Vaginal delivery can result in a widening of the vagina due to the expansion of the tissues and separation of the adjacent muscles resulting in laxity with a perineal gap and decreased sexual satisfaction. 

Vaginal tightening procedures include vaginoplasty and perineoplasty and are associated with improved sexual function with a low rate of complications. Submucosal lipofilling can be associated with these processes in order to reduce the vaginal diameter and improve mucosal trophism. 

Vaginoplasty

Vaginoplasty encompasses a series of techniques that are aimed at reducing the diameter of the vaginal cone. 

Through lateral colporrhaphy, the excess mucosa is excised from the lateral walls. 

In posterior vaginoplasty, the apex of the intravaginal V is located 10 cm from the hymenal ring while the two axes of the V are located at 5 and 7 o'clock. During dissection, the mucosa is elevated until the levators are seen. which are sutured until they are approximated, as are the bulbocavernosus and transverse perineal muscles. The excess mucosa is excised, and the patient must avoid tampons and intercourse for 6-8 weeks. 

Perineoplasty

Through perineoplasty, the posterior hairpin is narrowed, the perineal skin and redundant vaginal mucosa are excised, and the introitus is narrowed by approximating the transversus perinealis and bulbocavernosus muscles. This procedure is of choice in cases of vaginal laxity but also in those patients who want to improve their appearance and sexual function after a vaginal delivery. 

The risk of hematoma and infection is low and other possible complications such as pain or dyspareunia are usually related to neurotic phenomena not evaluated prior to surgery. 

Procedure

The best technique is the one in which the surgeon is most comfortable and with which he achieves notable and consistent results. The procedure may be combined with a labia minora reduction and labia majora surgery (reduction/augmentation/lifting).