It’s Just Not Right Down There… Fix It!

It’s just not right down there… fix it! Newport Beach
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Dr. Karen Leong | 08/17/2020

Okay ladies, it’s time to get personal! Let’s talk about VAGINAS!

This is a “hands-on” activity, go grab a mirror and get comfy because you and I, we’re going to look together and really get to know you, down there.

The whole goal of the consultation is to get you comfortable talking about what troubles you about your labia and vagina. Now, I completely understand how awkward this may be. We’re taught to keep our legs together and our mouths shut when it comes to our private bits, but I find that with a little humor, you and I will do just fine.

The most important thing to remember is that WE ARE ALL NORMAL. In the same way that we come light or dark, short or tall, chubby or skinny, our vaginas also come in different shapes, sizes and colors. True, hormones, childbirth and/or trauma all play a role in changing how our vaginas look and feel over time, but you should never be ashamed of yourself or afraid to seek help.

Quick anatomy and medical terminology lesson:

Labiaplasty – cosmetic reduction of the inner lips of the vagina so that they are flush with the outer lips

Vaginoplasty – tightening of the vaginal opening (may involve inside the vaginal canal, just the muscular ring, or both)

Perineoplasty – tightening of the muscular ring (introitus) of the vagina and repairing the tissue that is torn during childbirth or cut during episiotomy. 

When you come in for your consultation, we have a frank discussion about the areas that trouble you. This may have to do with appearance,  muscle laxity, sensation, and/or lubrication. Let’s go over this one by one.

Appearance: Typically involves the labia minora (inner lips). These may be elongated and have dark discoloration. The clitoral hood is involved in most cases with too much skin around the clitoris as an extension of excess tissue of the labia.    

  • Common complaints: uncomfortable/chafing in underwear, swimwear, leggings; tissue paper gets caught/difficulty with hygiene; gets in the way during sexual penetration; embarrassed to wear form fitting bottoms due to “camel toe”.
  • Treatment: Labiaplasty or trimming of the extra tissue of the inner lips so that they are flush with the outer lips (labia majora) and removal of the excess clitoral hood. This procedure is done in the office with mild sedation and a numbing medicine. You will feel sore and swollen for 1 week. Sutures are trimmed at 1 week. You should not be sexually active or use tampons for 6 weeks after surgery.

Muscle Laxity: Most often due to childbirth where the muscles of the pelvic floor are stretched apart and do not return to their original position. I examine you by having you cough/bear down and feeling for a bulge or weak spot along the vaginal canal. If you have symptoms of urine leakage or chronic constipation, I may refer you to a urogynecologist or gynecologist to make sure that your bladder and rectum are not involved.  


  • Common complaints: Decreased sensation during sexual penetration; feeling that you are “loose”; your partner complains of laxity    
  • Treatment:  
  1. Mild cases may benefit from our vaginal laser, BellaV. This is an Er:YAG laser that stimulates blood flow to the lamina propia/muscle layer of the vaginal canal to thicken the tissue and therefore tighten. 
  2. Moderate cases may require surgical tightening. This is a procedure done under general anesthesia to bring the edges of the levator ani muscle of the vaginal canal back into alignment. The muscle ring of the vaginal canal (introitus), which allows you to voluntarily squeeze the opening of the vagina may also require repair. You will feel sore and swollen for 1 week. Sutures are trimmed at 1 week. You should not be sexually active or use tampons for 6 weeks after surgery.

Sensation and/or Lubrication: Blame your hormones! Women are an ever-evolving stew of progesterone, estrogen and testosterone. In sexual function, testosterone is responsible for libido, progesterone for fantasy, and estrogen contributes to lubrication and mood. However, normal levels of these hormones still may not indicate a normal sex drive. Yes, it’s complicated!

  • Treatment:  ZENA Medical offers bio-identical hormone replacement therapy (BHRT) in the form of subcutaneous pellets. 
  1. We offer two kinds of pellets: estradiol pellets and testosterone pellets. These pellets are inserted into the hip area during an in-office visit after testing has been done to determine the exact quantity of the hormone you require. Every dose is custom created based on your tests to ensure you have the exact number of hormones needed over time. 
  2. BHRT is a treatment designed to bring you to optimal hormone levels; making you feel balanced and whole. For each and every patient, the treatment is customized based on your individual hormone and vitamin levels to give you optimal results.

Your treatment plan may consist of one or more of the above depending on your needs. We’ll have a chance to go through your concerns in depth and answer any other questions you may have. Remember, there is nothing to be embarrassed about and everything we discuss is protected health information between you and me. So, take a good look with that mirror and if there’s anything I can help you with, come on in and let’s chat!

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