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With age, especially after natural childbirth, a woman ceases to get those sensations in bed, as before. This is due to the expansion of the vagina, when the walls lose their elasticity. it natural process, but after all, a young woman in her prime cannot come to terms with this and put an end to her personal life. Both partners should have fun in bed. This problem can be solved surgically by performing a colporrhaphy operation. It is also called vaginoplasty.

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This is an operation aimed at restoring anatomically correct form vagina. In most cases, its narrowing is carried out, because over time it expands. But it may also be that the vagina is naturally too narrow, of some irregular shape, etc. And in this case, colporrhaphy is applicable. This operation is advisable to carry out if:

• the vagina has expanded after multiple or difficult births to give the woman back the opportunity to experience pleasure during intercourse.
• there is a fistula between the ureter and bladder what causes urinary incontinence
• I want to improve the elasticity of the walls of the vagina so that the woman herself and her sexual partner can get the most out of sex
• there is a prolapse or prolapse of the uterus

The main types of colporrhaphy

There are two main types of colporrhaphy: anterior and posterior. With the anterior, a small section of the vaginal mucosa is excised in the anterior part, with the posterior, respectively, in the back. The walls are then stitched together. Either one of these procedures or both can be carried out.

A narrowing of the vaginal opening may also be performed. In some cases, a special mesh implant to increase the elasticity of the walls. But it is usually installed in women aged 45 and above.

What do seams look like?

It all depends on the specific situation, the site where the operation was performed. Often, combined sutures are applied, since the loads in this area are quite serious. The surgeon may apply submersible catgut sutures. Colporrhaphy: photos BEFORE and AFTER In order for the sutured edges of the vaginal wound to come into contact with wider surfaces and heal faster, when suturing, they often recede from the edge of the wound by 0.7–1.0 cm. After the application of submersible sutures, the edges of the wound are additionally sutured with silk ligatures.

What are the consequences of the operation

It is extremely important to follow all the instructions of the doctors after the operation so that there are no complications. Otherwise the following problems may occur:

• divergence of sutures, repeated descent of the walls of the vagina
• bleeding and internal bruising caused by rupture of sutures
• wound infection, etc.

To avoid such problems, within 2 months it is necessary strictly follow all the rules:

• give up intimacy
• carefully observe intimate hygiene
• try to avoid the occurrence of intestinal disorders
• empty on time bladder, and do not endure for half a day
• try to avoid constipation
• take drugs prescribed by the surgeon
• avoid heavy physical exertion, etc.

How much does the procedure cost

It all depends on the complexity of the operation and the site on which it is performed. Rates may vary depending on the city, selected clinic, etc.

On average, the narrowing of the entrance to the vagina will cost 40,000 - 80,000 rubles. The price of posterior or anterior colporrhaphy varies from 45,000 to 100,000 rubles. Often, vaginoplasty is accompanied by some other operations, so the price can be higher and reach 200,000 - 250,000 rubles, for example, adding plastic pelvic floor, perineum, etc.

Reviews about colporrhaphy

• Anna, 34 years old, Moscow. She gave birth twice. And each time the birth was difficult, especially the second. After intimacy generally ceased to bring pleasure to either me or my husband. I noticed that the intimacy between us is less and less, because we are tired, because there is no pleasure. I wanted to save my family. No, my husband was not going to leave me because of this, but I'm sure that sooner or later, he would at least get someone on the side. Therefore, I decided to look for ways. At first I tried to do Kegel exercises, but did not achieve any effect. It took a long time to decide on the operation, but I had no other choice. I didn't mean to put an end to mine intimate life at 33 years old. For a long time I was looking for a clinic, a doctor, I read reviews of women who had such an operation. It cost me 83,000 rubles, along with anesthesia, fees, etc. The sensations became brighter, I began to enjoy sex as before.
• Rimma, 38 years old, Rostov-on-Don. I did not really believe that such an operation could help. She did it solely for the sake of her husband, so that he could have fun, but I can say I didn’t think about myself. But, I was very wrong, because now I enjoy sex during sex. The operation itself seemed easy to me. Yes, it is relatively simple, but anesthesia and withdrawal from it are quite complex and unpleasant.
• Aida, 26 years old, Mirny.I had 2 operations at once: narrowing of the vagina and cervix. I want to immediately, based on my experience, give the girls advice: do the operation not in clinics plastic surgery, but in the hospital, because anything can happen, and there will be doctors who will quickly respond and take action. I did it in the hospital. Everything went well. On the 5th day I was discharged. Then for about 2 more months I avoided intimacy to be sure that everything healed there. And one more piece of advice - do this operation after you decide that you will not give birth again.
• Margarita, 24 years old, Essentuki. To me, unlike most women, this operation was done not to narrow, but, on the contrary, to expand the vagina. During the first pregnancy, it turned out that it was narrowed. It seemed good to me and my husband, especially during intimacy. It turned out that this is not the norm. But, during pregnancy, I could not have an operation of such a plan, therefore, during the birth itself, they performed a caesarean section, because. naturally I wouldn't have given birth. After that, I decided that I needed to fix the problem so that I could give birth next time. Everything went well, there was no pain, I followed all the doctor's instructions.

Colporrhaphy is a plastic surgery, the essence of which is the suturing of the walls of the vagina. It is one of the variants of vaginoplasty (colpoplasty). Such surgery may be performed to improve the quality sexual life women or medical indications.

Tasks of colporrhaphy

Vaginoplasty aims to achieve several goals:

1. Reducing the volume of the vagina, narrowing its lumen.
2. Elimination of sagging or pathological expansion of the walls of the vagina, correction of the line of arches.
3. Strengthening the walls of the vagina as one of the stages of surgical intervention for prolapse (prolapse) or.
4. Elimination of rough, deforming or causing pain scars that form after suturing ruptures of the genital organs or episiotomy.

The result of a well-performed colporrhaphy will be the release of the patient from her omission and excessive stretching of the walls of the vagina and associated secondary disorders from adjacent organs. At the same time, the vagina fully retains its functionality, including in women of childbearing age.

Indications

Medical indications for colporrhaphy include prolapse of the vaginal walls and associated secondary anatomical and functional changes. It is the occurrence of complications from adjacent organs that in most cases becomes the basis for making a decision on surgical treatment.

Vaginal prolapse of the 1st degree is not an unequivocal indication for surgery. The woman is usually offered conservative treatment, the basis of which is daily gymnastics to strengthen the muscles of the vulvovaginal region and the pelvic floor (). But 2-3 degrees of omission require surgical intervention.

The indications for it are:

• Urinary incontinence varying degrees expressiveness. This is due to the displacement of the urethra and overstretching of its mouth, the prolapse of the bladder (cystocele) with prolapse of the anterior wall of the vagina.
• Gas incontinence and (less commonly) fecal incontinence due to anal sphincter leakage due to rectal displacement during prolapse rear wall vagina.
• Difficulty and discomfort during bowel movements (in the absence of constipation).
• Pain during physical activity and sexual intercourse associated with the unstable position of the internal genital organs.
• Protrusion of the vaginal mucosa outside the genital slit. In this case, there is a constant maceration and ulceration of the prolapsed tissues, chronic recurrent with a tendency to bleeding. The risk of malignant degeneration of tissues constantly injured by underwear increases.
• Uterine prolapse.

In addition, colporrhaphy can be performed at the request of a woman to reduce the volume of her vagina and in the absence of signs of organ prolapse. The reason for intervention in this case is usually a deterioration in the quality of sexual life after childbirth, anorgasmia. Sometimes there are individual anatomical features, leading to a mismatch in the size of the genital organs in partners.

Surgery may also be requested by women complaining of an unaesthetic appearance vulvovaginal region with the expansion of the vaginal fissure up to its gaping. This condition usually occurs in women who have given birth repeatedly.

Why does vaginal prolapse occur?

Vaginal prolapse is not physiological state. In fact, this long-term effect trauma to the tissues of the genital organs (including during childbirth) and endocrine changes in the body of a woman.

Vaginal prolapse is promoted by:

• repeated births;
• childbirth in a natural way with multiple pregnancies;
• childbirth with a large fetus;
• complicated childbirth - with a prolonged pushing period, abnormal insertion of the fetal head, accompanied by the imposition obstetric forceps and vacuum extractor, flowing with rupture of the tissues of the genital organs and perineum;
• atrophic processes in the tissues of the genital organs against the background of estrogen deficiency (with age-related changes, after radical gynecological interventions or radiation therapy);
• chronic constipation, accompanied by regular prolonged straining;
• heavy physical exercise especially those associated with heavy lifting.

There is also a congenital predisposition to omission internal organs and vagina, associated with defects in the structure of the elastic fibers of the connective tissue.

Contraindications for colporrhaphy

The general contraindications for vaginal plasty are the same as those for any operation performed under general anesthesia. These include severe decompensated somatic diseases with lesions of cardio-vascular system, liver and kidneys, acute infections, thrombophlebitis and pronounced violations blood clotting.

Colporrhaphy is not performed in the acute and early recovery period after strokes and heart attacks, with severe concomitant injuries, in postpartum period. It is also inappropriate for oncological pathology, STDs.

Varieties of the operation

Currently, several types of vaginal plastics are used:

1. Anterior colporrhaphy - suturing and strengthening the anterior fornix of the vagina, which borders the bladder and urethra.
2. Colporrhaphy of the posterior wall adjacent to the rectum. Often supplemented by the plasticity of the muscles of the perineum.
3. Median colporrhaphy of Lefort-Neugebauer is a combined version of the operation, in which both walls of the vagina are excised and sutured. The indication for such an intervention is a pronounced prolapse of the vagina with prolapse of the cervix in a woman who has come out of reproductive age.

At pronounced changes tissue colporrhaphy can be supplemented with other surgical techniques. It is often combined with perineo- and levatoroplasty - surgical strengthening of the muscles that are the basis of the pelvic floor. And when the uterus is lowered, it is possible to combine vaginal plastic surgery with ventricular fixation of the uterus and the installation of implants to increase the degree of support for the internal genital organs.

Operation technique

Colporrhaphy is carried out only in stationary conditions. The patient is undergoing outpatient preliminary comprehensive examination, allowing to identify the presence of contraindications and clarify the nature of the existing violations. Hospitalization is in planned a few days before the operation. In the hospital, a control examination is carried out, carried out preoperative preparation. Be sure to produce preventive sanitation vagina and bowel cleansing.

The food on the eve of the operation should be light, well digestible. At the same time, 10-12 hours before the transfer of the patient to the operating room, it is necessary to strictly limit food intake and drink, as colporrhaphy is performed under general anesthesia. Some institutions also practice epidural anesthesia. But in this case, it is desirable to withstand the period of fasting.

All manipulations during vaginal plastic surgery are performed transvaginally. The cervix is ​​additionally fixed with atraumatic clamps and retracted. The walls of the vagina are excised with the release of a diamond-shaped flap, the underlying muscles are sutured and fixed. In this case, the position of the incision is determined by the type of colporrhaphy performed.

After completion of the main stage of the operation, layer-by-layer suturing of tissues is performed. Separate absorbable submerged sutures are placed on the fascia and muscles. And the mucous membrane is closed with a continuous suture. In this case, the surgeon carefully controls the position of the edges of the surgical wound in order to avoid the formation of so-called pockets. Necessary condition is also the prevention of roll-like deformations around the seam, which is a risk factor for the development of gross scarring.

During median Lefort-Neigebauer colporrhaphy, sutures are applied simultaneously to the anterior and posterior walls, connecting them together. At the same time, 2 channels are formed on the sides to drain the uterine secretions.

The operation is completed by draining the vagina, treating its walls with alcohol and then introducing a swab with a disinfectant ointment (for example, synthomycin emulsion). Urine must be removed with a catheter.

Postoperative period

The postoperative period is 4-5 days. If the operation was performed under general anesthesia, the patient is under enhanced medical supervision for 1 day. If necessary, she is placed in the intensive care unit.

In the early postoperative period All patients have pain syndrome. To reduce the severity discomfort painkillers of narcotic and non-narcotic action, non-steroidal anti-inflammatory drugs are prescribed. How long the perineum hurts after colporrhaphy depends on the number and depth of sutures, the volume of the operation performed and individual pain sensitivity.

Usage general anesthesia also imposes certain dietary restrictions. During the first 24 hours, the operated woman is allowed to consume only semi-liquid easily digestible food. Subsequently, her diet is rapidly expanded. In general, all patients are prescribed a diet that prevents the occurrence of constipation and flatulence. At the same time, they try to calculate the menu in such a way that the first bowel movement occurs only by the end of day 2 or on day 3. It is desirable that during the first 1.5 weeks the stool was semi-formed, regular. This is especially important if posterior colporrhaphy with levatoroplasty was performed.

In the first days after the operation, frequent emptying of the bladder is recommended - every 2 hours. In this case, the patient may not experience obvious urge to urinate, which may be associated with a change in the sensitivity of the receptors due to tissue edema. If it develops acute delay urine after surgery, the bladder must be emptied with urinary catheter. At the same time, antispasmodic drugs are prescribed to reduce the reflex spasm of the urethral sphincters.

In the first 5-6 days after each urination, the perineum is irrigated antiseptic solutions(e.g. Chlorhexine, Miramistin, aqueous solution Chlorophyllipt). In this case, rubbing movements should be avoided, which can lead to uneven stretching of the mucous membrane and divergence of the sutures. Several times a day, the sutures are treated with anti-inflammatory and antiseptics, after which napkins with Levomekol ointment are applied to them.

Also appointed vaginal suppositories With antibacterial action. And when increased risk infectious and inflammatory complications, systemic antibiotic therapy is carried out.

Silk sutures on the skin and mucous membranes are removed on the 5th-6th day. Patients are discharged after colporrhaphy, usually on the 10-14th day, for outpatient observation.

Rehabilitation and possible complications

The rehabilitation period after colporrhaphy takes an average of 2 months. During this period, the patient is recommended to adhere to certain restrictions, which serves as a prevention of suture failure and allows you to consolidate the result achieved by the operation. Subsequently, the woman returns to her usual way of life.

• Avoid constipation, which is accompanied by excessive straining during bowel movements and therefore can provoke a recurrence of the disease. You should also limit the consumption of foods that enhance the fermentation process in the intestines and provoke increased gas formation.
• Carefully observe the hygiene of the external genitalia to avoid the development of vulvovaginitis with infection and inflammation postoperative sutures. Within 7-10 days after discharge, it is necessary to do a gentle douching with a solution of Chlorhexidine twice a day.
• Promptly treat emerging intestinal disorders. Diarrheal syndrome contributes to bacterial contamination and irritation of the mucous membrane of the vulvovaginal region, which is fraught with the development infectious complications in the area of ​​operation. Increase during diarrhea hygiene measures, several times a day, irrigate the perineum with antiseptic solutions.
• To prevent the divergence of the seams during the first 1.5 weeks, it is forbidden to sit, and for 2-2.5 weeks - to squat. If avoided sitting position impossible (for example, if a flight or travel by car is necessary), the patient must use a special adaptation ring. A semi-sitting posture is also acceptable with minimum load on the perineum.
• For 2 months, observe sexual rest. At the same time, it is desirable to avoid sexual arousal in the first month, and in the future, only the vaginal version of sexual intercourse is limited.
• It is forbidden to use vaginal tampons and menstrual caps during menstruation.
• Avoid heavy lifting (loads over 5 kg) and increased physical activity. Equestrian sports are prohibited gym, step aerobics and other types of fitness. Extension physical activity produced gradually and only after the final control examination of the doctor.
• It is forbidden to visit baths, saunas and swimming pools.
• Within six months, it is necessary to wear special medical underwear, which has a preventive effect due to the support of the perineum.

During rehabilitation period the patient is advised to periodically visit a doctor to monitor the healing process. The schedule of visits is made individually. And if any adverse changes occur, an unscheduled consultation with a doctor is required.

This is necessary when resuming spotting in the intermenstrual period, the appearance of pain in the perineum or lower abdomen, the detection of whites and other signs of inflammation of the vulvovaginal region.

What are the possible complications?

Complications of colporrhaphy are most often associated with non-compliance with medical recommendations. In this case, the failure and divergence of the sutures are most likely, followed by the formation of a rough scar, repeated omission of the walls of the vagina.

The divergence of the seams is fraught with the development of bleeding and internal hematomas. Normally, the duration of discharge during colporrhaphy is several days. At the same time, they are scarce, smearing. If after the operation there is bleeding for more than 3-4 days, scarlet blood and clots appear, the discharge intensifies, you should think about bleeding. These symptoms require immediate medical attention. In most cases, repeated surgery is performed to stop bleeding and apply new sutures.

Hematoma after colporrhaphy is not considered serious complication. Even a well-performed operation can be accompanied by the formation of small interstitial hemorrhages, which usually does not require special treatment. But if the hematoma tends to increase, appears some time after the intervention, or is the cause pain syndrome, medical assistance is required.

infection postoperative wound- the cause of septic complications. Suppuration of tissues leads to insolvency of the sutures, is a risk factor for the development of abscesses, lymphadenitis, the spread of infection outside the vagina with the development of sepsis.

The low efficiency of colporrhaphy may be due to the irrationally narrowed volume of the operation, the refusal of levatoroplasty and the installation of implants. Insufficient effectiveness can also be expected in patients with impaired tissue healing, severe dystrophic changes.

Colporrhaphy and childbearing

Is it possible to get pregnant after colporrhaphy? This is the main concern of patients young age. Plastic surgery of the vaginal walls does not lead to violation reproductive function, is not accompanied by a violation of the ovulatory-menstrual cycle and does not interfere with natural conception.

Therefore, when resuming sexual activity, care must be taken to use adequate contraception. When it is possible to put a spiral after colporrhaphy, the doctor determines, taking into account the peculiarities of the course of the postoperative and recovery periods.

Vaginoplasty is not a contraindication for childbearing. After colporrhaphy, it is possible and natural childbirth if the fetus is not expected to be large. In this case, the pregnant woman should warn the obstetrician-gynecologist about the operation. In most cases, after completion breastfeeding she will be shown a second colporrhaphy in a planned manner.

Alternatives

Classical colporrhaphy is surgical intervention associated with the use of general or epidural anesthesia, hospitalization and a sufficiently long recovery period. Such an operation is justified with 2-3 degrees of vaginal prolapse and the development of complications against this background.

For more early stages omissions can be carried out and more gentle treatment - laser colporrhaphy. However, under the influence laser beams there is an increase in tissue tone due to the reduction of collagen and elastin fibers. This technique has much fewer contraindications, is well tolerated and does not require hospitalization.

Slight prolapse of the vaginal walls can also be partially corrected by regular vaginal exercises, including the use of specially designed vaginal simulators.

Colporrhaphy refers to plastic surgery, although it does not always pursue aesthetic goals. This operation is effective method getting rid of the release and overstretching of the vagina, concomitant urinary and fecal incontinence, correction of postpartum deformities. But at the same time, compliance with all the recommendations of the doctor is no less important than the competent technique of the operation.

• Posterior colporrhaphy

Posterior colporrhaphy is a type of colpoplasty, which consists in resection of the posterior wall of the vagina in order to reduce the volume of the organ. A wide vagina is often the result of childbirth, especially if we are talking about several fruits, and provokes a number of problems, including:

• lack of orgasm;
• incontinence of urine and gases (is the result of changes in the topography of the pelvic organs);
• prolapse and prolapse of the uterus;
• hernia of the rectum.

In some cases, the indication for vaginal plastic surgery is only the desire of the patient herself, without any medical indications.

How to prepare?

Preparing for posterior colporrhaphy like any other plastic surgery begins with a consultation with a surgeon. The doctor conducts an examination and prescribes a number of tests, primarily blood and urine. It is also necessary to do a fluorography, an ECG and conduct some other studies that allow you to get an objective picture of the woman's health status. Having on hand the anamnesis data and the results of the examination, the specialist decides on the possibility of conducting surgical intervention. In the presence of pathological conditions the operation may be denied.

The main contraindications include:

• severe diseases of internal organs that are in the stage of decompensation;
• blood diseases that occur with violations of hemocoagulation processes;
• malignant tumors;
• mental disorders and general instability of the psycho-emotional background (prevents the patient from adequately assessing possible risks and consequences of plastic surgery);
• pregnancy;
• minor age;
• menstrual bleeding.

If at the time of contacting the clinic you are being treated with anticoagulants, you should notify the surgeon in advance and stop taking these drugs a few days before the expected date of the operation.

How is it carried out?

Performing posterior colporrhaphy begins with providing a blockade of pain perception by general anesthesia. Access to the posterior wall of the vagina is opened through a transvaginal incision. manipulation plastic surgeon are reduced to resection of a triangular tissue flap and fixation of the muscles and fascia of the perineum and pelvic floor. After that, sutures from self-absorbable materials are applied. Total duration actions varies from 30 minutes to an hour and is determined by the complexity of each specific case.

a - preparing the patient for surgery, performing general anesthesia, transition to bimanual examination;
b - fixation of the labia with sutures, the imposition of clamps on the mucous membrane of the posterior wall of the vagina;
c - making incisions, removing a triangular flap;
d - dissection of the mucosa, separation of the perirectal fascia.

e - reduction of the rectocele, suturing;
e - tying sutures (in the order of application);
g - excision excess mucous;
h - stitching of the perirectal fascia.

and - suturing;
d - suturing the mucous membrane of the posterior wall, restoring the hymen ring;
k - suturing the perineum;
l - suturing the subcutaneous layer.

m - closure of the subcutaneous layer of the perineum;
n - stitching the skin of the perineum;
o - view after the operation.

How is the rehabilitation going?

During the rehabilitation period, which begins on the second day, when the patient is allowed to leave the hospital (subject to a satisfactory condition), there are pronounced pain in the operated area, which also manifests itself during the act of urination. Mandatory bed rest for a period of at least 7 days. In the first 2-3 weeks, it is better to abandon the sitting position and limit serious physical activity. Shown special gymnastics, which allows you to normalize the muscles of the pelvic floor (the attending physician will tell you more about this). You can resume sexual intercourse after 30-40 days (minimum). The prognosis is favorable. Intimate plastic reduces the risk of developing urogenital infections, restores sexual activity, to carry out the prevention of displacement of the pelvic organs and vaginal relaxation syndrome, thereby improving the quality of life of a woman, relieving her of complexes and self-doubt.