Vaginal Tightening

Vaginal tightening covers a group of treatments aimed at slackness of the vaginal walls and the muscles supporting them, most often after childbirth or with the loss of tissue elasticity that follows the menopause.

The treatments are of two very different kinds. A surgical repair removes a strip of stretched vaginal lining and brings the muscle layer beneath it back together with stitches; it is an operation with a real recovery and a measurable change. Energy-based treatments using laser or radiofrequency heat the tissue in short clinic sessions with the aim of stimulating collagen. The published evidence for the energy-based devices is limited, regulators have warned manufacturers against claiming that they treat medical conditions, and any practitioner offering them should say plainly what is known and what is not before you agree.

A proper assessment comes first, because the same feeling is produced by several different things. Weakness of the pelvic floor muscles, prolapse of the vaginal wall, leaking of urine and vaginal dryness after the menopause each have their own treatment, and each is treated better in its own right than by tightening. Pelvic floor exercises taught by a physiotherapist are the starting point for almost everyone, they cost nothing, and they are the one measure with good evidence behind it.

A surgical repair is done under local anaesthetic, with an injection into the tissue around the area so that you feel pressure and no pain, and you stay awake. It takes about thirty to sixty minutes. Your surgeon marks and removes a strip of the stretched lining, brings the muscle underneath together with dissolvable stitches, and closes the lining over it. Some women are offered sedation alongside the local, and that is worth asking about if you would find being awake difficult.

An energy-based treatment is quicker and simpler. A probe is placed in the vagina and moved through the canal for ten to twenty minutes; numbing cream is sometimes used and often nothing is needed. These are given as a course of sessions spaced several weeks apart, and the effect, where there is one, is gradual.

Either way this is a Day Care attendance. After a surgical repair you are observed for a couple of hours, need to pass urine before you leave, and should have someone to take you home. After an energy session you can leave almost immediately and drive yourself.

After a surgical repair expect soreness and swelling for one to two weeks, worst in the first three or four days, and ice packs and loose clothing help more than anything else. Light bleeding and discharge continue for a week or two as the stitches dissolve, which takes two to four weeks. Most women are back at desk work in two to three days and avoid sitting on hard surfaces for a while.

Nothing goes into the vagina for six weeks after surgery: no tampons, no swimming and no sex, because the repair needs that long to gain its strength. Avoid heavy lifting and the gym for four weeks and build activity back gradually. The tissue continues to settle for three months, so judge the result then and not at three weeks.

After an energy-based session there is little to recover from. Expect mild warmth or spotting for a day, avoid sex, tampons and swimming for two to three days, and carry on otherwise as normal. Any effect appears over the weeks following the course and is generally reported to fade over a year or two, so maintenance sessions are usually proposed.