Transvaginal Posterior Levatorplasty Combined with Perineoplasty: An Effective Surgical Method for Vaginal Rejuvenation.

BACKGROUND: Recently, gynecological cosmetic surgery and rejuvenation surgery have become increasingly popular, with a surging vaginal surgery demand for female vaginal laxity. However, follow-up data on the effectiveness of such procedures remain limited. OBJECTIVE: We conducted a retrospective study aimed to investigate the effects of transvaginal posterior levatorplasty combined with perineoplasty on vaginal rejuvenation. METHODS: Forty-five patients, who underwent transvaginal posterior levatorplasty combined with perineoplasty between July 2020 and May 2022, were included. Patient characteristics before operation, at baseline, 3, 6, and 12 months postoperatively, questionnaires on patient symptoms, quality of life, and sexual function, including Vaginal Laxity Questionnaire (VLQ) and Female Sexual Function Index (FSFI) were evaluated. Pelvic ultrasound imaging was performed preoperatively and 3 months postoperatively. RESULTS: Mean vaginal capacity index and Vaginal laxity scores were different at baseline, 6, and 12 months postoperatively (p<0.01). Female sexual function including libido, sexual arousal, lubrication, orgasm, sexual satisfaction and pain were significantly improved (preoperative: 21.68±4.15; 6 months postoperatively: 26.88±2.44; 1 year postoperatively: 29.97±2.10; p<0.01). The symptoms of stress urinary incontinence (SUI) and recurrent vaginitis were improved in 78.6% and 90.5% of the patients, respectively. In pelvic floor ultrasound, retrovesical angle (RVA), urethral rotation angle (URA), levator hiatus (LH), and bladder neck distance (BND) were significantly different preoperatively and at 3 months postoperatively (p<0.01). Overall satisfaction was 93.3% at 12 months postoperatively. CONCLUSIONS: Transvaginal posterior levatorplasty combined with perineoplasty is effective for the improvement of patient symptoms, quality of life, sexual function, SUI, and postnatal constipation. Further research on the underlying mechanism is required. LEVEL OF EVIDENCE: Therapeutic, III.