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

Comparison of various vaginal tightening surgeries

Vaginal opening tightening

(Vaginal rugae rejuvenation)

Whole-layer vaginal tightening

(Whole-layer vaginoplasty)

Autologous fat augmentation
Ideal candidates Patients with mild to moderate vaginal laxity due to aging but without vaginal delivery Patients with severe vaginal laxity due to a previous vaginal delivery or laceration Young or unmarried patients who have not had natural birth via vaginal delivery
Vaginal symptoms Vaginal opening dilation or laxity Distinct slackness from the vaginal opening to inside the vagina Vagina with adequate elasticity but poor adaption
Labor conditions No vaginal delivery Multiple births or with vaginal delivery No vaginal delivery or pregnancy
Surgical incision 3–5 cm inside the vaginal opening 8–10 cm inside the vaginal opening No
Anesthesia method IV sedation + local anesthesia IV sedation + local anesthesia IV sedation + local anesthesia
Surgical depth Vaginal superficial mucosa/regional vaginal muscle stitching for tightening Vaginal deep muscle and superficial mucosa stitching Injection below the superficial vagina
Surgical recovery period 2–3 days 5–7 days 1–2 days
Postoperative stitch removal No No No
Postoperative pain Mild Obvious Mild
Sexual intercourse limitation 1 month 1 month 2 weeks
Vaginal tightness Moderate Good No
Result durability Approximately 2–3 years Approximately 3–5 years Unstable