Progress of vaginal constraction / 中华整形外科杂志

With the development of social economy and the progress of medical technology, more and more women begin to accept vaginal contraction due to the harmony of sexual life. Now, surgical procedures for vaginal contraction includes resection of posterior vaginal mucosa, contraction without injury of vaginal mucosa, and contraction with embedded vaginal thread. This review aims to summurize the anatomic structure of vagina and the mechanism of vaginal relaxation, as well as the basic operative methods and development of vaginal contraction. The related literature on vaginal contraction at home and abroad was summarized. Different surgical methods have their own advantages and disadvantages.

Comparison of clinical efficacy between vaginal tightening surgeries of buried lead needle suture and vaginal posterior wall mucosa excision for treatment of vaginal relaxation / 中华医学美学美容杂志

Objective To compare the clinical effects of needle buried suture and the posterior wall of vagina mucosa excision vaginal tightening surgery for the treatment of mild to moderate vaginal relaxation.Methods A total of 71 patients with mild to moderate vaginal relaxation were randomly divided into observation group (39 cases) and control group (32 cases).The patients in the observation group were given buried lead needle suture,and the control group were treated with posterior wall of vagina mucosa resection.Analysis of two groups was conducted in patients with operation time,intraoperative bleeding,vaginal secretion color,postoperative wound healing and complications;sexual satisfaction was evaluated after 6,12 and 24 months in two groups of patients.Results There was no significant difference between two groups in operation time and vaginal secretion color (P＞ 0.05).Intraoperative blood loss was much more in the observation group than those in the control group,with statistically significant differences between the two groups [(6.23±2.43) ml vs (15.79 ± 7.31) ml,P＜0.05)].The follow-up for a number of months showed that sexual satisfaction had significant difference between the two groups (P＜0.05).None of the patients had rectal or urethral injury,no fistula,incision infection or other complications occurred,and the incision healed in stage Ⅰ.Conclusions For patients with mild to moderate vaginal relaxation,buried lead needle suture vaginal tightening surgery does not damage the vaginal mucosa,no scar,and fewer complications,which is a more simple and effective method to improve the quality of life in patients with vaginal relaxation.

Clinical efficacy and safety of vaginal rejuvenation surgery with porcine small intestine submucosa / 中华医学美学美容杂志

Objective To evaluate efficacy and safety of porcine small intestine submucosa (SIS) for the repair of severe vaginal relaxation (stage Ⅳ) in women.Methods Biological repair meshes were fixed in 18 patients with stage Ⅵ vaginal relaxation,among which anterior walls were fixed in 12 cases,posterior walls in 5 cases,and both walls in 1 patient.Patients with POP underwent vaginal vault suspension first,then patient with SUI underwent transvaginal urinary incontinence surgery.Extravesicle fascia was transversely folded and sutured with 2-0 Mousse.The pelvic arch ligament together with vesicle fascia,SIS mesh and vaginal submucosa were sutured 3 stitches per side with 1-0 Mousse.Scar tissue at posterior vaginal wall was rhombically excised followed by transverse folding constriction of the rectovaginal fascia with 2-0 Mousse.A 1-0 Mousse was then used for colpoperineoplasty by suturing ruptured superficial anal sphincter,superficial transverse perineal muscle,and bulbocavernosus muscle.Patients were followed at 2,6,and 12 months post-operatively.Unsuccessful outcome was defined as diameter of outer 1/3 of vagina greater than 3.5 cm,or vagina prolapsed beyond hymen.Results The median follow-up was 13 months.Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire (PISQ-12) was obtained in 13 patients and the score increased was noted (P＜0.01).Pelvic floor distress inventory-short form for scoring the quality of life (PFIQ) was collected from 18 patients and the score decreased was noted (P＜0.01).Pelvic floor impact questionnaire (PFIQ-7) was gathered in 18 patients and the score decreased was noted (P＜ 0.01).One unsuccessful case with stage Ⅱ anterior vaginal wall prolapse who underwent posterior vaginal wall fixed with patch ended with a diameter of outer 1/3 of vagina greater than 4.0 cm post-operation.Severe complications like infection,rosion,rejection or SUI were not noticed in any case.Conclusions The anatomical repair of pelvic floor is the most effective modality for vaginal rejuvenation.Adjunct SIS can enhance vaginal elasticity,reduce scar formation and recurrence,particularly.

Vaginal tightening surgery by strengthening the pelvic floor support / 中华医学美学美容杂志

Objective To explore the related pelvic floor anatomy to the pathological vaginal relaxation and key points of the vaginal tightening surgery.Methods The vaginal tightening surgery was performed in 24 cases of vaginal relaxation.The key points of this operation included levator ani muscle suturation and perineal body reconstruction,and anal sphincter reconstruction as in case of the muscle injury grade Ⅲ.Results The degree of levator ani muscle separation was positively correlated with that of vaginal relaxation in all the 24 cases.18 cases were followed up from 6 months to 2 years,and had no complications of rectovaginal fistula and infections.The average level of perineal body was increased from 2.3 cm to 3.5 cm.Vaginal length of 6 cm from vaginal orifice was proper with good tightness.The patients felt strong anal contraction,enhanced ability of vaginal tightening and improved quality of sex life.There were no more infections of genitourinary tract.Conclusions Through levator ani muscle suturation and perineal body reconstruction,it can get the vaginal tightening effect.

Clinical efficacy of improved vaginal tightening surgery on vaginal relaxation / 中华医学美学美容杂志

Objective To explore more effective methods in vaginal tightening surgery for vaginal relaxation treatment. Methods 132 cases of patients who suffered the decline in quality of sex life owing to vaginal relaxation, requiring improved vaginal tightening surgery. The vaginal surgery was performed to repair the muscles and fascia of the anterior and posterior walls effectively, meanwhile the perineal laceration was also repaired. According to the hammock theory of the treatment of urethral disruption, patients with urinary incontinence with tension was treated to strengthen one suture needle on muscle fascia in the middle of urethra, when repairing anterior of vagina. For patients with constipation, the posterior of vagina was repaired to strengthen 3 suture needles on levator ani during repairing the anterior and posterior wall, so that the vaginal mucosa could get maximum protection. Results 118 patients had been followed up for 2-7 years. A questionnaire survey was conducted about four elements targeted on improving sexual satisfaction, tension incontinence, constipation and vaginal discharge. The clinical results were satisfactory. Conclusions The surgical design is professional and highly effective, and the patients are satisfied with the results. It is suitable for experienced specialists to perform the procedures.