Vaginoplasty

What is vaginoplasty?

Vaginoplasty is an operation that aims to repair the walls of the vaginal canal and the supporting tissues that carry them. On the back wall the supporting layer between the rectum and the vagina is brought together, excess mucosa is removed where needed, and the muscles are joined in the midline.¹² In this practice, muscle repair is part of the operation.

The scope of this page: The same name is used for two separate operations. This page describes only one of them: repair of a vaginal canal that has loosened after childbirth or with age. Vaginoplasty carried out as part of gender affirmation is an entirely different operation, is not the subject of this page, and none of the information here holds for it.

Vaginoplasty does not change the shape of the inner lips; that is a separate operation and is described on the labiaplasty page. Repair of pelvic organ prolapse, operations for urinary incontinence and repair of the perineum are separate headings as well; which of them is needed is taken up below.

"Genital aesthetic surgery" is a broad umbrella name gathering different procedures in this area. "Vaginal rejuvenation" is not a single technique; procedures as different as surgical repair and applications using energy-based devices are offered under that name. A procedure being called by that name says nothing about either its content or its result.

Is a sensation of vaginal laxity a diagnosis?

It is not. A systematic review published in 2026 states that vaginal laxity is not a standardised diagnosis but a complaint that can have various causes, and stresses that the definitions are inconsistent between studies.³ A randomised trial reports the frequency of this complaint as ranging from 24 to 38 per cent across studies.⁴

This has two consequences. First, the sensation itself is not a measurement and does not stand in for an examination finding. Second, different problems can lie beneath the complaints gathered under the heading of "laxity"; the operation described in this article is not the answer to all of them.

Who is it suitable for?

Reasons for seeking assessment fall into two separate groups, and this distinction is central to the article. Functional complaints listed include problems with urinary or bowel control, difficulty with defecation, pain and signs of prolapse.⁵ Separately from these, the sensation of width a person describes, or discomfort about appearance, is also a reason for seeking assessment.

The two can be present together, but they do not stand in for one another. A functional problem being present is not evidence that this operation corrects that problem; a wish about appearance or sensation being present does not mean an underlying problem should go unsought.

The American College of Obstetricians and Gynecologists (ACOG) states that for genital procedures carried out without a medical indication, solely to change appearance or sexual function, there is insufficient evidence of medical necessity, safety and efficacy.⁶ That warning holds on this page too, and the sections below are to be read within that frame.

The lower age limit in this practice is 18. Not having surgery is also an option; the decision is made according to what the person's complaint is and whether their expectation can be met by this operation.

Where do prolapse, urinary incontinence and bowel problems belong?

They are separate headings and are assessed separately. Pelvic organ prolapse developing from loss of vaginal support follows its own path of diagnosis and treatment; because the same operation name and similar surgical steps can be used for different indications, the distinction cannot be made from the name of the incision.⁷

In urinary incontinence, the type of incontinence is determined separately. The United Kingdom's National Institute for Health and Care Excellence (NICE) advises that anterior vaginal repair (anterior colporrhaphy) not be offered to treat stress urinary incontinence.⁸ No benefit for urinary incontinence is therefore expected from the operation described in this article.

Operations for prolapse or urinary incontinence can be carried out in the same session. NICE states that concurrent surgery may be considered in women with anterior or apical prolapse together with stress urinary incontinence.⁸ That does not mean prolapse or incontinence surgery is advised for everyone who describes a sensation of width; nor is the result of a separate procedure attributed to the canal repair.

What is assessed at the examination?

The examination covers the history of childbirth, the type and number of deliveries, when the complaint began and whether it has changed over time. The perineal area, the supporting tissues and the vaginal walls are each assessed separately, and signs of prolapse are looked for.⁷

Urinary and bowel control, difficulty with defecation, pain and dryness are asked about as well. Pain during intercourse present from the outset, pain in the vulval area or continuing pelvic pain calls for assessment in its own right and is not taken as a target of this operation.¹ Dryness and thinning of the tissue related to the menopause are also considered separately; ageing does not produce the same change in everyone.

A questionnaire or score does not stand in for the examination. The sensation the person describes, the examination finding, and any measured sexual function outcome are each recorded separately.⁹

The timing of the operation is planned according to the menstrual cycle. These procedures are avoided during menstruation.

How is the operation planned?

The operation is carried out under general anaesthesia and in this practice usually takes 1-2 hours. The hospital stay is planned as 1 night.

The starting point of planning is which structure has loosened and at what level repair is needed. Repair of the canal and repair of the perineum at the vaginal opening concern different structures; whether both are needed is determined at the examination.¹

Which tissues are repaired?

In repair of the back wall the supporting layer between the rectum and the vagina is brought together, and in this practice the muscles are joined in the midline.⁷² Removing excess vaginal mucosa is part of some techniques; the operation is not simply the removal of tissue from the surface.²¹

Repairs concerning the front and side walls have also been described and address different tissues.¹ Which wall is repaired is determined by the examination finding; not every wall is addressed in every person.

When is perineal repair added?

In perineal repair the perineal body is strengthened and the superficial perineal muscles are brought together in the midline.¹¹⁰ In this practice, perineal repair is added where it is needed; it is not a step carried out in everyone and is not the same thing as repair of the canal.

How does it differ from repair of pelvic organ prolapse?

The difference is the indication, not the name of the incision. Repair of the back wall can be used both in the treatment of prolapse and within the scope of this article.⁷ What is being done in a given person is therefore determined by looking at the complaint and the examination finding. Treatment of prolapse is not presented as a cosmetic operation; nor does the operation in this article stand in for treatment of prolapse.

Is urinary incontinence a separate problem?

Yes. The type of incontinence and its treatment are determined separately; NICE does not advise anterior vaginal repair for stress urinary incontinence.⁸ One example shows why this distinction matters: in a series of 38 people reporting the results of perineoplasty, 16 (42 per cent) had another operation at the same time, and 10 of those were tape operations for stress urinary incontinence.¹⁰ In such a series, improvement in incontinence cannot be attributed to the perineal repair.

What is the place of exercise and physiotherapy?

The place of pelvic floor muscle training depends on which complaint is being discussed and is not the same in every case.

In urinary incontinence: NICE states that a trial of supervised pelvic floor muscle training of at least 3 months should be offered as first-line treatment to people with stress or mixed urinary incontinence.⁸

In prolapse: NICE advises considering a programme of supervised pelvic floor muscle training for at least 16 weeks as a first option in symptomatic stage 1 or stage 2 prolapse.⁸

In a sensation of laxity: In a randomised trial, 87 people describing a sensation of laxity were divided into radiofrequency (42 people) and pelvic floor muscle training (45 people) groups. Improvement was reported on the questionnaires in both groups at 30 days and at 6 months, and better results were found in the exercise group at 6 months.⁴ That trial has no surgical comparison group; the result does not show that exercise is equivalent to the operation.

No number of exercises or home protocol is given in this article; a programme is meaningful when it is supervised and varies with the complaint.⁵ Nor could it be shown in this search that a set period of exercise must be completed before surgery.

Are laser and radiofrequency the equivalent of surgery?

They are not, and the state of the evidence is mixed.

ACOG reports that in July 2018 the United States Food and Drug Administration (FDA) issued a warning about the use of energy-based devices for this purpose; burns, scarring, pain during intercourse and recurring or chronic pain were reported in that warning.⁶ That information is conveyed here through ACOG's document.

On the evidence side, two reviews look in different directions. A systematic review and meta-analysis published in 2024 examined 38 studies and, in pooling 8 observational studies, found a mean difference of 6.51 points in the sexual function score (95 per cent confidence interval 5.61-7.42), but reported that this improvement could not be shown in randomised trials.¹¹ Another systematic review published in 2026 reports, across 3 sham-controlled radiofrequency studies, a result favouring active treatment for the response the studies themselves defined (risk ratio 3.15, 95 per cent confidence interval 2.17-4.58), and, in 2 trials, a small gain in the sexual function score (mean difference 1.64, 95 per cent confidence interval 0.31-2.98).³

The two reviews do not use the same set of studies or the same comparison; one of them is not picked out and presented as the single correct result. In the second review's own appraisal, the overall evidence is of low certainty and the evidence for the surgical groups of very low certainty.³ It therefore cannot be said either that all the research shows a lack of effect or that these devices are the equivalent of surgery. Long-term safety data are limited as well.³

How do childbirth and plans about pregnancy affect the timing?

Childbirth can affect the pelvic floor muscles, their nerves and the supporting tissues; the complaints that arise are assessed separately for urinary, bowel, sexual function and prolapse.⁵ The International Urogynecological Association (IUGA) advises that the decision on surgery is generally made after the family is complete, while noting that a different decision may be reached for an individual with severe complaints.⁵ The Aesthetic Society likewise states that a delay should be considered where a pregnancy is planned in the near future, and that pregnancy can affect the result.¹²

No waiting interval holding for everyone after childbirth was found in this search. The timing is determined by the plan about pregnancy alongside the complaint and the examination finding; no fixed number of months is given in this article.

Where a pregnancy is contemplated later, no prohibition or obligation is created about the mode of delivery. IUGA advises that people who have had pelvic floor surgery discuss the options for delivery with their obstetrician and with the surgeon who performed the operation.⁵

How do you prepare for surgery?

Smoking and nicotine: Smoking is a risk factor for wound healing problems after surgery. Direct surgical data on nicotine products other than cigarettes are scarcer. The practice reference of the American Society of Plastic Surgeons notes a lack of clinical data on e-cigarette use and surgical risk, but states that because nicotine is known to reduce blood flow, e-cigarettes and other nicotine products are regarded as a potential risk factor.¹³ Stopping smoking, vaping and other nicotine-containing products at least 1 month before the operation, and not using them after surgery until healing is complete, is therefore advised. The studies below concern smoking cessation; their results do not establish the same reduction in risk for every nicotine product. A review pooling 6 randomised and 15 observational studies showed that every week of abstinence added benefit, and that studies with at least 4 weeks of abstinence produced markedly better results than shorter ones.¹⁴ A study appraising systematic reviews together reported that cessation interventions beginning at least 4 weeks before surgery and combining multiple behavioural support sessions with pharmacotherapy reduced complications. The same study notes that interventions with only one component, even when started more than 4 weeks before surgery, raise quit rates without reducing complications.¹⁵ Shorter intervals are not useless either: in a meta-analysis of 55 studies covering adults undergoing a range of operations, the risk of pulmonary complications was 27 per cent lower in relative terms among those who stopped at least 2 weeks before surgery, and 29 per cent lower among those who stopped at least 4 weeks before, compared with those who continued smoking.¹⁶ The benefit therefore grows as the interval lengthens; being late does not make stopping pointless. The interval applied and the nicotine policy can vary from surgeon to surgeon.

Coexisting illness: Diabetes and blood pressure are expected to be under control before surgery. Where there is an active infection in the body, surgery is postponed.

Medication: Blood thinners and some herbal products can increase bleeding. Every medicine and supplement you take needs to be declared. Prescribed medication should not be stopped on your own decision.

Tests and anaesthetic assessment: The tests required are determined by general health and by the anaesthetic assessment. Any previous problem with anaesthesia or drug allergy should be declared. The instructions given about fasting and about how to take medication on the day of surgery are followed.

Home and transport: Someone is arranged to accompany you home on discharge. The timing of check-ups, the help you may need in the first days and the plan for time off work are organised beforehand. Follow the surgical team's guidance on preparing the operation area; do not shave or prepare the incision area at home on your own initiative.

The menstrual cycle: The operation is planned according to the menstrual cycle and is not carried out during menstruation.

What is recovery like?

The intervals below are a general framework. They can vary with the extent of the operation performed, the person's work, the speed of healing and the surgeon's practice.

• The operation is carried out under general anaesthesia and usually takes 1-2 hours
• The hospital stay is mostly 1 night
• A vaginal pack is placed on the first day; when it is removed depends on the surgical team's instructions
• The first check-up takes place within the first week
• Sutures that dissolve on their own are used; there are no sutures needing removal
• Bruising takes 7 to 10 days to fade
• Marked swelling takes 1 to 2 weeks to subside
• Returning to work takes 1 to 2 weeks for most people
• 1 to 2 weeks are allowed before driving
• Strenuous sport is postponed for 4 to 6 weeks
• A full return to daily life takes 4 to 6 weeks
• Slight residual swelling can last 1 to 3 months, and the result is assessed at the end of that period

In the first days, swelling, bruising, tenderness and a deep ache in the area are expected.² Because of the swelling in this period the final result cannot be assessed.

What should you pay attention to after surgery?

Dressings: A vaginal pack is placed on the first day. For removal of the pack, the subsequent arrangement for cleaning and for checking the area, the surgical team's instructions are followed.¹⁷

Cleaning the area: After using the toilet, the area is wiped in turn with a moist gauze swab, a dry gauze swab and then povidone iodine; a clean pad is then placed in the underwear. The area is cleaned from front to back. This care is for the external area; no cleaning is applied inside the vagina.

Sleeping: Rest with the head elevated. Your surgeon decides how long that position and the avoidance of physical strain are continued. A sleeping position that puts no pressure on the incision is preferred. Returning to sleeping on the side or front is assessed according to the state of the incision and the swelling.

Showering, wound and dressings: When you may shower depends on the dressing used. If there is a skin incision, once allowed you can shower without rubbing the wound and pat the area dry gently. Baths, swimming pools and the sea wait until the wound has closed completely; your surgeon sets that interval.¹⁷

Clothing and sitting: Loose underwear and clothing that does not rub the area are preferred. There can be discomfort when sitting and when standing up in the early period.¹⁷ The arrangement for sitting is adjusted to the complaints and to the care plan given; the same period of sitting is not advised for everyone.

Movement: Strain such as bending the head down, straining and heavy lifting is limited in the early period. Movements that stretch or rub the incision area are avoided. Even if you feel well, do not return to strenuous activity suddenly. Activity and rest through the day are organised according to the plan given on discharge.

Pain: There can be tenderness, tightness and a deep ache in the vaginal and perineal area.² The painkillers given are used as instructed. Pain that markedly prevents walking or changing position is reported to the team; rather than abandoning the movement plan altogether, pain control and the need for help are assessed. No new painkiller or additional medicine is started on your own decision.

Returning to work and sport: 1-2 weeks are set aside for a return to work. Sedentary work can also put strain on the incision area; the nature of the work is assessed separately. The American Society of Plastic Surgeons likewise states that 1 to 2 weeks of time off may be needed for this operation.² A return to sport is planned in stages within 4-6 weeks; approval from your doctor is awaited before moving on to movements that strain the area. 4-6 weeks are expected for a full return to daily life as well. Being able to carry out a task comfortably does not mean that all activities are permitted.

Driving: A return can be assessed within 1-2 weeks. There must be no effect of medication reducing attention, no dizziness and no pain preventing movement. You need to be able to sit with a seat belt, to check your surroundings and to brake suddenly or manoeuvre comfortably. Where there is marked discomfort in the incision area while sitting, driving is not undertaken even if the timetable has run its course.

Sexual activity and tampon use: No fixed interval is given in this article. The decision on returning varies with the course of healing, with the procedure carried out and with the person; it is considered together with the healing of the operated area and the instructions given at the check-up. The frameworks given by institutions also differ from one another: the American Society of Plastic Surgeons states 8 weeks for intercourse and tampon use, the care table of one review states 6-8 weeks, and The Aesthetic Society leaves the interval to the surgeon.²¹¹⁷ These intervals come from separate care frameworks, not from comparative research. Having returned to daily activities is not on its own permission to return; continuing pain or a wound problem is not disregarded because an interval has elapsed. The surgical pack on the first day of the operation and the later restriction on menstrual tampons are different things.

Menstruation: A period can occur during recovery. The restriction above applies to tampon use; a pad is used in that period.

Smoking: Smoking impairs wound healing after surgery as well; cigarettes and nicotine products should be avoided until healing is complete.

Findings that are normal: Bruising, swelling, tightness and altered sensation around the incision can occur; a brown or yellow discharge can also be seen.¹⁷ What matters is that the findings are decreasing. Foul-smelling discharge, increasing pain or fever are not counted among the expected findings and are reported.⁷ Swelling that grows rapidly or gathers markedly on one side should not be attributed to the healing period given alone.

How do the incisions and sutures heal?

The incisions lie inside the vagina and, where needed, in the perineal area. Sutures that dissolve on their own are used for closure; there are no sutures needing removal.¹⁰

The sutures finish dissolving over a number of weeks, and a slight discharge can be seen during that period.¹⁷ Because healing inside the vagina cannot be followed from outside, the check-up examination is important.

The formation of scar tissue is part of healing. Scarring in the area and narrowing arising from it are among the reported risks; a "scar-free" or "risk-free" result is therefore not promised.¹

Risks and complications

The headings below are grouped by subject rather than by frequency. No overall complication rate with a clear denominator, follow-up period and spread between studies was found in this search for an operation of this scope. A risk being given without a figure does not show that the risk is rare or unimportant. The figures for different outcomes are not added to one another.

Pain, over-tightening and sexual function

Pain during intercourse is among the reported risks.⁶¹ In a series of 38 people reporting the results of perineoplasty, at an assessment of at least 6 months 4 people described pain at the vaginal opening during intercourse.¹⁰ In that series 16 people had another operation at the same time, and only people who were sexually active after surgery were assessed; the figure cannot be turned into a general rate.

Over-tightening, scarring and vaginal narrowing (stenosis) are also among the reported risks.¹ It has not been shown that tightening more gives a better result; the aim of the operation is not to reach a measure of narrowness.

The results for sexual function do not all point the same way. A worsening of vaginismus is among the harms the review published in 2026 reports in the surgical group.³ A measured example of this is given in the outcome section below.

Bleeding, wound dehiscence and infection

Bleeding, haematoma, infection and the wound opening are possible.⁶¹ In a series of 38 people, early separation of the sutures occurred within the first week in 2 people, and these did not require re-suturing.¹⁰ That is a raw count from a single-centre series, not a pooled rate.

Neighbouring organs and fistula

The vagina is adjacent to the bladder and the rectum; injury to these organs and the development of a fistula are among the reported risks.⁶¹ No reliable frequency for an operation of this scope was found in this search.

Further procedures and repeat surgery

Repeat surgery may be needed because of a remaining complaint or a problem that develops; this is among the harms counted in the surgical group by the review published in 2026.³ No rate of repeat surgery with a verified follow-up period and denominator was found in this search.

Anaesthesia and general surgical risks

Reactions related to anaesthesia, allergic reactions and pain persisting after surgery can occur. These are assessed together with state of health and the extent of the procedure.

Blood clots: A clot forming in the leg veins and travelling to the lungs is serious. One-sided leg pain and swelling, sudden shortness of breath or chest pain need urgent assessment.

How does the result change over time?

The area continues to change after tissue healing is complete. A later pregnancy and childbirth can affect the result; the plan about children is therefore part of the decision on surgery.⁵¹² Ageing, the menopause and changes in weight also affect the supporting tissues.

The follow-up periods of the published studies are mostly around 6 months.¹⁸¹⁹¹⁰ A result a study reports at 6 months is not evidence that the result is lasting. Long-term outcome and repeat surgery data were not found in this search.

What can be expected from the result?

Three separate things are being measured here and they should not be confused with one another: the scores a person reports themselves, the anatomical measurements made at examination, and statements of satisfaction.

Scores based on self-report: In a retrospective study covering 250 people, a sexual satisfaction scale was applied before surgery and at 6 months. The total score and most of the subscales changed in a favourable direction, while the vaginismus subscale changed in the opposite direction, rising from an average of 4.81 to 5.91.¹⁸ On this scale a higher score means more of a problem. The study has no comparison group, and people with pain during intercourse at the outset and those with symptomatic prolapse were excluded.

In another study of 40 people who underwent perineal repair, significant improvement was reported in desire, arousal, lubrication, orgasm and satisfaction, while no significant improvement was found in pain during intercourse.¹⁹ That result belongs to perineal repair and cannot be generalised to all canal repairs.

Anatomical measurements: In a series of 38 people, after perineal repair the genital hiatus narrowed, the perineal length increased, and no significant change was found in total vaginal length.¹⁰ A change in an anatomical measurement does not mean that the person's complaint has resolved.

The evidence as a whole: A systematic review examining 11 studies states that most of the studies implied improvement in sexual function, but that when their methods were assessed in detail these findings were not robust enough to guide clinical decisions.⁹ Among the review's reasons are the absence of a precise measurement of laxity and the inconsistency of the surgical techniques, methods and tools used.⁹

Reports of satisfaction are not taken as evidence that the procedure is clinically effective.⁶ The assessment of a partner or of anyone else is not used as an outcome measure in this article.

The expectation should relate to the complaint the person has described themselves. Reaching a particular measure of narrowness, copying another person's anatomy, or resolving every problem concerning sexual life is not the aim of this operation.

When should you contact a doctor?

After surgery, the following are not left to wait for a check-up:

• Swelling and hardening that keep increasing
• Pain that worsens or is not relieved by painkillers
• Foul-smelling discharge
• Increasing bleeding or the passing of clots
• Being unable to pass urine, or increasing difficulty in passing it
• Fever, redness and increased warmth
• One-sided leg pain and swelling, sudden shortness of breath or chest pain

An ordinary complaint being expected does not mean that a worsening finding is disregarded.

About the numbers in this article

The anaesthesia, the duration of the operation and the hospital stay, the use of sutures, the first check-up, the timetable for bruising, swelling and the result, and the intervals for returning to work, to driving, to sport and to daily life in full are the clinical framework approved by the surgeon. No fixed interval is given for a return to sexual activity; the intervals named by institution are those institutions' care advice, not this practice's approved value. The timing according to the menstrual cycle is likewise a clinical decision, not a research finding.

The research figures come from particular outcome definitions and sets of studies. Some of the data in this article are pooled estimates given with a confidence interval; some are raw counts from single-centre series and carry no confidence interval. Some are scale scores rather than frequencies. The three should not be read as carrying equal weight.

Scale scores are not numbers of people or rates of success. On the sexual satisfaction scale a higher score means more of a problem; a rise in a subscale therefore indicates a worsening.¹⁸

In the series reporting the results of perineal repair, 16 of the 38 people had another operation at the same time; the results in that series therefore cannot be attributed to the perineal repair alone.¹⁰ Because the unit of the anatomical measurements in that series could not be read with confidence from the source, the measured values have not been taken into this article and only the direction of change is reported.

The results of the two reviews concerning energy-based devices come from different sets of studies and different comparisons; neither made a comparison with this operation.¹¹³

The data in the smoking cessation paragraph cover a range of operations.¹⁴¹⁵ In the results reported from Tang, the relative risk was 0.73 with a 95 per cent confidence interval of 0.60-0.89 for those who stopped at least 2 weeks before, and 0.71 with a 95 per cent confidence interval of 0.61-0.82 for those who stopped at least 4 weeks before.¹⁶ The 27 per cent and 29 per cent relative reductions in the shared paragraph are not an absolute complication rate specific to this operation.

A number not being given for a risk in this article does not mean that the risk does not exist.

References

1. Furnas HJ, Canales FL, Pedreira RA, Comer C, Lin SJ, Banwell PE. The safe practice of female genital plastic surgery. Plast Reconstr Surg Glob Open. 2021;9(7):e3660. doi:10.1097/GOX.0000000000003660 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹²

2. American Society of Plastic Surgeons. Vaginoplasty. Accessed 19 September 2026. plasticsurgery.org ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

3. Randombage PJS, Hettipathirana PS, Akurugodagama M. Comparative effectiveness of conservative and surgical interventions for vaginal laxity: a systematic review and pairwise meta-analysis. Int Urogynecol J. 2026. Advance online publication. doi:10.1007/s00192-026-06833-y ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

4. Pereira GMV, Almeida CM, Martinho N, et al. Pelvic floor muscle training vs radiofrequency for women with vaginal laxity: randomized clinical trial. J Sex Med. 2024;21(8):700-708. doi:10.1093/jsxmed/qdae068 ↩ ↩²

5. International Urogynecological Association. Maternal pelvic floor trauma. Accessed 19 September 2026. yourpelvicfloor.org ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

6. American College of Obstetricians and Gynecologists. Elective female genital cosmetic surgery: ACOG Committee Opinion, Number 795. Obstet Gynecol. 2020;135(1):e36-e42. doi:10.1097/AOG.0000000000003616 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

7. International Urogynecological Association. Posterior vaginal wall and perineal body repair. Accessed 19 September 2026. yourpelvicfloor.org ↩ ↩² ↩³ ↩⁴ ↩⁵

8. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NG123, recommendations 1.4.4, 1.5.14, 1.7.5 and 1.9.1. Accessed 19 September 2026. nice.org.uk ↩ ↩² ↩³ ↩⁴ ↩⁵

9. Alavi-Arjas F, Goodman MP, Simbar M, Majd HA, Nahidi F. The effect of vaginal tightening surgery on sexual function: a systematic review. Int Urogynecol J. 2025;36(1):11-24. doi:10.1007/s00192-024-05969-z ↩ ↩² ↩³

10. Ulubay M, Keskin U, Fidan U, et al. Safety, efficiency, and outcomes of perineoplasty: treatment of the sensation of a wide vagina. Biomed Res Int. 2016;2016:2495105. doi:10.1155/2016/2495105 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

11. Pereira GMV, Cartwright R, Juliato CRT, et al. Treatment of women with vaginal laxity: systematic review with meta-analysis. J Sex Med. 2024;21(5):430-442. doi:10.1093/jsxmed/qdae028 ↩ ↩²

12. The Aesthetic Society. Vaginoplasty. Accessed 19 September 2026. theaestheticsociety.org ↩ ↩²

13. American Society of Plastic Surgeons. Managing the risks of smoking in plastic surgery patients. Practice reference, 9 October 2024. Accessed 19 September 2026. plasticsurgery.org ↩

14. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8. doi:10.1016/j.amjmed.2010.09.013 ↩ ↩²

15. Fiddes RA, McCaffrey N. Preoperative smoking-cessation interventions to prevent postoperative complications: a quality assessment and overview of systematic review evidence. Anesth Analg. 2025;140(6):1377-1387. doi:10.1213/ANE.0000000000007187 ↩ ↩²

16. Tang E, Rodriguez RM, Srivastava A, et al. Impact of short duration smoking cessation on post-operative complications: a systematic review and meta-analysis. J Clin Anesth. 2025;106:111967. doi:10.1016/j.jclinane.2025.111967 ↩ ↩²

17. The Aesthetic Society. Vaginoplasty: aftercare and recovery. Accessed 19 September 2026. theaestheticsociety.org ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

18. Erdogan G. Experience of vaginoplasty for enhancement of sexual functioning in a center in Turkey: a before and after study. Cureus. 2021;13(4):e14767. doi:10.7759/cureus.14767 ↩ ↩² ↩³

19. İnan C, Ağır MÇ, Sağır FG, et al. Assessment of the effects of perineoplasty on female sexual function. Balkan Med J. 2015;32(3):260-265. doi:10.5152/balkanmedj.2015.15073 ↩ ↩²