Cum se efectuează vaginoplastia la femeile postpartum?

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Cuprins

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.

What are the Surgical Techniques for Vaginoplasty After Childbirth?

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.

Postpartum Vaginoplasty Benefits and Risks

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.

Îngrijire și recuperare postoperatorie după vaginoplastie pentru proaspete mame

Există o mulțime de tehnici diferite de operație de întinerire vaginală, dar medicii vor începe întotdeauna cu construcția vulvei. Intervenția chirurgicală se face de obicei sub anestezie generală într-o sală de operație de spital. Intervenția chirurgicală începe cu îndepărtarea penisului. Scrotul este uneori folosit pentru a crea labiile exterioare. Testiculele sunt îndepărtate din scrot, iar pielea scrotului este răsturnată pentru a forma buzele exterioare ale vaginului. Pielea penisului este îndepărtată chirurgical și este folosită pentru a crea un canal vaginal. Chirurgii folosesc adesea lungimea colonului pentru a căptuși canalul vaginal, care este acoperit cu un lambou de piele pentru a crea labia interioară. Dacă aveți suficientă piele penisului, chirurgii o pot inversa pentru a căptuși canalul vaginal și a înlocui oricare dintre mucoasa intestinală cu pielea scrotului. Aceasta se numește „căptușeală intestinală sau completă”.

Înainte de operație, veți avea o parte din propriul dumneavoastră fluid corporal (sânge sau ejaculat) colectat și înghețat dacă doriți să aveți copii înrudiți genetic în viitor. Veți avea o rană între picioare care necesită curățare. Este posibil să aveți nevoie de un cateter timp de o săptămână după operație. Cusăturile din interiorul vaginului se dizolvă după 4 luni. Cusăturile folosite pentru a închide pielea se dizolvă de obicei după 2 săptămâni. Dizolvarea cusăturilor vă scutește de nevoia de a le scoate. Nu există nicio garnitură sau stent plasat în neovagin la sfârșitul intervenției chirurgicale. Studiile arată că nu există niciun beneficiu să ai ceva în vagin în timp ce acesta se vindecă.

Recuperare și îngrijire în ambulatoriu Dacă aveți un loc de muncă cu normă întreagă, chirurgii recomandă, de obicei, să fiți liber timp de 6-8 săptămâni sau mai mult dacă munca este fizică. Este posibil să reveniți la activități ușoare imediat după intervenția chirurgicală. Activitatea sexuală regulată poate fi adesea reluată după 3 luni. Progrese în tehnicile chirurgicale pentru proceduri de vaginoplastie au dus la evoluția țesutului neovaginal de înaltă calitate fără păr. Din păcate, stenturile uretrale sunt necesare chiar și după uretroplastia pielii cu păr. Au fost investigate opțiuni sintetice, cum ar fi lambourile libere detabulate sau deepitelizate, dar niciuna dintre aceste tehnici nu elimină complet riscul căderii părului.

What’s New in Postpartum Vaginal Surgery?

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.