Impact of vaginoplasty on hiatal dimensions measured by translabial ultrasonography

Vaginal laxity (VL), characterized by a sensation of vaginal looseness, is a condition that can adversely affect quality of life. Vaginoplasty is a surgical intervention aimed at addressing VL by enhancing both functional support and aesthetic appearance. The outcomes of vaginoplasty have frequently been reported as favorable based on self-reported questionnaires; however, such results are inherently subjective and reflect individual perceptions of satisfaction. This study aimed to objectively evaluate the effectiveness of vaginoplasty in treating VL by using translabial ultrasonography to measure changes in the levator ani muscle hiatus before and after surgery. This prospective study included 36 women aged 18 to 45 years who underwent vaginoplasty at the Cosmetic Gynecology and Sexual Dysfunction Clinic, Ankara Bilkent City Hospital, between June and December 2024. Preoperative and postoperative assessments were performed using translabial ultrasonography to measure the levator ani muscle hiatal area and anteroposterior diameter at rest, during the Valsalva maneuver, and at maximum pelvic floor contraction. Postoperative ultrasonographic evaluations demonstrated significant reductions in both the anteroposterior diameter and hiatal area (P < .01). The hiatal area during Valsalva decreased from 29.14 ± 2.68 cm² preoperatively to 23.51 ± 3.41 cm² postoperatively, indicating a measurable improvement in pelvic floor support and a reduction in vaginal laxity. Vaginoplasty significantly improves vaginal laxity, as evidenced by objective ultrasonographic measurements of the levator ani muscle hiatus. These findings provide objective support for the effectiveness of vaginoplasty, complementing previous subjective outcomes. However, further studies with larger sample sizes are needed to confirm the long-term effects of the procedure.