• A sense of vaginal laxity and reduced sexual sensation
• Widening after childbirth that has not recovered
• Laxity together with prolapse of the vaginal wall (cystocele/rectocele)
• Discomfort when walking or sitting
• Poor healing of an episiotomy

A detailed examination precedes any decision to operate. Prolapse, urinary incontinence and pelvic floor muscle strength are assessed separately, because some symptoms improve without surgery, through pelvic floor exercises and physiotherapy.

Discussing expectations openly is the most important step in this process. An unrealistic expectation can leave even a technically successful operation ending in dissatisfaction.

The lax vaginal wall and the supporting tissue beneath it are repaired and excess mucosa is removed. The perineum is repaired at the same time where required. The procedure usually takes under an hour and absorbable sutures are used.

The type of anaesthesia is chosen according to your general health. Most patients are discharged the same or the following day.

• Pain and swelling are expected in the first days and are controlled with analgesia
• Intercourse is avoided for about 6 weeks
• Heavy lifting and strenuous exercise are not advised for the first 4 to 6 weeks
• Avoiding constipation makes recovery noticeably easier
• Review appointments are arranged at set intervals

If a future vaginal birth is planned, it is advisable to postpone surgery until afterwards, as childbirth can render the repaired tissue lax again.

As with any surgery there is a risk of bleeding, infection and problems with healing. These risks are discussed in detail beforehand and consent is taken on that basis.