Colporrhaphy
Gynecology & Uro-Gynecology Information, Education 
and Resources for Dads & Husbands

What is Colporrhaphy?

Colporrhaphy is the surgical repair of the vaginal wall.  This includes repairing many types of vaginal surgery, including the repairs of the vagina in a "pelvic organ prolapse," "vaginal prolapse," "vaginal vault prolapse," or the repair of a "cystocele" in the vaginal wall(s) or vaginal vault or a rectocele.  A cystocele occurs when the bladder protrudes into the vagina, and a rectocele when the rectum protrudes into the vagina.

In the colporrhaphy procudeure, a uro-gynecologist, or gynecological surgeon, places a vaginal speculum inside the vagina, which spreads/keeps the vagina open, for the doctor to inspect and repair the vagina.  The vaginal wall is cut opened to reveal an opening in the supporting structures, or fascia and the defect is closed and then the vagina is repaired by suture and closed, and the speculum removed.  

Who performs the colporrhaphy and where is it performed?

Colporrhaphy is usually performed in a nearby hospital operating room by a uro-gynecologist, urologist or gynecological surgeon.

Pelvic Laparoscopy
Information, Resources & Education

What is Pelvic Laparoscopy?

Pelvic laparoscopy is a surgical procedure that examines and treats a woman's pelvic organs through a small surgical viewing instrument (laparoscope) inserted into the abdomen at the navel.

How is Pelvic Laparoscopy performed?

After the female patient has been administered anesthesia and is deep asleep and pain-free under general anesthesia, a one-half-inch incision is made in the skin below the navel (umbilicus). Carbon dioxide is pumped into the abdomen to make the organs of the abdominal cavity more easily visible.

The laparoscope, an instrument similar to a small telescope on a flexible tube, is inserted so the area can be viewed. Other instruments may be inserted through other incisions in the lower abdomen to obtain tissue samples or perform additional procedures. After the pelvic laparoscopy is completed, the carbon dioxide gas is released, and the incisions are stitched.

Pelvic laparoscopy is used both for diagnosis and for treatment and may be recommended for the following conditions or symptoms:
 
*  Pelvic pain
*  Uterine tissue found outside the uterus in the abdomen (endometriosis) 
*  Infections (pelvic inflammatory disease) not responsive to drug therapy 
*  Suspected twisting (torsion) of an ovary 
*  Ovarian cyst 
*  Scar tissue (adhesions) in pelvis 
*  Perforation (puncture) of the uterus following D and C or by an IUD 
*  Infertility evaluation 
*  Sterilization (tubal ligation) 
*  Evaluation and removal of an abnormal pelvic mass that was confirmed by abdominal
    ultrasound 
*  Removal of uterine fibroids (myomectomy) 
*  Removal of uterus (hysterectomy) 
*  Surgical treatment of tubal pregnancy 
*  Evaluation of a woman who may have appendicitis or salpingitis 

Pelvic laparoscopy is not recommended for patients with:

*  Severe obesity 
*  Existing severe pelvic adhesions from previous surgeries 

Laparoscopic procedures are growing more popular with physicians, especially with the advent of more high-tech laparoscopes.

Pelvic Floor Dysfunction
Information, Resources & Education

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction, which is also referred to as outlet obstruction or outlet delay, refers to a condition in which the pelvic floor muscles of a woman's lower pelvis - that surround the rectum, do not function normally. It is not known why these muscles fail to work properly in some women, but they can make the passage of stools difficult even when everything else seemingly is normal.

What Causes Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction find that muscle pain occurs when muscles are tense, strained, traumatized and/or otherwise inflamed. Their pelvic muscles are no exception. Causes of pelvic floor dysfunction can include:

*  Chronic faulty posture with weak core musculature 
*  Trauma (fall on tailbone, old tailbone fracture, auto accident)
*  Inflammation or infection
*  Pelvic organ disease (endometriosis, irritable bowel syndrome, interstitial cystitis) 
*  Repetitive motion injuries such as those from gymnastics, volleyball, soccer, ballet or ice
    skating
*  Abdominal muscle wall weakness or hernias 
*  Chronic constipation
*  Pregnancy or complicated vaginal delivery 
*  Abdominal or pelvic surgery such as a hysterectomy 

Do I have Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction often have changes in their spine and/or pelvis.  Symptoms or conditional might include; scoliosis, short leg, swayback or a "torsioned" sacrum. The most common symptoms of pelvic floor dysfunction include one or more of the following:

*  Vaginal pain 
*  Pain with urination 
*  Urinary urgency and frequency 
*  Rectal pain 
*  Pain during vaginal intercourse 
*  Pain with sitting, standing, walking 
*  Pain and/or difficulty getting up from a seated or lying down position
*  Hip pain often with loss of range of motion in hips 
*  Deep pain in lower back radiating to legs, thighs, groin, hips 
*  Abdominal and lower abdominal/intestinal pain
*  Pelvic pressure or a feeling like your vagina or uterus are "falling out."
*  Involuntary loss of urine or stool

What are Pelvic Adhesions?

Pelvic adhesions are the cause of many gynecological problems including significant pain, infertility and conception. Pelvic adhesions are irritations of a woman's pelvic organs as a result of a "pelvic inflammatory event" or from trauma to the area such as in the case of pelvic or gynecological surgery.

Examples of a pelvic inflammatory event include; fallopian tube infections that might occur from endometriosis, removal of an ovarian cyst, sexually transmitted diseases such as gonorrhea, post surgery infections, and even appendicitis and appendectomies. 

As a woman's body's pelvic area recovers from an inflammation, trauma or surgery, it begins the healing process and starts to repair itself.  The woman's body and its' healing process may cause some tissues and structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal woman's healthy pelvis, this space is lined with a tissue called the peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In the pelvis of a non-injured/non-irritated woman, the peritoneum can be very "slippery" with the the organs and structures lying immediately next to each other that "slip" off each other and do not become bonded together. With a woman who has had a pelvic inflammation, trauma or injury, her body's healing process starts a sequence of events that may result in some of the pelvic tissues becoming "stuck" to or "adhering" to tissues or organs next to the inflamed, or injured tissue, and when this occurs, the outcome may be pelvic adhesions.

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Pelvic Prolapse?

Pelvic Prolapse is another term used for "pelvic organ prolapse."  Pelvic prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis. 

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

Why should I (or my wife) consider clitoral hood removal?

Female sexual dysfunction affects over twice as many women (and marriages) as man that have "ED." In fact, female sexual dysfunction oftentimes is related to a woman's clitoris inability to achieve a "clitoral erection.  "Female Erectile Dysfunction" is an increasingly greater problem for couples, wherein the wife is unable to achieve orgasm, or no longer enjoys intercourse, and many times this can be linked to a thick clitoral hood, or too much skin covering her clitoris. Many people don't understand the importance of the clitoris and a wife's sexual happiness. A woman cannot reach orgasm unless her clitoris is fully erect. Having a thick clitoral hood, prevents the clitoris from becoming aroused, and erect.

Therefore, more and more women are seeking to have clitoral hood removal or clitoral hood reduction surgery, many times in conjunction with labia minora reduction surgery (see below for more information on labia minora reduction).  

After the clitoral hood has been reduced (or removed), most women regain their capability to enjoy intercourse and reach orgasm much more quickly and easily.

Why should I or my wife consider Labia Minora Reduction, or Labial Reduction surgery?

If you or your wife has become concerned about the/her unsightly, or uneven labia minora,which may be causing pain during intercourse, you/she may be a candidate for "labia minora reduction."  

When one or both of the labia minora (the inner lips of the vulva) extend past the labia majora, many women become ashamed or embarrassed by their "mis-shapen" unsymmetrical labia minora.  

You should know that a woman's labia minora frequently changes, elongates, or extends past her labia majora - most frequently occurring after childbirth (either vaginal childbirth or cesarean birth). 

Women with elongated or mis-shapen labia minoras frequently complain of having a "floppy" feeling with their labia minora. Intercourse may become difficult and very painful as the elongated labia minora are pulled or tugged deep into the vagina, causing additional pain, and even cause "female sexual dysfunction."

Many women stop wearing bikinis and swimsuits, for fear that their elongated labia minora may "flop" or fall out of their swimsuits and cause additional embarrassment. Women with extended labia minora also find their labia minora causes them pain when wearing tight pants, when sitting for extended periods, and pain or discomfort when riding bicycles.

And, many women are very self-conscious and embarrassed when their husbands view their vulva due to their elongated, "flopping-looking" labia minora.

What is Labia Minora Reduction surgery?

Labial reduction and labia minora reduction surgery is a surgical procedure performed on women that reduces and shortens the inner, labia minora lips of her vulva. Labia minora reduction surgery is a safe, simple, and increasingly popular "out-patient" surgical procedure requiring less than 1-2 hours for most women.  

The labia minora reduction procedure will help women who are experiencing pain, "floppy feelings," female sexual dysfunction and/or embarrassment with their long, protruding labia minora.  

The procedure is done in the doctor's office, under general anesthesia, and afterward, women who undergo this procedure will no longer find their labia minora uncomfortable, floppy, or continue to be self-conscious and embarrassed about her labia minora due to the excessive length of their inner labial vaginal lips.

How is labial reduction and labia minora surgery performed? 

Labial reduction, or labia minora reduction, is a very safe and simple surgical procedure performed in the doctor's office (no hospital) requiring about 1-2 hours for most women .

Your doctor will trim the labia minora so that it no longer protrudes from your vulva. Many women also elect to have their clitoral hoods reduced when they undergo labia minora reduction as the extra skin that makes up the clitoral hood interferes with sexual pleasure. Adding clitoral hood reduction to the labia minora reduction procedure only adds less than 30 minutes to the overall procedure.

The doctor performs labia minora reduction by cutting and re-stitching the inner vaginal lips together . Many doctors now use a v-shape incision that can be made in the tissue and the sides sewn together thereby reducing the overall length of the labia minora.

How long does labia minora reduction surgery take?

This procedure takes anywhere from 1 - 2 hours to complete and is performed under general anesthesia.  Even though the procedure is relatively safe, you will need to have your husband or a friend present, as they will need to drive you home after being under anesthesia, and help care for you after the procedure.  

What is the recovery time for labia minora reduction?

Recovery time from labia minora reduction is fast - taking about 10 - 14 days on average. 

Your doctor will ask you to avoid sexual intercourse for about 4 weeks.

How long will the labia minora reduction surgery results last?

Labial minora reduction produces results that should be life-lasting.

Are there any side effects to labial reduction?

For a brief period, there will be general soreness and swelling of the labia minora and vulva.  Urination might also be uncomfortable for the first 2-3 days but this will quickly pass. There are no side effects to be concerned about.

What are labial adhesions?

Young girls and adult women may get “labial adhesions.” Labial adhesions are similar to clitoral adhesions except the smegma adheres to the labia minora (sometimes the labia majora) or the “lips” of the vulva surrounding the vagina — that has caused the labia minora to fuse or become stuck together. This happens to about 5% to 10% percent of all young girls.  Young girls and women with labia that are stuck or fused together should immediately be seen by a pediatrician or gynecologist as the urine flow (and menstrual flow in adult women) can become blocked and a serious infection or infections are very likely to occur if she is not seen by a doctor. 

What causes labial adhesions?

This probably happened because your daughter has little to no estrogen. Baby girls get a large dose of estrogen while they're still in the uterus.  About one to two months after her birth, the maternal estrogen level drops off, and this hormonal change can affect many parts of a baby's body, including the lining of a girl's labia. Her labia may even stick together. This "adhesion" of her labia can continue or come and go throughout childhood, according to many pediatricians.

What can be done to treat labial adhesions?

First of all, parents should NOT try to pull or separate your daughter's labia apart, since that might hurt. Unless the adhesion is causing any problems, it's best to leave it alone. The idea of your daughter having labial adhesion probably worries you more than it bothers her.  However, if the adhesion extends to cover the opening of the urethra and is trapping urine in the genital area, then you'll definitely want to see your child's doctor about treatment. Trapped urine can cause irritation and possibly infection. You'll know if your daughter's labial adhesions are covering the urethral opening if you find less urine in her diaper (for a young child) or she's having trouble peeing, or if her genital area looks irritated, she's irritable and crying, and she has a fever (due to infection).

Normally doctors prescribe a topical estrogen cream to treat the problem. Your doctor will tell you to apply this cream directly to the affected tissue, and in about two weeks it should unseal the labia. You'll probably start by applying the cream two or three times a day, then two times a day, then just once a day. It's important to reduce the amount of estrogen cream you use gradually. If you just stop the treatment suddenly, the labia will close up again.

Will our daughter always have labial adhesions?

Your daughter may continue to have clitoral or labial adhesions off and on throughout childhood, but the labia tend to unstick when a girl approaches puberty and her body starts producing higher levels of estrogen. Until then, though, there's no reason to worry about the adhesion(s) as long as they are not causing any problems. Many little girls never even know they have them.

Importance of proper feminine hygiene and vulva care

Baby girls are born with special glands that are located on the inner surfaces of the clitoral hood.  These glands produce an oily substance called sebum that lubricates the glans of the clitoris. The glans of the clitoris is the end or the tip of the clitoris that is sometimes exposed or can be exposed when you retract the clitoral "hood."  The clitoral hood is that portion of the vulva where the labia minora come together above the vagina and urethra and looks like an inverted "v"  ^ .   The clitoral hood protects the clitoris and in particular, the glans of the clitoris which is very sensitive. 

The sebum that comes from the glands that surround the clitoris produces a shiny appearance on the glans of the clitoris. When the sebum or oily substances are not regulary cleaned or bathed away, it accumulates, and then it is called smegma.  Smegma has a white cheesy appearance, that becomes sticky and begins to adhere to the skin surrounding the vulva with greater, the longer it is not cleaned or washed away. 

Without proper care and hygiene, the smegma will collect under the hood that covers the clitoris and the glans of the clitoris, which can result in pain, irritation and/or inability to experience orgasm.  When the smegma is not properly cleansed from the vulva, and in particular, the areas surrounding and under the clitoral hood, the clitoral hood will adhere to the glans of the clitoris, which is referred to as a "clitoral adhesion."    When the clitoral hood adheres to the clitoris, either partially or entirely, this prevents the hood from properly protecting and caressing the glans, making orgasm difficult or impossible.

It is very important for the glans of the clitoris to have adequate lubrication.  This permits the the clitoral hood to slide over the glans of the clitoris easily and without undue sensitivity or discomfort.  The clitoris, and especially the glans of the clitoris, is usually most sensitive to frictional stimulation, versus direct pressure. Womens masturbation methods almost always involve sliding the clitoral hood in various back and forth or circular motions across and over the glans of the clitoris.  Without proper lubrication from the glands next to the clitoris, pain will result in the stimulation of the clitoris and when there is movement of the clitoral hood.

Importance of washing and cleaning the vulva

The smegma accumulations of the vulva, specifically in the area of the clitoris, needs to be cleaned on a regular basis.  Otherwise, the smegma can accumulate and dry out, causing the smegma to harden beneath the clitoral hood, which causes resulting irritation leading to significant pain.  This can result in pain during masturbation, vaginal intercourse, and perhaps when walking, or wearing tight pants. In addition, using sanitary napkins may be painful.

This accumulation of smegma also occurs in infants and preadolescent girls. Parents should check their daughter's vulva for these accumulations of smegma at every diaper change and bath by gently separating the vulva and looking for the cheesy-white accumulations and gently wiping/cleaning away.  Always be sure to wipe her from the top of the vulva toward the bottom or rectum to prevent germs and bacteria from entering her vagina.  In mild cases the dried smegma may only slightly irritate the clitoris, resulting in your daughter's need to rub or scratch it. This can result in infants and young girls masturbating frequently. The resulting redness, irritation, caused by the frequent masturbation may conceal the primary problem. Adult women may also be distracted by this mild irritation, feeling a need to masturbate or engage in sex frequently. This sensation should not be confused with that of having an erect clitoris. When the irritation is severe though, while the desire to touch the area is there, the inflammation makes any contact extremely painful. So accumulated smegma can either increase the desire for sexual contact, or make it impossible.

Proper bathing and care of the vulva prevents clitoral adhesions

Preventing clitoral hood adhesions means that you need to retract the clitoral hood each time you bathe or shower, and wash out the secretions from this area. Most women need to be aware that simply wiping their vulva with a washcloth or their hand may not be enough to keep it clean.  The spaces between the labia minora, labia majora and the area under the clitoral hood can retain the sebum from the glands around the clitoris, as well as other accumulations such as sweat, vaginal lubrication, toilet paper, menstrual fluid, urine, bacteria and feminine hygiene products. The normal body fluids don't expose a woman to any harm as long as they are removed before bacteria that are normally present are able to reproduce, resulting in infection and odor. 

Special "feminine" soaps and washes are not necessary to clean your vulva. All one needs to use to wash and clean the vulva is plain water.  In fact, the use of soap and feminine hygiene products can irritate the delicate genital tissues. And douching is rarely, if ever needed, to cleanse your vagina.

Douches, vaginal deodorants or vulva deodorants, and chemical additives pose unnecessary risks when applied to the vulva and placed inside the vagina. These products have been linked to increased cases of vulvovaginitis and vaginal yeast infections.

Clitoral adhesions

Clitoral adhesions or labial adhesions limits or prevents the clitoral hood to slide across the glans of the clitoris.  If you have adhesions, when you pull on your clitoral hood, the glans of the clitoris moves with it instead of the hood retracting by itself, i.e., the glans of the clitoris moves with your pulling the clitoral hood. This can be very painful.

You may not be able to pull the hood back far enough to expose the entire glans if you have clitoral adhesions.  This could make cleaning the clitoral area difficult if not impossible.

Minor clitoral adhesions may be remedied by without the need for a doctor's intervention. The clitoral adhesions may be released through pressure on the clitoral hood. Things like bathing, masturbation, bicycle riding, and horseback riding.  If you do not properly wash your vulva in a manner that places traction on her hood, or masturbate in a manner that causes you to pull back the clitoral hood, you may not separate any clitoral adhesions that form, or prevent the formation of adhesions in the future.

If you believe you have clitoral or labial adhesions, you may be able to eliminate them by repeatedly pulling on your clitoral hood, in 360 degree directions (up, down, left, right, rotating in circles as well), or by taking a hot bath.

Clitoral adhesions will not disappear immediately as it took some time for the clitoral adhesions to form.

Women who experience pain can ask their partner or doctor to examine their vulva, and separating the labia, attempt to locate the source of the pain or by using a mirror and seeking the source of the pain themselves.  If you experience a clitoral adhesion, either you or your partner can moisten a q-tip with baby oil or vitamin E to clean and loosen the secretions. Remember, the clitoral hood needs to "glide" easily over the clitoris. To lubricate the clitoral hood and loosen the secretions underneath, you or your partner may want to massage the area with a topical cream or baby oil.  This may require you and/or your partner to do this for several days or for several weeks.  Due to the sensitive nature of the clitoris and clitoral glans, it may be painful during the cleaning or massage due to the adhesions.

In the event you are unable to treat the symptoms of clitoral adhesions, and you or your partner cannot determine the reason for the pain, a doctor may need to be consulted. If your clitoral hood extends well past the glans, or if your clitoral hood is thick or closed, the adhesions may be totally concealed, with no visible indications. You should be very explicit in your office visit with the physician regarding your pain and show him the exact location of the any pain, even retracting your clitoral hood, if necessary for his viewing. 

The clitoral adhesions caused by the accumulated smegma is caused by the two tissues surfaces growing together, due to failure to wash away these accumulations. As a result, the body tries to heal and eliminate the source of the irritation, thus causing the tissues to fuse as adhesions. These clitoral adhesions, or labial adhesions in the event the labia minora fuse together, may also form as a result of the hood laying in constant contact with the glans of the clitoris.

Additionally, either you or your partner may want to massage baby oil, vitamin E, or a petroleum based lubricant or antibacterial ointment up under your clitoral hood and on the glans of the clitoris.  

Proper washing and cleaning of the vulva

Naturally, one of the best ways to keep from having clitoral adhesions is through proper washing of the vulva and to wash away the secretions before they turn into smegma. Proper care of your vulva or your daughter’s vulva means to wash away these secretions at every bath or shower. When you wash your vulva, it is important for you to retract the clitoral hood and wash this area. Also, be sure to wash the inner and outer portions and folds of the labia minora.

Parents can teach their daughters how to properly wash their vulva and help prevent them from experiencing the pain of clitoral or labial adhesions. Parents need to educate their young daughters about the various parts of their vulva so that they know they have more than "just a vagina," which they can't see, but a clitoris, clitoral hood, labia minora and labia majora, that they can see.

Proper cleaning of your daughter's vulva includes the following;

1. Gently spread the inner and outer labia and wash between them.

2. Place upward traction on the clitoral hood (in the direction of her bellybutton) while washing the exposed surfaces.

3. The glans of the clitoris may not be exposed when you do this. If there are adhesions, don't forcibly try to remove them.

4. Do not use any soap or other harsh ointments while cleaning away the, sebum, secretions or smegma.

5. You may need to use a q-tip or cotton ball moistened with baby oil or vitamin E to help loosen any stubborn smegma collections. If doing this, use another q-tip or cotton ball that is moistened with water to remove the baby oil or vitamin E.

6. Make sure that you are very gentle and use only light pressure when cleaning your daughter's vulva due to the sensitivity.

7. When your daughter is old enough to understand how to wash her vulva, may also be the right time to teach her the correct parts of her vulva, as well as explaining that her vulva is "private," and that she should be the one that cares for it. Also, when she is old enough, ask her permission to wash her vulva at bath-time, or ask her if she wants to wash her own vulva, following your directions to make sure that she removes the accumulated secretions or smegma.

SPECIAL NOTE: 

Talcum powder has been linked to numerous cancers, including vulva, vaginal, cervical, uterine and ovarian. NEVER USE TALCUM POWDER NEAR YOUR DAUGHTER'S VULVA. 

Instead of using talcum powder, you may want to consider the use of corn starch in this area, making sure that the corn starch is used externally and never placed in or near her vagina.

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