Besides the primary function of delivering newborns, the vagina is responsible for menstrual hemorrhage and sexual behaviors and is the most frequently used and important private part. However, along with age and usage, the pelvic floor muscles and suspension ligaments around the vagina gradually loosen, which, combined with muscular laceration at the vaginal opening due to rapid dilation from natural delivery, is highly likely to cause the loss of vaginal elasticity and render the original smooth tubular vaginal wall into a hollow gourd shape. Mild cases result in no tightening sensation during sexual activity, and severe cases suffer from recurrent vaginal infection and even concurrent uterine prolapse or cystocele. If vaginal laxity diminishes the satisfaction of sexual life, patients should consider undergoing vaginoplasty in due time to improve the symptoms and intimacy.

Currently, there are no objective judgment rules on vaginal looseness in medicine; therefore, it is subjective and based on the following:

• No sensation during the whole or latter course of sexual behaviors
• No sensation due to vaginal lubrication on sexual behaviors
• Unable to feel the male sexual organ motion during sexual intercourse
• Occurrence of embarrassing circumstances such as gas discharge sounds during sexual intercourse due to vaginal laxity
• Unknown recurrent vaginal inflammation or leukorrhea at the vagina
• Subjective dissatisfaction of the male partner

The improvement that vaginal tightening can render is difficult to be quantified, so the patient should honestly communicate with the physician, and factors, including self-requirements and even the size of the partner’s sexual organ, should all be taken into account. Currently, Dr. Chuang recommends finger breadth as the basis for the measurement of vaginal tightness. The erect genitals of Oriental males measure approximately 3–3.5cm in diameter, which is approximately equal to the width of two fingers. Therefore, if the vagina could be shrunk within the width of two fingers, it satisfies the requirements of a majority of patients. However, in case of any particular requirements, the patient should inform the physician; otherwise, under-reduction results in insignificant improvements or poor durability, and over-reduction results in intercourse pain and difficulty or possible vaginal laceration, which gives rise to unnecessary complications. Currently, Dr. Chuang primarily offers the following techniques of vaginoplasty based on the patient’s conditions and requirements:

Vaginal Rugae Rejuvenation

Whole-layer Vaginoplasty

Autologous Fat / Hyaluronic Acid Injection