Urogynecologist’s Vaginal Rejuvenation Surgery Worsens Sexual Problems

This case involves a female patient who had surgery to remove a vaginal polyp five years ago. After the patient had spoken to a sex therapist about her discomfort, she was told that the issue may be medical and contacted her Ob/Gyn. The consequent surgery was conducted without incident, but the patient began to experience pain, bleeding, and tearing during intercourse in the area where the polyp had been removed. The patient’s Ob/Gyn referred her to a specialist to develop an effective treatment plan. She was referred to an urogynecologist and was informed that a corrective rejuvenation surgery would solve her problem. The patient underwent the corrective procedure and the surgery was performed without any intraoperative complications. The patient, however, continued to experience long-term sexual dysfunction that included the inability to orgasm during intercourse.

Question(s) For Expert Witness

1. What are the indications and contraindications of vaginal rejuvenation surgery?

Expert Witness Response E-004801

Patients who report unpleasant aesthetic appearance, hygiene problems, chronic irritation, painful intercourse, and trouble with tight clothing are all considered candidates for surgery. Labia reduction surgery is relatively contraindicated in patients who have active gynecological disease, such as infection or malignancy. Patients who are smokers, and are unwilling to quit temporarily or permanently to optimize wound healing, may be excluded. Perhaps most importantly, patients with unrealistic goals or expectations should be appropriately counseled or excluded from surgery. This patient may have had some underlying psychiatric issue that should have been addressed before surgery and the corrective procedure may have uncovered a more ominous situation.