Trishanna is a 28-year-old female who gave vaginal birth to a healthy six-pound girl. During her delivery she received an episiotomy to her perineum to aid with the safe delivery of her daughter. Episotomies are fairly common during deliveries and are easily repaired by the obstetrician right after delivery.

Six weeks post delivery she was dissatisfied with the healing of the area – to her it wasn’t aesthetically pleasing and it decreased her confidence in the bedroom. She did her research on corrective measures and discovered that a perineoplasty may be beneficial. After speaking with her gynaecologist about her research, she was referred to a cosmetic gynaecologist who was specifically trained in these procedures.

At her consultation with the cosmetic gynaecologist she was relieved to hear that the area could be rectified easily. He explained the simple technicalities of the procedure and how it would also improve sexually gratification as the introitus would become smaller. The cosmetic gynaecologist also offered her an Orgasm Shot (O Shot). The O Shot is when the patient’s own blood is injected into the top of the vagina and clitoris to stimulate rejuvenation of the tissues. This was offered at the end of the procedure to help enhance her lubrication and orgasm intensity during intercourse.

A few days later Trisha presented to the office. The procedure was done under local anaesthesia, which she tolerated it extremely well whilst she and her doctor conversed as he operated. Within 30 minutes, the procedure was completed. Immediately, post-op, she was filled with tears as the area seemed flawless. She went home with antibiotics, stool softeners, and was instructed how to keep the area clean.

Within six weeks the area was healed and she was immensely satisfied. She was cleared for intercourse and the level of enjoyment she had in addition to the effects of the O Shot were unparalleled. She thanked her doctor profusely and referred a few of her friends for the same procedure.

The perineum (most commonly known in Jamaica as the “batty bridge”) is the area between the bottom of the vagina and the anus. It usually has a very strong muscle consistency with good tone. Its main purpose is to provide support to the bottom of the vagina and the top of the rectum for sexual activity. As women age, and as child birth occurs (especially with large babies, or the use of an episiotomy), the muscles of the perineum can become weakened. What can result is a weaker, sagging area of skin over the perineum. Sexual intercourse may become painful due to possible scar tissue present within the perineum.

Also, post-birth and ageing, the natural distance between the vagina and the anus can become shorter, which can predispose women to recurrent urinary tract infections (as bacteria from the anus can enter the urethra). Additionally, the natural tone of the anus may be reduced, resulting in the leakage of stool (faecal incontinence).

A perineoplasty involves removal of the skin of the perineum and a reapproximation of the muscles underneath using absorbable stitches in a three to five layer closure, thus restrengthening the area. Additionally, the natural distance of the perineum is lengthened resulting in a smaller introitus. What results is an aesthetically pleasing area and also there is the additional bonus of an increase in sexual gratification. This is so because 75 per cent of pleasure from intercourse occurs at the level of the introitus. The procedure is fairly quick in expert hands and healing occurs extremely well due to the blood supply of the perineum. Complications, though rare, include infection and wound breakdown.

The procedure can also be combined with other gynaecological cosmetic procedures such as labiaplasty, clitoral hood reductions, labia major augmentation, the Orgasm Shot, and also Fractional CO2/High Intensity Focused Ultrasound Vaginal Energy.

Dr Daryl Daley is a cosmetic gynaecologist and high-risk obstetrician. He is a Laser Vaginal Rejuvenation Institute of America associate and a European Society of Aesthetic Gynaecology senior member. He is located at Gynae Associates, 23 Tangerine Place, Kingston 10. He can be contacted at ddaley@3dgynae.com