Category: female genital surgery

INTRODUCTION

• Hymenoplasty or Hymenorraphy is a surgical reconstruction or repair of the hymen membrane (ring-like skin covering the entrance to the vagina).
• Intact hymen in some cultures or places is the basis of a woman’s virginity. Blood on wedding sheets after the first sexual intercourse following the marriage is recongised as a proof of a woman’s virginity.
• The tearing and bleeding of the hymen cannot be used as a genuine confirmation of virginity. Some women tear their hymen membrane during vigorous exercise or due to use of tampons.
• Various techniques of hymenoplasty:
  • Suturing the torn hymen (true repair of hymen) :
    • This is a very delicate surgery that has to be done with precision and the surgeon must ensure durability of the result.
    • Dr Ng prefers double repair method. A more durable methodology.
  • Vaginal lining flap :
  • • Done by cutting a piece of vaginal lining to reinforce the hymen and sometimes this is combined with the injection of a gelatin capsule to fake bleeding during sexual intercourse.

SUITABLE CANDIDATES

• Patients who require an intact Hymen for personal, cultural or religious purposes.

CONCURRENT PROCEDURES

• Patients who undergo this procedure may also request labiaplasty, laser vaginal rejuvenation and G-spot augmentation.

ANAESTHESIA

• A combination of local and intravenous sedation (The procedure can be assisted by an anaesthetist according to patient preference).

DESCRIPTION OF PROCEDURE

• Administration of sedation and local anaesthesia.
• Identification of torn edges of the hymen followed by a repair using absorbable sutures in two layers.
• Surgical duration : 1 hour
• Home on the same day

POST OPERATIVE CARE

• Medication : Oral and topical antibiotics, analgesics (pain relief), anti-swelling medication
• Sanitary padding for 2-3 days for residual discharge.
• Avoid activities that will exert pressure to the groin for 2-4 weeks.
• Earliest time for sexual activity : 2-3 weeks.

RISK AND CAUTION

• Infection
• Swelling
• Bleeding

INTRODUCTION

• G- Spot also known as the Grafenberg spot. It is the erogenous area of the vagina that when stimulated, may lead to strong sexual arousal, powerful orgasms and potential female ejaculation. (Morris, Desmond (2004). The Naked Woman: A Study of the Female Body. New York: Thomas Dunne Books. pp. 211–212. ISBN 0-312-33852-X.)
  G-spot Location
• It is said to be located within 1-2 inches in the anterior vaginal wall. It feels like a spongy bump which is different from the other part of the vaginal lining.

• The G-Spot can be augmented to provide better sensation by injection of Hyaluronic Acid filler or autologous fat in this region.

SUITABLE CANDIDATES

• Females that wants to enhance their sexual gratitude and pleasure.

CONCURRENT PROCEDURES

• Can be combined with hymenoplasty, laser vaginal rejuvenation and G-spot augmentation

DESCRIPTION OF PROCEDURE

• Sedation can be given according to patient’s preference.
• Fat harvest from inner thigh or abdomen and injected to the G-spot using a very fine needle.
• Alternatively, a hyaluronic acid filler can be injected.
• Procedure duration: 15 min – 1 hour.
• Home on the same day.

ANAESTHESIA

• Sedation can be given according to patient’s preference.

POST OPERATIVE CARE

• Medication : Oral and topical antibiotics, analgesics (pain relief), anti-swelling medication
• Sanitary padding for 2-3 days for residual discharge.
• Avoid activities that will exert pressure to the groin for 2-4 weeks.
• May resume sexual activity after 2-3 days.

RISK AND CAUTION

• Possible minimal bleeding and mild discomfort for 1-2 days

INTRODUCTION

• With ageing, the facial skin tissue loses elasticity and sagging occurs. The same occurs to the genital area and vaginal lining. However, the most common cause of vaginal wall laxity is overstretching of the vaginal wall during childbirth, which worsens with the number of child deliveries.
• Loss of tissue tensile strength can also result in an increase in the inner diameter of the vaginal wall. It can result in loss of friction and sexual satisfaction for both the woman and her partner.
• Laser Vaginal Rejuvenation is a non-invasive procedure that can address these conditions. In addition it is also used to rejuvenate the outer part of the female genital (labia minora and labia majora). It can treat stress incontinence but not all types of urinary incontinence.
• Urinary incontinence (leakage of urine) is also frequently noted in patients with vaginal laxity.
  There are different types of urinary incontinence :
  • Stress Incontinence – urine leakage caused by activities that increase intra-abdominal pressure, such as coughing, sneezing and laughing. This is due to weakness in the pelvic floor muscles.
  • Urge Incontinence – urine leakage caused by an overactive bladder resulting in involuntary loss of urine occurring when the patient suddenly feels the urge to urinate. This can be due to issues in the bladder nerves or muscles.
  • Overflow Incontinence – urine leakage due of inability to totally empty your bladder, which is usually caused by a weakened bladder and blockage within the ureters.
• This procedure uses a laser probe inserted into the vagina canal that emits Er:YAG non-ablative laser for tightening the vaginal wall. It heats up the genital mucosa to initiate collagen remodelling and subsequent production of new collagen.
• The final result of collagen neogenesis is the shrinking and tightening of vaginal mucosa tissue and collagen-rich endopelvic fascia and subsequently greater support to the bladder and the return of normal continence function.
• This procedure has been reported to provide over 90% patient and partner satisfaction rate.
• This treatment consists of 2 laser sessions done 6-8 weeks apart. Significant results are usually felt by 6 weeks.

Vaginal Tightening
Courtesy of: Fotona
Laser source: Fractional Er:YAG

Stress Urinary Incontinence Treatment
Courtesy of: Fotona
Laser source: Fractional Er:YAG

SUITABLE CANDIDATES

• Vaginal muscle and lining laxity resulting in dissatisfaction in both partners.
• Urinary incontinence (involuntary passage of urine while laughing, coughing and sneezing)

DESCRIPTION OF PROCEDURE

• Two laser sessions – 6 to 8 weeks apart
• Pap Smear done prior to the procedure.
• Sedation can be given according to patient’s preference.
• Application of topical anaesthesia (numbing cream) to the genital area
• Insertion of laser probe for vaginal tightening.
• Laser treatment to the labia for further tightening and rejuvenation.
• Application of antibiotic cream to the outer genital area
• Duration of procedure : 30-45 minutes
• Patient can go home on the same day.

ANAESTHESIA

• Topical anaesthesia + IV Sedation – Sedation can be given according to patient’s preference.

POST OPERATIVE CARE

• Medication : Oral and topical antibiotics, analgesics (pain relief).
• Avoid activities that will exert pressure to the groin for 2-3 days.
• May resume sexual activity after 1 week.
• 2^nd laser session in 6-8 weeks

RISK AND CAUTION

• Patient may experience transient vaginal dryness for up to 1 week.

REFERENCE

• Novel Minimally Invasive VSP Er:YAG Laser Treatments in Gynecology
  Vizintin Z, Rivera M, Fistonić I, Saraçoglu F, Guimares P, Gaviria J, Garcia V, Lukac M, Perhavec T, Marini L.
  Journal of the Laser and Health Academy, Vol. 2012, No. 1, P. 46-58.
• Minimally invasive laser procedure for early stages of stress urinary incontinence (SUI)
  Fistonić I, Findri-Guštek Š, Fistonić N.
  Journal of the Laser and Health Academy, Vol. 2012, No. 1, P. 67-74.