LASER VAGINAL REJUVENATION (LVR)
Laser Vaginal Rejuvenation is a surgical procedure that tightens the walls of the vagina for the purpose of improving sexual function. The vagina gets stretched during normal childbirth, and after several pregnancies, this can result in vaginal laxity which compromises sexual function and can also cause stress urinary incontinence (SUI).
During the procedure, a surgical laser is used to dissect the vaginal tissues and expose the muscles in the walls of the vagina. The muscles are then carefully tightened with stitches to reduce the size of the vaginal canal, thus making it suitably tighter. Excess internal vaginal lining is removed, again with the laser. The result is a tighter vagina, enhanced sexual function and relief from the symptoms of SUI.
The LVR procedure was created by Dr David Matlock, a renowned OBGYN specialist from Los Angeles, U.S.A. Dr Huang was personally trained by Dr Matlock in his practice in Los Angeles in 2007 and learned the technique directly from him. He is certified by Dr Matlock to be competent and proficient in his trademarked LVR procedure. He has been performing this procedure in Singapore for the past ten years.
ADVANTAGES OF THE LVR TECHNIQUE
The advantage of using a laser is that it cuts with surgical accuracy and stops bleeding at the same time. This is an important advantage when working in the vagina because, being a narrow deep tube-like structure, surgical access and visualization can be difficult. It is therefore technically challenging to perform surgery in the vagina. In addition, any bleeding that occurs during surgery will only make it harder for the surgeon to see what he is doing.
Furthermore, the vagina is right next to two vital organs: The bladder and urethra in front, and the rectum behind. When the vaginal muscles are stitched to tighten them, it is extremely important that these vital adjacent structures are not inadvertently injured by the needle going through the vaginal wall. This is why clear visualization in a clean, bloodless surgical field is so crucial in this operation. Working with the laser therefore facilitates a safe, and adequate muscle repair, resulting in effective tightening of the vagina with minimal risk of complications.
LVR is a two hour operation completed under general anesthesia as a day surgery procedure. A long acting local anesthetic is injected around the pelvic nerves that supply sensation to the vagina to provide immediate postoperative pain relief. A urinary catheter is inserted and the bladder is emptied. The front and back walls of the vagina are injected with a saline solution containing adrenaline to make the tissues expand and swell up. This facilitates subsequent surgical dissection and reduces bleeding.
Incisions are made along the inner lining of the front and back walls with the laser. The lining is dissected off the underlying muscles. The muscles are then tightened with sutures.
Excess lining is removed, and the wounds are closed with dissolving stitches that do not need to be removed. A gauze pack is inserted into the vagina like a large tampon to prevent postoperative hemorrhage.
Postoperative pain is managed adequately with oral painkillers. The vaginal gauze pack is removed after one day. Initially, the swollen vaginal tissues around the urethra will constrict it, making urination difficult. For this reason, the urinary catheter is maintained for four to five days to allow unimpeded emptying of the bladder. As it is attached to a flexible urine bag that can be conveniently strapped to the thigh, the patient is able to walk freely with the catheter in place from day one. After this period, the swelling will have subsided sufficiently to allow normal urination, and the catheter is removed.
Due to their proximity to the vagina, the rectum and anus will also be swollen. Anti swelling suppositories are therefore required during the first week. Stool softeners are prescribed during the first one month to prevent constipation, so that the vaginal wall repair is protected from undue strain and tension. Physical exercise and sexual intercourse can be resumed at around six weeks after the surgery.
The use of the surgical laser helps to make this procedure efficient and safe. Blood loss is therefore minimal. The risk of infection is also low. Injury to the bladder, urethra, rectum or anus are rare because of good visibility in the dry surgical field afforded by use of the laser. Undercorrection, i.e. inadequate tightening of the vagina is also uncommon because it is easier to perform an adequate repair under the optimal conditions created by use of the laser. Overcorrection can be prevented by careful judgment and the avoidance of overzealous tightening of the vagina.