Perineorrhaphy

Hi Kate,

I know it doesn’t help much to hear, but we are an entire generation of women before you who received unwanted and un-consented episiotomies. It is true that the opening is never the same, but when we have our reproductive hormones it hardly seems to matter because vulva skin is elastic and the real tightening and gripping during sex is coming from the pelvic wall muscles. I think most women my age would agree that at least our generation didn’t have to deal with the extreme self-consciousness of the appearance of the vulva that is so prevalent today. I never thought or cared about what my vaginal opening looked like.

I can’t tell you whether a very careful, superficial repair would improve your condition or not. As you must know, they can’t simply bring the two edges together and stitch them closed, but must make a cut, or colporrhaphy, so that the raw edges can knit together. This means making the opening smaller, which sounds like what you are looking for.

The danger with a deeper posterior colporrhaphy is that the fascia layers between vagina and rectum become fused together. When you bend over to touch your toes, your vagina and rectum move independently due to sliding motion of the inner fascia layers. Same is true when you have a bowel movement or sexual intercourse. If the back vaginal wall is permanently fused to the front rectal wall, these organs must move as one unit. The result is a surprising loss of flexibility. Pulling of the bladder toward the back is a common result, which has been widely published in the gynecologic literature over decades. Here are the words of one of our members, Blissedout:

“I had fascial plication/vagina trimmed and posterior wall sewn back with the result that fexibility, as Christine said is gone and a bladder prolapse is now unmasked and descending with a bulge on the outside front wall which feels awful!”

Perhaps you found this lovely post by Granolamom:

“I dont even remember all the ins and outs of my own history anymore but in a nutshell, my perineum is a mess. I never tore through my sphincter though, so that's a good thing. I've had more babies anyway and it hasnt gotten worse. I dont know if the unrepaired tears are 'why' I developed a prolapse, but that doesnt even matter anymore because my prolapse is well controlled. if you dont have a prolapse now, dont go borrowing trouble, but do read all you can here and adopt the posture, which will be your best bet in attempting to prevent POP.
as christine said, I did toy with the idea of having my tears repaired, but felt that the risk of surgery did not outweigh the benefits.
I will be very honest with you, the worst part of this messed up perineum is the psychological stuff. there is a real loss here, a loss of body integrity, possibly a loss of what you feel is your femininity, or beauty or female strength. it is so many different things to different women, but I do think the commonality is that something feels taken. and that loss, even if you cant pinpoint what it is exactly or why its so important, is real and deserves to be mourned. the grief process has been well studied and defined, and I can tell you that I spent YEARS mourning the loss of my perineum and I did come out the other side with full acceptance. I am healthy and strong. I have birthed more babies with this less than perfect perineum of mine, I've carried them on my back and danced with them in the rain. I'm ok, and so will you be. not the same, but ok. and that is life, none of us get through it unscathed. you will find your new normal, and you can still live a full and happy life. for now its scary, I know that, but maybe you can trust me just a tiny bit..maybe enough to take the edge off the fear..that you will be ok.”

I think this is one of those journeys you are going to have to take on your own, Kate. Perhaps the psychological aspect of a careful repair will help you feel healed. What must be avoided however is a too-tight, inelastic vagina.

How are you coming along with the WW work? You’ve probably heard us say that the vagina closes in two ways. The round, drawstring closure (kegel) is one, which just like a drawstring purse, never fully closes. The other closure follows the movement of the bony pelvis. When we’re in WW posture the back vaginal wall clamps down against the front vaginal wall creating a closed, airless space. This is the real, tight closure that protects against prolapse and incontinence. The “gaping” vagina that gynecology has terrified many a woman with can only happen when the pelvic wall is slack. Lift your tailbone and the entire area tightens up.

Please keep us posted on your progress!

Wishing you well,

Christine