Cosmetic vaginal surgery includes both internal (vaginal) and external (vulvar) procedures, with around a dozen different types. Below is an overview of each procedure.

Vaginal Laxity: to enhance female intimacy and sexual gratification. Using a precise and artistic surgical technique, Dr Pilzek reduces the vaginal diameter in tightening both the internal and external vaginal canal to enhance friction during intercourse.

Vaginal Rejuvenation – Non Surgical: ThermiVa is a non-surgical, pain-free, in-office treatment for vaginal laxity, decreased sexual sensation, and labia majora rejuvenation. Using radiofrequency energy, it gently heats internal (vaginal) and external (vulvar) tissue to restore and enhance feminine wellness. Three 30-minute sessions improve vaginal and vulvar tone, increasing friction and sensation during intercourse. Peri- and postmenopausal women may also experience enhanced lubrication and increased clitoral sensitivity.

Perineoplasty – enlarged vaginal opening surgery: The surgical procedure used to correct both a small and a large vaginal opening is called a perineoplasty. The term perineum refers to the area between the vaginal opening and the anus, while plasty signifies surgical reconstruction, which can involve either tightening or enlarging the area depending on the patient’s needs.

For patients with an enlarged vaginal opening, perineoplasty focuses on reconstructing and strengthening the perineal tissues. This procedure restores the integrity of the perineum, providing better structural support and narrowing the vaginal opening. By doing so, it can enhance both function and aesthetics, improving overall vaginal tone and sensation.

Vaginal Cosmetic Surgery (Labiaplasty): is a cosmetic surgery aimed at improving the appearance of the external vaginal and vulvar structures. Some women are born with enlarged labia or experience changes due to aging or childbirth, leading to discomfort or dissatisfaction. Labiaplasty can enhance aesthetics and relieve irritation caused by enlarged labia.

Labia Majora Augmentation: is a cosmetic vaginal surgery commonly performed alongside other procedures, such as labiaplasty or revision of a botched labiaplasty. This surgery is typically done to address the deflated or flattened appearance of the labia majora, a condition known as labia majora atrophy. This atrophy often occurs as a result of aging, weight fluctuations, or changes following pregnancy and childbirth.

Clitoral Hood Reduction (Prepuce) Lift: Shorten the Length of the Hood: To enhance the natural appearance of the vulva, many women request a clitoral hood lift in conjunction with their labiaplasty. However, an inexperienced surgeon may either fail to properly remove the excess skin or remove it incorrectly, leading to less than ideal cosmetic results.

Clitoropexy – clitoris reduction surgery: Due to aging, childbirth, weight changes, or pregnancy, some women experience a sagging or protruding clitoris. This can lead to dissatisfaction with the appearance of the clitoral hood or the clitoris itself, which may protrude outward, sometimes described as resembling a “small penis.” At the patient’s request, the clitoris can be repositioned upward and inward, reducing the protrusion.

Monsplasty – Mons Pubis Reduction: (also known as mons pubis liposuction or monsplasty) is considered a type of cosmetic vaginal surgery, although it is not directly related to the vagina or vulva. This procedure is typically performed for women dissatisfied with the excess fatty deposits at the base of the abdomen, where the belly meets the pubic area. The mons pubis is located just above the pubic bone, above the clitoris and its hood.

Hymenoplasty – Hymen Restoration: a procedure designed to repair a torn hymen for individuals who wish to restore it. The hymen can tear early in life due to factors other than intercourse, such as heavy lifting, cycling, or accidents that cause trauma to the vulva and vaginal opening. This surgery reconstructs the hymen to restore it to a virginal state. Often performed for cultural, religious, or social reasons, this procedure can be done in a private office setting to ensure confidentiality and anonymity.

G-Spot Atrophy: designed for patients with G-spot atrophy or reduced G-spot sensation. This painless procedure is performed in our office under local anesthesia, with the injection taking less than 15 seconds and the total procedure lasting under 15 minutes. The shot enhances sensitivity during intercourse for women who are familiar with their G-spot or helps those who have difficulty locating it. The effects can last up to 4 months. In a pilot study, 87% of women reported increased sexual arousal and gratification after receiving the G-Shot. Results may vary by individual.

Vaginal Cosmetic Surgery (Labiaplasty) is a cosmetic surgery aimed at improving the appearance of the external vaginal and vulvar structures. Some women are born with enlarged labia or experience changes due to aging or childbirth, leading to discomfort or dissatisfaction. Labiaplasty can enhance aesthetics and relieve irritation caused by enlarged labia.

Contrary to common belief, labiaplasty is not a simple procedure—it requires precision, expertise, and artistry to achieve optimal results. Many plastic surgeons lack experience in this specialized field, making surgeon selection crucial.

Cosmetic vaginal surgeries include:

• Labia Minora/Majora Reduction

• Clitoral Hood Reduction & Lift

• Botched Labia Revision

• Mons Pubis & Perineal Reduction

Achieving the best results often requires a combination of procedures. For example, 70% of women with enlarged labia minora also have excess lateral prepuce, which must be reduced for balanced aesthetics. True expertise is essential to create natural, symmetrical results.

Female Urinary Incontinence refers to the involuntary loss of urine, often leading to anxiety, social embarrassment, and limitations on daily activities. Fortunately, most cases can be effectively treated.

The two main types of urinary incontinence are:

1. Urgency Incontinence (Overactive Bladder) – Characterized by a sudden, strong urge to urinate, often leading to leakage before reaching the restroom. Symptoms include frequent urination, urgency, and nighttime urination. Treatment typically involves medication.

2. Stress Urinary Incontinence – Occurs during physical activities such as coughing, sneezing, laughing, running, or exercising. The most effective treatments are the Burch procedure or sling surgery, both designed to support the urethra and prevent leakage.

Treatments

• Laparoscopic Burch (A NON-MESH surgical treatment)
• TVT Sling
• TOT Sling
• Single Incision Sling

Laparoscopic Burch Procedure
Non-Mesh Surgery for Incontinence (SUI)

The Burch procedure has been a leading surgical treatment for stress urinary incontinence since the early 1960s. Unlike mesh-based procedures (such as TVT, TOT, and single-incision slings), the Burch procedure uses sutures to lift the vagina and support the urethra, preventing urine leakage. This technique provides a mesh-free alternative with cure rates comparable to sling procedures, especially when performed laparoscopically.

The Laparoscopic Burch procedure is a minimally invasive surgery performed through small abdominal incisions in under 30 minutes. The surgeon places four sutures through the vaginal wall, anchoring them to the Cooper’s ligaments on the pelvic bone, effectively preventing urine leakage in 90% of cases.

First, you would need to be evaluated by Dr. Pilzek to determine the potential causes.

Adhesions can occur when inflammation develops on the inner surfaces of the abdominal and pelvic cavities, leading to the formation of scar tissue as part of the body’s natural healing process. Adhesions can become problematic when they cause symptoms or complications.

Abdominal adhesions may attach to various abdominal organs, including the intestines, bowel, colon, liver, gallbladder, peritoneum (the lining of the abdominal wall), appendix, spleen, kidneys, or ureters. Pelvic adhesions typically form in the lower abdomen and within the pelvic cavity, affecting organs such as the uterus, vagina, fallopian tubes, ovaries, rectum, bladder, and sigmoid colon.

Adhesions can be asymptomatic or cause mild to severe symptoms. Abdominal adhesions often lead to bloating, nausea, and abdominal pain. Pelvic adhesions are linked to increased menstrual pain, pelvic discomfort, and infertility. A serious complication of abdominal and pelvic adhesions is bowel obstruction, with mild symptoms including cramps, pain, and distension, worsened by eating. Severe obstruction causes intense pain, vomiting, and significant abdominal swelling, requiring immediate medical attention.

Treatment: The medical term for surgery to remove adhesions is adhesiolysis.

Dr. Anna Pilzek understands the pain and frustration that adhesions can bring. While many surgeons may claim adhesions don’t cause pain, they likely haven’t experienced what you’re going through—pain. Learn about solutions for abdominal or pelvic adhesions, including the minimally invasive surgery used to remove them.

Bulkamid Injection: Bulkamid is a water-based gel used as a bulking agent to treat stress urinary incontinence (SUI) in women. It is injected into the urethral wall to help it close more effectively and prevent urine leakage. The gel is made of 97.5% water and 2.5% polyacrylamide, making it a long-lasting and biocompatible option for SUI treatment. Unlike some other treatments, Bulkamid does not require surgery and is typically performed as a minimally invasive outpatient procedure.

Sacral Neuromodulation: (SNM) with Axonics. The Axonics System is a rechargeable, long-lasting SNM device that helps regulate bladder and bowel function by stimulating the sacral nerves with mild electrical impulses. It is implanted under the skin and can be controlled externally. Axonics offers a small, MRI-compatible device that is designed to last over 15 years, making it an attractive alternative to traditional SNM systems.

eCoin: is a minimally invasive, neurostimulation-based treatment for urge urinary incontinence (UUI) caused by overactive bladder (OAB). Unlike traditional sacral neuromodulation (SNM) devices, eCoin is implanted in the lower leg near the tibial nerve, making it simpler and quicker to implant than sacral-based solutions like Axonics or Medtronic’s InterStim. A small, coin-sized neurostimulator is implanted under the skin near the ankle in an outpatient procedure that takes about 20 minutes. The device delivers automatic, programmed stimulation to the tibial nerve, which plays a role in bladder control. The battery lasts about 3 years before replacement.

IncontiLase is a non-invasive laser treatment used to treat mild to moderate stress urinary incontinence (SUI) in women. It utilizes Er:YAG (erbium-doped yttrium aluminum garnet) laser technology, which works by stimulating collagen production and tightening the vaginal and urethral tissues.

Botox (onabotulinumtoxinA): is an FDA-approved treatment for overactive bladder (OAB) and neurogenic detrusor overactivity (NDO) when other treatments, like medications or behavioral therapies, are ineffective. It works by relaxing the bladder muscles, reducing involuntary contractions that cause frequent urges to urinate, urgency, and leakage.