Genital Surgery
Women and even men may want to have their genitals changed. In women it is usually vaginal surgery, surgery of labia minora and majora and the hymen reconstruction surgery. Men usually want to have the size and volume of penis changed, eventually do a circumcision.
Female Genital Surgery
Vaginoplasty
In general it represents modification of female vagina. Most frequent procedure is the narrowing of vaginal opening, eventually specific narrowing of the vagina, which can lead to its partial firmness.
The aim of the surgical procedure is to return, eventually enable better sexual life to the patient.
This surgery is usually performed in women of middle age that gave birth already and when it came to loosening of vagina and vaginal opening caused by deliveries and increasing age.
The procedure is performed under general anesthesia, it lasts usually 45 minutes. It is performed with following technique: In the area of vaginal opening, on its back side, an excision of a tissue in various extents (according to the wish of the patient, anatomical finding and so on) is made. Then the wound is sutured. It is better to make the extent of the excision bigger and therefore narrow the opening more because consequently during the life it is usual that the vaginal opening widens again slightly.
If the incision is expanded even to the back vaginal wall and into different distances, we can contract the whole vagina like this. This surgery is also performed under general anesthesia, it lasts around 1, 5 hours.
The surgery does not involve only the mucosa, but it intervenes even into the muscle layer of vaginal wall. At first the vaginal mucosa is excided in needed (chosen) extent, next the muscle layer of vagina is firmed and shortened and the last phase of the surgery is to suture the vaginal mucosa. The same is valid about the extent of the excision as it is mentioned in correction of vaginal opening. During this surgery a big prudence and experience of the surgeon is necessary because of the near vicinity of vagina and terminal part of colon to prevent the creation of so-called rectovaginal pouch.
Both methods of the surgeries use absorbable suturing material, we do not recommend sexual intercourse, sometimes even for 6 weeks.
Labiaplasty
Labia minora
This term means surgical modification of inner and outer lips in women.
The labia minora in women often protrude between the labia majora and many times reach unbelievable size. The aim of the surgery is to reduce such protruding inner lips, sometimes even almost completely remove. According to their function we do not recommend their total removal.
The surgery is not usually difficult, it can be performed even under local anesthesia, analgosedation, or eventually under general anesthesia. We use absorbable material and we do not recommend a sexual intercourse for about one month.
Labia majora
Atrophic labia majora, when the fat tissue and elasticity reduce in time and therefore the labia loose their fullness.
There are several ways of solution:
- Filling of labia with own fat. The procedure is usually often repeated because own fat can be very soon absorbed according to the frequency of sexual activities.
- Another method is the skin reduction of labia majora, when the incision is usually made in the inner side to labia minora.
- The combination of both methods.
It is possible to perform all the surgeries even under local anesthesia, although it is better under analgosedation or general anesthesia.
Hypertrophic (excessively large) labia majora
Most often in young women, there are also several ways of solution:
- Liposuction.
- Surgical reduction, when the incision is led the same way as in skin reduction of atrophic labia.
- The combination of both methods.
Hymenoplasty – Hymen reconstruction surgery
A lot could be written about the motives for which women decide to undertake this surgery.
There are several methods, although they never mean the real hymen reconstruction. It is always just a surgery with the only one aim to have bleeding during the sexual intercourse so that the man has the feeling that he was the first man for his partner.
Most often a thin and short small flap of mucosa is separated from the vaginal wall (approximately 1/3 of vaginal width), it is then sewed very gently to the opposite vaginal wall. Like this the vagina is not blocked too much to let the menstruation blood flow away, although at the same time it comes to bleeding during the sexual intercourse.
The surgery is not difficult for an experienced surgeon, it is better to perform the surgery under general anesthesia.
Male Genital Surgery
Foreskin
Circumcision
- Total (complete) removal of penis foreskin, when the foreskin is removed to that extent that the glans penis is uncovered. The sutured surgical wound is led under the glans penis.
The reason is most often:
- Ritual – religious (Jews)
- Medical – such extent because of medical reasons is rare, see article 2.
So-called Burian Plastic Surgery
- Incomplete foreskin removal that is combined with the enlargement of the opening of the foreskin flap for the glans penis.
This type of procedure is chosen in most of the cases when the indication for the surgery is caused by medical reasons:
- Phimosis (the foreskin of the penis cannot be fully retracted over the glans penis – narrow opening caused by different reasons – injury, chronic inflammation, congenital)
- Paraphimosis (the foreskin becomes trapped behind the glans penis, and cannot be pulled back)
It is possible to perform both types of surgeries under general anesthesia with several hours or one day stay in hospital. It cay also be performed under local anesthesia as an out-patient procedure, when the patient goes home after the surgery. The sutures are not removed, they are from absorbable material. Sexual abstinence is necessary for approximately 3 to 4 weeks.
Many questions from men are aimed to possibilities of penis enlargement, or its extension. It is necessary to have in consideration that this surgical procedure has its difficulties and at the same time the risks of complications are not small. In case of those complications, the consequences can lead even to irredeemable penis damage not only anatomically but also functionally (penis deformation, erection defects and so on).
Penis Enlargement
Extension
- And eventually even enlargement of the penis volume. It involves in principle several procedures, usually their combination is suitable.
- The least penetrative is simple liposuction in the area of the penis root to achieve satisfying result. The risk of complications is minimal in this method, almost none.
- The separation of columns of erectile tissue of penis from the pubic bone is another method, much more penetrative, where the incision is led above the penis root. The separation of erectile tissue of penis is not totally without risks though and it can lead to increased danger of peni s injury during sexual intercourse. The erection itself can also be negatively influenced by this procedure, which represents another complication of this surgery.
It is necessary to wear special bandage with weight to retain the achieved state for several weeks after this procedure. In case this bandage is not worn, the penis could shorten during the healing process back to its original size.
- It is advantageous to combine the liposuction of fat tissue in the area of penis root. Although the advantages of one method cat negatively influence eventual complications of the other method.
Size Enhancement
The most advantageous method is the usage of own tissue – usually it is a fat tissue:
- Lipofilling – the most gentle, a method with the lowest amount of complications, the smallest and shortest lasting effect
The tissue is taken for example from the lower abdomen and is applied with subcutaneous injections to the penis.
- Corium Fat Implants – the skin with subcutaneous fat is inserted through small incisions without top layer epidermis into the hypodermis of the penis along its sides.
Corium Fat Implants – the skin with subcutaneous fat is inserted through small incisions without top layer epidermis into the hypodermis of the penis along its sides.
This method is accompanied with high risk of necrosis of implanted tissue, purulence and so on, on both sides eventually on only one side. An adequate cooling and calm mode for 4 to 8 weeks are necessary. The effect is more visible and long lasting.
- Another method are various penile implants to enhance the volume but also its function, this belongs more to the urologic field.
It is always necessary to gain precise, complete patient’s idea about the result, which should be reached through the surgery and especially about the motivation, (reasons), why he intends to undergo this surgery. Like this we get the idea, if we can meet patient’s expectations, and we can eventually come to some compromise solution. This is of course valid in all procedures in the field of esthetic surgery.