dentro de la vagina se disuelven después de 4 meses. Los puntos que se usan para cerrar la piel generalmente se disuelven después de 2 semanas. Los puntos que se disuelven evitan que tengas que quitártelos. No se coloca ningún tipo de taponamiento ni stent en la neovagina al final de la cirugía. Los estudios muestran que no hay ningún beneficio en tener algo en la vagina mientras cicatriza.
Recuperación y atención ambulatoria Si tiene un trabajo de tiempo completo, los cirujanos generalmente recomiendan ausentarse durante 6 a 8 semanas o más si el trabajo es físico. Es posible volver a realizar actividades livianas inmediatamente después de la cirugía. La actividad sexual regular a menudo se puede reanudar después de 3 meses. Los avances en las técnicas quirúrgicas para procedimientos de vaginoplastia Han llevado a la evolución de tejido neovaginal de alta calidad sin pelo. Desafortunadamente, se requieren stents uretrales incluso después de una uretroplastia cutánea con pelo. Se han investigado opciones sintéticas, como colgajos libres desepitelizados o desprovistos de pestañas, pero ninguna de estas técnicas elimina por completo el riesgo de pérdida de pelo.
Although vaginoplastia in natal women with vaginal agenesis has undergone evaluation and assessment, no reports of successful RCT vaginoplasty in postpartum women have ever been attempted. There are emerging and promising technologies that are currently being investigated in animal models and preclinical studies, such as Magnetic Anastomosis, Fecal Microbiota Transplantation, and Fibrin Sealant. These technologies have the potential to be aggressive and safe and may have implications to reduce the risk of vaginoplasty for new mothers dehiscence, protect spontaneous healing and avoid sutures, reduce hematoma and seroma formation with fewer quantity and duration of postoperative infection and inflammation, simplify the surgical procedure by reducing the overall surgery time and recovery. In addition, reducing specified and non-specific inflammation and sex steroids, fibroblast activity, modulating extracellular matrix deposition and organization, reducing apoptosis of vaginal and perineal tissues, and regulating the immune system could be an attractive approach to assist in the primary outcome indicating that early wound healing has been improved in postpartum vaginal surgery. We anticipate human trial(s) to be evaluated and implemented within the next 5-10 years. However, further animal studies and preclinical trials will need to be conducted.
The goal of this process is to further reduce the dehiscence incidence from one in seventeen patients to further reduce the length of the longitudinal epithelial scar. The initial outcome would not only significantly promote the wound healing process (12-15 days), reduce the submucosal tear and fall in the extracellular matrix, use of wound adhesives to reduce subcutaneous tension, but also increase sexual manageability after surgery. Thus, where these initial studies will add to the enhancement of the patient, the ongoing studies will add to the reduction in maternal adverse outcomes.
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