Vaginal repair operation

Vaginal repair (colporrhaphy) is a procedure that lifts, strengthens and tightens weakened muscles and ligaments in the vaginal walls and surrounding tissues. 

The procedure is carried out through the vagina, and although it’s considered major surgery, it’s less invasive than surgery through an incision in the abdomen. While you’re under general anaesthetic, your surgeon makes incisions inside the vagina to access the muscles and ligaments, lifting and attaching them to bone and other ligaments to stabilise them. 

Vaginal repair operations have a high success rate. Around 3 in 4 patients feel their symptoms are completely resolved following treatment, and 1 in 10 need follow-up support.

Why you might need a vaginal repair operation 

Weakening and loosening of the vaginal muscles is common and can happen for several reasons, including: 

• Ageing and menopause — hormones affect muscle tone
• Childbirth — especially multiple or difficult deliveries
• Chronic (long-term) strain — caused by chronic cough, constipation, or being overweight
• Genetics — naturally weaker tissues
• Long-term heavy lifting — causing strain
• Previous hysterectomy — removing the womb (uterus), which supports the top of the vagina 

Vaginal repair surgery can be performed for health-related and cosmetic reasons — it can ease symptoms such as: 

• Loss of confidence or self-esteem
• Loss of vaginal tone, libido or sexual pleasure
• Not being able to hold in urine
• Pain during sex
• Stress urinary incontinence (leaking urine) when you jump, sneeze or laugh 

Weak muscles can also cause a pelvic organ prolapse, which is common and usually affects those aged over 50. Some people don’t notice any symptoms from a vaginal prolapse, while others experience: 

• A heavy feeling in the pelvic area 
• Feeling or seeing a bulge
• Inability to empty the bladder or needing to go more often 

Is a vaginal repair operation right for you? 

You might need a vaginal repair operation if: 

• Non-surgical treatments haven’t been successful
• You have a prolapse
• Your symptoms are affecting your daily life 

Your doctor will assess your symptoms and may give you an internal exam, bladder function and pelvic floor strength tests. They may also recommend an ultrasound or MRI scan. 

Vaginal repair surgery may not be suitable if you: 

• Are allergic to anaesthetic or other medications
• Are obese
• Are pregnant or planning future pregnancies
• Have a blood-clotting disorder, an active infection, or uncontrolled diabetes
• Have a heart or lung condition 

Surgery for a weakened pelvic floor may be unnecessary if you don’t have symptoms that interfere with your quality of life. However, this may change over time. 

There are also several types of vaginal rejuvenation operations that can change the structure and appearance of the female genitalia. These include: 

• Clitoral hood reduction — removes excess tissue for cosmetic reasons or to improve discomfort
• Labiaplasty — reshapes the labia (lips) of the vulva
• Monsplasty — removes fatty tissue from the pubic bone area, which can also improve discomfort
• Perineoplasty — strengthens or rebuilds the perineum, often after childbirth
• Vaginoplasty — reshapes or rebuilds the vagina (internal) for cosmetic, or medical reasons, such as gender affirmation or after physical trauma
• Vulvoplasty — changes the shape of the vulvar (external) area for gender-affirming reasons 

Alternative treatments for vaginal repair 

In many cases, non-surgical treatment options may be helpful. These include: 

• Lifestyle changes — minimising smoking, managing weight, avoiding heavy lifting and minimising straining by treating symptoms like coughing or constipation
• Oestrogen — a pill, hormone-releasing ring or cream can be useful for a mild prolapse if you’ve already been through menopause
• Pelvic floor exercises — to strengthen muscles and reduce symptoms, however, these can’t correct a prolapse
• Vaginal pessary — inserted every 6–9 months to push a prolapse back; penetrative sex is still possible with a ring pessary, but not with a gellhorn (shelf pessary)

Some treatment options may be suitable for short-term relief: 

• CO2 laser — heat stimulates tissues to produce more collagen, which improves tightness
• Radiofrequency (RF) treatment — electromagnetic waves heat the tissue to increase blood flow and collagen 

If you’ve been through menopause and do not want to have penetrative sex, vaginal closure surgery (colpectomy/colpocleisis) may be an option. 

The procedure is usually done through an incision in the vaginal wall from the inside, but sometimes it takes place through an incision on the lower abdomen above your pubic bone. 

The type of pelvic repair operation you have depends on where the lift is needed and the type of prolapse. You may need more than one option:

• Anterior colporrhaphy — tightens the front of the vaginal wall to treat a cystocele (the most common type of pelvic prolapse when the bladder collapses into the vagina because your muscles can no longer hold it in place)
• Posterior colporrhaphy — tightens the back of the vagina to treat a rectocele (the rectum, part of the bowel, collapses into the back of the vagina)
• Sacrocolpopexy — lifts the vagina and attaches it to the sacrum (the bone at the base of your spine)
• Sacrohysteropexy — lifts your uterus and attaches it to the sacrum
• Sacrospinous fixation — lifts the top of the vagina with a ligament in the pelvis; often done in combination with a vaginal hysterectomy
• Vaginal hysterectomy — removal of the uterus through the vagina 

Rarely, surgical mesh is inserted to hold the organs in place. While this can be beneficial for some people, it comes with a greater risk of complications such as pain or nerve damage.

How to prepare for your procedure 

You must attend all pre-operative appointments. Your gynaecologist will explain the procedure, including any risks and aftercare information. You’ll fill out a pre-admission form which will cover your medical history, medications (including supplements), allergies and support needs. Some scans and tests may also be recommended. 

You may be asked to stop taking your contraception for at least 4 weeks prior to your surgery, in which case you should use condoms during this time. You may also be asked to pause or adjust certain medications, eg blood thinners, before your surgery. 

Improving your overall health before surgery will minimise risks and aid your recovery. This includes stopping smoking, maintaining a healthy weight, managing any health conditions, eating well and staying active.

As the surgery involves having a general anaesthetic, you may be asked not to eat or drink (ie to fast) for a period leading up to the procedure.

On the day of your surgery, you’ll need to wash and bring comfortable clothes and personal items for your stay in the hospital. You may be asked to use a depilatory cream the night before your surgery or your care team will shave your pubic hair for you.

It’s also a good idea to have a friend or family member who can take you home and support you for a few days.

Who will be involved in your surgery? 

Your consultant gynaecologist, anaesthetist, operating team and ward nurses will all support you.

Your vaginal repair operation 

You’ll be given a hospital gown and disposable underwear to put on. 

Once you’re under general anaesthetic, you’ll be asleep and won’t be aware of anything until after the procedure. 

In the operating suite, you’ll have a catheter inserted into your bladder to drain urine. This will stay in place for a couple of days after the procedure. 

Once your surgery is complete, you’ll have sutures (stitches) to close the wounds. If your surgery was performed through your vagina, these will be internal, so you won’t have any visible scars. If you had an incision in your abdomen, you will likely have a faint scar.

How long the procedure takes 

The procedure takes around an hour.

What to expect straight after your vaginal repair 

You’ll be taken to a recovery room while your anaesthetic wears off. You might be given a regional anaesthetic to relieve your pain and oxygen through a mask for a few hours. You may also have a drip with fluids and a blood thinner to minimise the chance of deep vein thrombosis (DVT). 

Your hospital stay 

You’ll stay in the hospital for 2–4 days before continuing your recovery at home.

During your hospital stay, a physiotherapist will give you exercises to help speed up your recovery and strengthen your muscles.

Your doctor may prescribe some medication to take for a couple of weeks. They will answer your questions before you leave and will schedule a follow-up appointment and vaginal exam for 6 months’ time.

As the anaesthetic wears off, you’ll likely feel forgetful, clumsy, or slow. It’s common to feel nauseous, but you should be able to eat and drink within a couple of hours, and to get out of bed.

On the second day, you should be able to walk around slowly. It’s normal not to have a bowel movement for a couple of days.

After a couple of days, you’ll have your catheter removed. You can usually return to your usual activities in a month, and you should make a full recovery in 6–12 weeks. 

Urinating and bowel movements 

It’s normal to have difficulty emptying your bladder for a few days, but this should get better on its own. It’s important not to strain to have bowel movements for the first 6 weeks, so take laxatives if necessary.

Pain 

You may need to take over-the-counter pain relief for the first couple of weeks. 

Vaginal bleeding and discharge 

You may notice a blood-stained discharge for a few weeks after surgery. It’s important to use pads rather than tampons during this time. There may also be a creamy white discharge as your body absorbs the dissolvable stitches.

Diet 

You should be able to follow your usual diet during your recovery, but try to eat high-fibre foods to minimise constipation. You may need to avoid alcohol while you’re taking pain relief. 

Driving 

Avoid driving for at least 24 hours after a general anaesthetic. When you can comfortably perform an emergency stop, you can resume driving. 

Sex 

Avoid penetrative sex while your body is healing. This usually takes around 6 weeks, after which you can resume sexual activity if you feel comfortable.

Sports and physical activity 

Avoid swimming, strenuous sports and heavy lifting for the first 4 weeks, and heavy manual work for a couple of months. 

Work 

Depending on the nature of your work, you may be able to return after a month.

Smoking 

Stopping smoking can greatly improve and speed up your recovery, while reducing the risks of infection. This is a good opportunity to quit smoking.

Although uncommon, every surgery comes with risks, including very rare allergic reactions to anaesthetic. A few in every hundred people develop:

• An infection
• A wound haematoma (blood pooling in body tissues outside blood vessels)
• Bleeding
• DVT
• Headaches and side effects related to anaesthesia 

Risks of complications specific to vaginal repair surgery include: 

• Pain during sex
• Prolapse recurrence
• Urinary retention 

Occasionally, other organs are damaged during the procedure and need corrective surgery. Surgical mesh has a higher chance of complications, such as mesh protruding through the vaginal skin, pelvic pain, chronic infection, and pain during sex. Your doctor will discuss using mesh with you before the procedure if it’s the only viable option to treat your symptoms. 

You can lower your risks by improving your health as much as possible ahead of your surgery. For example, quitting smoking, consuming less alcohol, following a healthy diet, exercising regularly, maintaining a healthy weight, looking after your mental health, and keeping hydrated. 

Seek medical advice if you experience: 

• Abnormal discharge
• Burning sensation when you urinate
• Fever
• Heavy bleeding
• Severe or worsening pain