Posterior colporrhaphy, indications, contraindications, postoperative period

– surgical plastic correction of the posterior vaginal wall. Indications for intimate plastic surgery include prolapse and stretching of the posterior vaginal wall with the formation of a rectocele, and old postpartum scar deformities. The essence of the operation is to excise the excess vaginal mucosa to restore normal anatomy and narrow the organ. If the musculofascial structures of the pelvic floor are incompetent, colporrhaphy is supplemented with levatoroplasty. Stages of the operation: excision and removal of a flap of the posterior vaginal wall, joining the edges of the colpotome wound and the skin of the perineum. The most common postoperative complication is hematoma, which does not require repeated surgery.

According to the literature, the history of vaginal plastic surgery began in 1866, when a series of successful operations were first performed to correct genital prolapse. Posterior colporrhaphy with anterior levatoroplasty was proposed in 1889; the main stages of the technique are still used in modern modifications of the intervention. Prolapse of the vaginal wall is not only a medical, but a psychological problem that significantly reduces a woman’s quality of life. The disease is characterized by a long, protracted course and steady progression of the pathological process. To date, the most effective treatment for prolapse of the posterior vaginal wall is surgery - posterior colporrhaphy.

What is colporrhaphy

Colporrhaphy (derived from the ancient Greek words “womb” and “suture, stitching”) is one of the gynecological operations or vaginoplasty. It is performed through the vagina to restore wall defects. Essentially, the size of the vagina decreases due to its excessive expansion, prolapse and drooping of the walls. The operation may also be due to medical reasons. According to statistics, vaginal prolapse occurs before the age of 30 in every tenth of 100 women, before the age of 45 - in 40% of cases, and after that it is diagnosed in every 2 patients

Contraindications

• Inflammatory processes of the pelvic organs.
• Infections of the genital area.
• Pregnancy.
• The postpartum period and the first months after childbirth - the operation cannot be performed immediately; it is done after the end of breastfeeding.
• Blood clotting disorder.
• Severe pathologies of internal organs.
• Uncompensated diabetes mellitus and other severe metabolic disorders.
• Fever, fever, signs of various infections.
• Critical days, bleeding associated with menopause.

Symptoms of disorders with rectocele

Clinical picture:

• constipation;
• incontinence of feces and gases;
• prolapse of hemorrhoids;
• urine;
• discomfort during intimacy;
• discomfort in a sitting position;
• nagging pain in the lower abdomen and lower back, especially with exertion;
• feeling of a foreign body in the vaginal area.

Indications for surgery:

Posterior colporrhaphy is performed on women who complain of:

• weak orgasm or its absence due to the vagina being too wide, weakening of its walls during childbirth, or as a result of age-related changes in organ tissue;
• discomfort during intimacy;
• prolapse of the posterior vaginal wall with accompanying symptoms such as problematic emptying of the rectum, sensation of a foreign body in the external genital area, discomfort in a sitting position, nagging pain in the lower abdomen and lumbar region, which intensifies with physical activity;
• postpartum scar deformities;
• stress urinary incontinence (when sneezing, coughing or laughing).

Women who lead a sedentary or sedentary lifestyle and experience frequent constipation are at risk for such problems.

Adele Sergeenkova (@adelsergeenkova) is a famous Instagram blogger, mother of five children, singer and sex coach. In March 2021, she underwent intimate plastic surgery with posterior colporrhaphy and restoration of virginity. The surgeons of the millionaire blogger were Egorova Maria Vladimirovna and Blokhin Sergey Nikolaevich.

Preparatory activities

Preparation is standard and includes consultation with a therapist, gynecologist and tests:

• general blood analysis;
• biochemistry;
• blood test for coagulation, RV, HIV, STIs, hepatitis C;
• general urine analysis;
• bacterial vaginal smear;
• Ultrasound of the pelvic organs and extended colposcopy.

Important! A gynecologist will tell you about the need for colporrhaphy during an examination in a gynecological chair with parallel functional tests.

Preparing for colporrhaphy

Before the intervention, the patient is prescribed laboratory and instrumental tests. The preoperative preparation protocol includes CBC, OAM, biochemical blood test, coagulogram, determination of blood group and Rh factor, blood tests for dangerous infections (syphilis, hepatitis B and C, HIV), ECG and examination by a therapist. The list of gynecological examination methods before posterior colporrhaphy includes a bacteriological smear to determine the degree of vaginal cleanliness, an oncocytological smear from the cervical canal, extended colposcopy, and pelvic ultrasound. Upon admission to the hospital, the operating gynecologist performs a vaginal examination and rectal examination.

The evening before and the morning of the day of posterior colporrhaphy, it is necessary to do a cleansing enema. The hair in the area of ​​the external genitalia and perineum should be shaved on the morning of the operation to prevent the appearance of pustular rashes. A few days before posterior colporrhaphy, it is recommended to sanitize the vagina with antimicrobial suppositories (at night) and daily douching using antiseptic solutions (in the morning). For varicose veins, immediately before surgery, compression of the lower extremities with an elastic bandage or medical knitwear is required. Before entering the operating room, the bladder is catheterized with a Foley catheter. In menstruating women, posterior colporrhaphy is performed immediately after menstruation (day 6-8 of the cycle) so that the main reparative processes are completed before the next menstrual bleeding begins.

Features of the event

Any manipulations are performed transvaginally. Posterior colporrhaphy is performed under general anesthesia. The inner thighs and genitals are treated with an antiseptic, and the vagina is sanitized. A triangular flap of the mucous membrane is excised on the posterior wall of the vagina. Its size depends on the degree of vaginal prolapse.

The fascia of the rectum is strengthened, which expands the space for the vagina. The rectovaginal septum is also strengthened with its own tissues or with the help of mesh implants (if the woman does not plan to conceive). Next, the levator muscles are sutured and the edges of the wound are connected with self-absorbing sutures (catgut). The vagina is dried with alcohol and a tampon with an antiseptic - synthomycin emulsion - is inserted.

Accumulating urine is removed using a catheter. The vagina is sutured all the way from the cervix to the lower commissure. As a result, the vagina becomes narrow, and its internal part is not damaged. The operation will have a positive effect on the intimacy of partners.

“Posterior colporrhaphy is a complex manipulation technique that requires a highly qualified surgeon. He must have extensive experience and daily practice in it. Most often, posterior colporrhaphy is combined with anterior one for cosmetic reasons. All manipulations take about 40 minutes."

Egorova Maria Vladimirovna plastic surgeon

Contraindications for which colporrhaphy is prohibited

Contraindications to surgical intervention are divided into relative and absolute. Minor age is considered relative, but this prohibition is valid only for colporrhaphy, carried out to improve aesthetics. If the operation requires deviations in the functioning of organs, then colporrhaphy is done at any age.

Absolute contraindications:

• venereal diseases;
• chronic inflammation;
• acute thrombophlebitis;
• heart disease.

Rehabilitation

The colporrhaphy operation itself is well tolerated, but rehabilitation is required. It takes about 2 months. The patient remains in the hospital for another 2–3 days after the operation.

Upon discharge, the doctor always gives mandatory recommendations:

1. For another 2 weeks, it is advisable to lie down more - squatting and sitting at right angles is strictly prohibited.
2. The course of antibiotics and analgesics is the same as for a standard operation. After 3 weeks, physiotherapy using ultrasound is recommended.
3. At the same time, it is recommended to wear a bandage and compression garments.
4. After the operation, the patient must carry out antiseptic treatment of the wound surface for 7-10 days - Chlorhexidine in the form of douches (every 3 days) and Terzhinan antibacterial suppositories.
5. For 2 months after colporrhaphy, it is strictly forbidden to have any sex, and for 30 days even just sexual arousal, weight lifting and sports.
6. You should avoid all types of straining, watch your stool to avoid constipation, do not delay urination until the bladder is full, it can also put pressure on the vagina.
7. During menstruation, use only pads, not tampons or cups.

After 2 months, all restrictions are lifted, including sexual activity.

How and why colporrhaphy is performed, and what effects it gives

The essence of the operation is to tighten and strengthen the walls of the vagina, the tissues of which are often torn or stretched due to childbirth, physical activity or age-related changes. Colporrhaphy is also performed for women who want to reduce the size of the genital tract, making their intimate life more fulfilling.

Therefore, this technique is suitable not only for young mothers, women who actively engage in sports, and those who are at the age of “golden autumn,” but also for all patients who want to have more pleasant sensations from intimacy.

The woman is operated on through the vagina, so there will be no marks left on her body. After the operation, neat internal sutures are applied, which subsequently dissolve.

Improving the quality of intimate life

Colporrhaphy has a diverse positive effect not only on a woman’s reproductive system, but also on her entire body:

• The genital tract becomes denser
  and its size decreases. The quality of intimate life improves.
• The adjacent organs - the rectum, uterus, bladder, which have been displaced due to tissue stretching, return to their correct position
  and can perform their functions normally. A woman gets rid of difficulty urinating, incontinence of urine and gas, constipation, and pain during bowel movements.
• The uterus returns to its normal position
  , which avoids its removal, which further displaces neighboring organs. Colporrhaphy becomes a real salvation. In case of severe elongation and prolapse, the cervix is ​​completely or partially removed, but such an intervention has much fewer consequences compared to removing the entire organ.
• Positive changes in the body restore the patient’s psycho-emotional state
  .

There are colporrhaphy methods used in very elderly women that can control even severe pelvic organ prolapse. After the operation, the patient cannot have intimacy, which is already absent due to her advanced age, but she does not suffer from prolapse of the uterus, bladder, rectum or dysfunction of the pelvic organs.

All types of colporrhaphy are well tolerated and are not accompanied by prolonged hospitalization. After treatment, patients quickly return to their normal lives. The sooner a woman turns to a specialist, the easier the operation will be and the faster the recovery.

Indications for surgery:

• Vaginal prolapse
  , accompanied by its expansion and decreased tone of the walls.
• Discomfort and pain in the intimate area
  associated with displacement of the pelvic organs into the genital tract.
• Prolapse of the bladder
  , which protrudes through the weakened, stretched anterior vaginal wall, forming a bulge inside the genital tract (cystocele). This condition is often accompanied by urinary incontinence and urinary retention.
• Rectal prolapse
  , in which it protrudes into the vagina through an overstretched posterior wall (rectocele). This can cause constipation, pain and discomfort during bowel movements, and incontinence of feces and gas.

The operation can be performed at the request of the woman in order to reduce the volume of the vagina and increase sensuality during intimacy.

Recovery period

If we are talking about suturing the vaginal walls for aesthetic reasons (there are no serious problems such as prolapse of the uterus, vaginal walls, etc.), rehabilitation is relatively quick. The patient is recommended to have sexual rest, avoid saunas, swimming pools, and physical activity for two weeks.

The rehabilitation period after colporrhaphy, which took place for medical reasons, is about 4-6 months. During this time, the patient must constantly wear special underwear that supports the pelvic floor muscles. At first (about 2-3 months), it is very important to completely avoid any physical activity, sports, or the use of tampons; you will also have to forget about sexual relations for a certain period.

Alternatives to Vaginoplasty Surgery

Today, there are several procedures and operations that are alternatives to classic surgical vaginal plastic surgery, including procedures such as: laser vaginal rejuvenation, vaginal plasmolifting, injection of fillers into the walls and vestibule of the vagina, installation of vaginal threads (Vaginal Narrower)

. Let's look at each of the methods.

Laser vaginal rejuvenation

- This is a cosmetic procedure that is performed using a special device. During the procedure, a fractional laser beam penetrates through the mucous membrane and skin to the basement membrane, causes heating and stimulation of the formation of collagen and elastin, and improves blood flow in the mucous membrane. As a result, the tissues are rejuvenated. Often, to enhance the effect of the laser procedure, it is supplemented with plasma lifting. Plasma obtained from the patient’s blood is injected into the vaginal walls. The laser rejuvenation and plasma lifting procedure is carried out in a course of at least 3 procedures with an interval of 3-4 weeks. The effect of the procedures is cumulative, and according to experts, the procedure is effective at the first signs of vaginal prolapse and urinary incontinence. The cost of such a procedure in Moscow is from 10,000 rubles to 100,000 rubles. Depending on the device used, the reputation (rating) of the clinic.

Injection of fillers into the vaginal walls and vestibule.

Fillers of a certain density based on hyaluronic acid for a given area, or endogels (condensed plasma of the patient), are used. The effect is temporary, lasting from a year to a year and a half. It is recommended to repeat the procedure subsequently. The cost of 1 ml of the drug in Moscow is about 18,000 rubles, usually 2 ml of the drug is required. The cost of the doctor’s work and depreciation of the clinic office are also added.

Vaginal Narrower from Happy Lift and similar products.

Special threads that appeared on our market about 10 years ago. These threads pick up only the transverse (deep and superficial) muscles of the perineum. Threadplasty narrows the vestibule of the vagina, but not the body of the vagina. The technique is indicated for those who cannot or do not want to undergo a full-fledged operation. The effect of the procedure lasts about 3-5 years. Cost in Moscow from 70,000 rubles.

More information on alternative methods
>>

Anterior colporrhaphy

Anterior colporrhaphy involves suturing the anterior vaginal wall.
Sometimes the operation is combined with narrowing of the vaginal opening to obtain maximum effect. During the operation, excess tissue of the mucous membrane on the anterior wall of the vagina is excised, after which the urethra and bladder “safely” return to their natural places, and self-absorbing sutures are applied to the muscles of the anterior wall.

For medical reasons, anterior colporrhaphy is performed when there is a problem with the formation of a cystocele (protrusion of the urethra or bladder) against the background of prolapse (prolapse) of the vagina.

How much does colporrhaphy cost?

The cost of colporrhaphy depends on the type of operation. If you intend to contact the experienced specialists of DECA Blades to perform colporrhaphy, the price of the operation will be:

• anterior colporrhaphy – 30,000 rubles;
• posterior colporrhaphy – 30,000 rubles;
• combined colporrhaphy (anterior and posterior colporrhaphy) – 50,000 rubles.

By the way, today many problems of the genital area associated with postpartum or age-related changes can be solved without surgical intervention. For intimate rejuvenation, hardware laser technology (minimally invasive) MonaLisa Touch and contour plastic surgery (injections based on hyaluronic acid) are also used. Therefore, it is possible that in your case the doctor will not offer plastic surgery, but a simpler (and more effective) solution. And if you still need colporrhaphy in Moscow, the clinic’s specialists are ready to help you. Make an appointment with a doctor and come!

Take care of yourself and your intimate health!