Perineoplasty and Perineal Repair: When Is It Considered, and What Are the Risks and Evidence?

Perineoplasty is the surgical repair or reshaping of the perineal area between the vaginal opening and the anus, usually because of a scar from birth or a structural problem. This operation is not needed for every complaint; the decision is made together with your doctor after the cause of your complaint has been assessed and in the knowledge that the evidence is limited. The term "perineal repair" is sometimes used for the same procedure and sometimes for a different repair done during birth; this distinction and frequently asked points about the operation are explained below.

What are perineoplasty and perineal repair?

The perineum is the area between the vaginal opening and the anus, made up of muscle and connective tissue. Perineoplasty is the surgical rearrangement or repair of the tissue in this area.

Is perineoplasty different from the stitching done at birth (perineal repair)?

Yes. Repairing a tear that formed during birth, or a cut made (episiotomy), at that birth is a different process and is followed up in the postnatal period. Perineoplasty, on the other hand, is a separate operation planned electively, usually some time after birth, when there is an ongoing complaint.

In which situations is perineoplasty considered?

Perineoplasty may be considered in symptomatic situations, such as a marked scar that continues despite conservative treatment, a structural problem, or pain that continues during sex. In these situations the aim of surgery is to arrange the irregular scar tissue and to restore the anatomical integrity of the area.

Is perineoplasty also done only for cosmetic or perception-related reasons?

Yes. This operation may also be requested because of a perception of looseness in the tissue after birth, or a feeling of "emptiness" felt during sex. However, randomised controlled trials are lacking for this kind of cosmetic procedure; for this reason it is recommended that you keep your expectation of benefit cautious.

Can a non-surgical (conservative) method be tried before the operation?

Yes. Especially for functional complaints, non-surgical approaches such as pelvic floor rehabilitation and pain management can be considered before the operation.

What is assessed before the operation?

The doctor assesses the cause of your complaint, the examination findings, your pelvic floor condition and your expectations. If you are planning a pregnancy, this is also talked about in terms of timing.

How is the operation done and how does recovery go?

The details of the operation (type of anaesthetic, hospital stay, recovery schedule) vary according to the person and the extent of the operation; your doctor explains this information to you specifically. During recovery, mild pain, mild swelling and tenderness in the area are expected symptoms; they tend to lessen over time. The operation is performed by Assoc. Prof. Dr. Nurettin Türktekin at Memorial Şişli Hospital.

What are the risks of perineoplasty?

After perineoplasty, infection, bleeding or haematoma, wound separation, hardening of the scar tissue, pain that continues or begins newly, and a change in sensation can be seen; in some cases a repeat operation may be needed. In cosmetic or perception-related requests, the result not fully meeting your expectation is also a possible situation; for this reason it is important to form realistic expectations before the operation.

How strong is the evidence for perineoplasty?

High-quality comparative studies on the results of elective perineal surgery are limited. Although it is stated that there may be improvement in pain and discomfort during sex with careful planning and a suitable technique, these assessments do not offer numerical results or long-term follow-up data. For this reason the decision for an operation should not be made without the cause of the complaint being clearly assessed.

What should be considered about consent, age and expectations?

This operation is planned in adults who have completed their development; the informed consent process includes, if you are planning a pregnancy, timing being handled as part of this process. Realistic expectations are important for your satisfaction with the result; the operation may not remove every complaint completely.

Who may perineoplasty not be suitable for?

Deciding on an operation without the cause of the complaint being assessed, or without conservative options having been tried at all, is not recommended. The doctor decides whether the operation is suitable according to your examination and history.

What can you ask your doctor?

• What is the cause of my complaint, and is there a treatment that can be tried first?
• Which assessments will be done before the operation?
• What should I expect during recovery, and which symptoms are regarded as urgent?
• What are the risks and possible complications?
• Is there a possibility that the result will not meet my expectation?