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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, vaginoplasty 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.
Esistono molte tecniche diverse di chirurgia di ringiovanimento vaginale, ma i dottori inizieranno sempre con la costruzione della vulva. L'intervento chirurgico viene solitamente eseguito in anestesia generale in una sala operatoria ospedaliera. L'intervento inizia con la rimozione del pene. A volte vengono utilizzati gli scroti per creare le labbra esterne. I testicoli vengono rimossi dallo scroto e la pelle dello scroto viene girata per formare le labbra esterne della vagina. La pelle del pene viene chirurgicamente staccata e utilizzata per creare un canale vaginale. I chirurghi spesso utilizzano la lunghezza del colon per rivestire il canale vaginale, che è coperto con un lembo di pelle per creare le labbra interne. Se hai abbastanza pelle del pene, i chirurghi possono invertirla per rivestire il canale vaginale e sostituire qualsiasi rivestimento intestinale con la pelle dello scroto. Questo è chiamato un "rivestimento intestinale o completo".
Prima dell'operazione, ti verrà prelevato e congelato del fluido corporeo (sangue o eiaculato) nel caso volessi avere figli geneticamente imparentati in futuro. Avrai una ferita tra le gambe che deve essere pulita. Potresti aver bisogno di un catetere per una settimana dopo l'operazione.. I punti all'interno della vagina si dissolvono dopo 4 mesi. I punti utilizzati per chiudere la pelle di solito si dissolvono dopo 2 settimane. I punti di sutura riassorbibili ti evitano di doverli rimuovere. Non c'è alcun tampone o stent posizionato nella neovagina alla fine dell'intervento. Gli studi dimostrano che non c'è alcun beneficio nell'avere qualcosa nella vagina mentre guarisce.
Recupero e cure ambulatoriali Se hai un lavoro a tempo pieno, i chirurghi solitamente raccomandano di assentarsi per 6-8 settimane o più se il lavoro è fisico. È possibile tornare alle attività leggere subito dopo l'intervento. L'attività sessuale regolare può spesso essere ripresa dopo 3 mesi. I progressi nelle tecniche chirurgiche per procedure di vaginoplastica hanno portato all'evoluzione di tessuto neovaginale di alta qualità senza peli. Sfortunatamente, gli stent uretrali sono necessari anche dopo l'uretroplastica con cute pilifera. Sono state studiate opzioni sintetiche, come lembi liberi de-tabbed o de-epitelizzati, ma nessuna di queste tecniche elimina completamente il rischio di perdita di peli.
Although vaginoplasty 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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