Perineoplasty: what it can and cannot do. Post-partum scarring and excess skin

Perineoplasty is a procedure that removes excess skin and scars remaining after perineal incision or tearing during childbirth, then re-sutures the area to restore a pre-pregnancy appearance[1]. The main targets are visible irregularities and pain during intercourse caused by scarring[2]. Conversely, if scar tissue pain or underlying skin disease is present, those conditions should be evaluated before surgery[3][4].

Which concerns does this surgery suit?

The procedure is well-suited for excess skin remaining in the perineal area, raised scars, resulting tightness, or pain during intercourse. Obstetric textbooks describe this type of surgery as the choice when severe perineal scarring is associated with pain during intercourse[2].

Reports indicate that people who have experienced perineal incision or laceration often face difficulties when resuming sexual activity[5]. Some describe losing confidence due to scarring, and both appearance and emotional concerns tend to affect this area[5].

What does the surgery involve?

Excess skin and hardened scar tissue are removed, and the perineal muscles are re-sutured as needed to reshape the area[1]. When scarring is extensive, the incision may extend from below the urethra to just before the anus[2].

Suturing technique and thread material are known to affect post-operative pain and scar healing[6]. Before surgery, clarify how far the incision extends, which sutures will be used, and how they will be placed.

What should be checked before surgery?

Attention is needed if there is a nodule in the perineal scar that causes pain with each menstrual cycle. Endometriosis can develop in the scar tissue from episiotomy, and symptoms are reported to appear several months to years after delivery.[3][7].

If there is itching or whitish changes in the skin, it may be lichen sclerosus, a skin disease. In this condition, topical medication is the mainstay of treatment, and surgery is performed as an adjunct for people who continue to have pain during intercourse.[4]Even with surgery in nearby areas, it is reported that people with such conditions are more prone to wound separation or scarring.[8].

What cannot be achieved with surgery?

Even if surgery can improve the form, it cannot necessarily resolve all emotional concerns. It is reported that people with a strong preoccupation with body appearance (body dysmorphic disorder) are less likely to be satisfied after surgery.[9].

Additionally, there is no consensus among gynecologists about when perineal reshaping surgery is recommended. Only 20% of physicians consider fecal incontinence as an indication for surgery, and research in this field is currently limited.[10].

What is the rate of complications such as wound separation?

We did not find any research specifically counting complications of perineal skin reduction surgery itself. In labia minora reshaping surgery, which is a similar procedure, the most common complication is wound separation, reported at 4.7%.[11].

According to the same report, satisfaction rates are approximately 90–95%.[11]However, since this is data from a different procedure, use it only as a reference, and ask your doctor about the outlook in your specific case.

What should I confirm during consultation before the procedure?

It is important to confirm whether the concern is due to excess skin or scarring, or rather due to nodules or skin disease. Tell your doctor at the time of consultation whether you experience pain in sync with menstruation, have itching, or have pain during intercourse.

Then confirm with your doctor the extent of the area to be cut, the suturing method, and guidance on post-operative pain and bathing. Since the time since delivery and the condition of the scar differ from person to person, have an examination and discuss your specific situation to make a decision.