VAGINOPLASTY / VAGINAL TIGHTENING SURGERY CONSENT FORM
PATIENT NAME – SURNAME:
ID NUMBER:
DATE OF BIRTH:
CONTACT:
Dear Patient / Legal Representative,
This form has been prepared in accordance with patient rights regulations to ensure that you are informed about your medical condition and the medical/surgical treatment and diagnostic procedures recommended for you, as well as their possible risks. While the effects and outcomes of these procedures may follow certain general patterns, they may also vary from person to person or may not be limited to those listed below. Therefore, it is extremely important that complete, correct, and accurate answers are given to the questions of our physicians and healthcare staff.
After learning about the benefits and potential risks of medical treatment and surgical procedures, it is solely your decision to accept or refuse the recommended diagnosis and treatment. The purpose of this form is not to worry or frighten you, nor to dissuade you from undergoing medical procedures, but rather to involve you more consciously in decisions regarding your health and to obtain your informed consent. If you wish, all information and documents related to your health will be provided to you. All information below reflects practices and possible situations accepted worldwide within the scope of modern medical science.
INFORMATION
PRE-DIAGNOSIS:
PLANNED TREATMENT / ESTIMATED DURATION:
GENERAL INFORMATION
Relaxation and widening of the vaginal area is a significant sexual concern not only for women but also for couples. Vaginal loosening or widening may occur structurally due to genetics or body characteristics, or as a result of vaginal trauma caused by normal childbirth, weight gain or loss, excessive slimming, multiple curettages, or frequent sexual intercourse. These factors cause relaxation, widening, and sagging of the muscles, skin, mucosa, and soft tissues located in the lower vaginal area.
The purpose of vaginal tightening surgery or vaginal aesthetic surgery is to correct the aesthetic appearance of the outer area and improve sexual satisfaction inside the vagina, especially in cases where relaxation occurs due to childbirth or age.
Birth Tear – Vaginal Tightening
A birth tear occurs when, during the first vaginal delivery, the vaginal tissue tears uncontrollably toward the anus. In some cases, the tear can be severe and extend to the intestines. During the first birth, an episiotomy (a planned incision) is performed to prevent uncontrolled tearing. This incision must be stitched carefully with strong sutures underneath the skin. When sutures are placed improperly, they may loosen or open, causing the vaginal entrance to widen. Incorrect stitching can also negatively affect the vaginal appearance. Additionally, sexual intercourse should be avoided for six weeks following episiotomy.
A birth tear may cause loosening at the vaginal entrance, and vaginal tightening surgery is recommended to correct this. In this surgery—considered part of vaginal aesthetic procedures—excess tissue is removed from the posterior vaginal wall. If the vagina is considered a tube, tightening is performed at the front and the entrance of this tube. The middle and upper sections are not narrowed because the vagina naturally hugs and grips the penis during intercourse. However, loosening at the entrance prevents this function, which is why tightening is performed here.
Deep and long-lasting sutures should be used to repair the front part and the entrance. Otherwise, after the sutures dissolve, the area may loosen again. Two or three rows of sutures are placed in the muscle layer at different depths. Finally, the vaginal mucosa (inner lining) is closed.
Sutures used in the inner layers should dissolve no earlier than three months to ensure long-term durability and less scarring.
When is Vaginal Tightening Surgery Performed?
The surgery is preferably performed right after menstruation ends or at least 10 days before the next period. This timing helps prevent confusion between postoperative bleeding and menstrual bleeding. If the patient uses aspirin or vitamin supplements, these should be stopped one week before surgery.
Procedures Performed During Surgery
The surgery can be performed under sedation or general anesthesia. If sedation is used, the patient can usually return home shortly after the procedure.
During the operation, the vaginal canal is narrowed from front to back, excess mucosa and muscle tissue are removed, and separated muscles are re-approximated to restore tightness.
The main principle is not just reducing the internal width but reconstructing separated muscle structures. In many patients, the rugae (pleats inside the vagina that provide friction and sexual pleasure) become flattened. During tightening, the flattened tissue can be removed and ruga reconstruction (ruga rejuvenation) can be performed.
Possible Complications After Surgery
Complications common to all surgical or diagnostic procedures include:
• Infection
• Blood clots in veins or lungs
• Bleeding
• Allergic reactions
• Anaphylaxis
• Heart attack
• Reduced lung expansion (atelectasis)
• Even death (rare but exists in all surgeries)
Bleeding:
Although bleeding is typically controlled during the procedure, trauma afterward may cause new bleeding requiring minor intervention.
Infection:
The area contains many microorganisms but also has rich blood circulation, so infection is not common if hygiene and antiseptic recommendations are followed.
Wound separation:
Early tension, infection, or trauma may cause sutures to open. Usually manageable with dressings; rarely requires re-stitching.
Rectal injury:
During dissection or deep suturing, rectum or bowel injury may occur, possibly requiring a temporary colostomy. There is also a risk of fistula development.
Painful intercourse:
Rare. Early tightness may cause discomfort but usually resolves within months.
Postoperative Care
Pain is usually minimal. Some discomfort due to the tampon may be felt. The tampon is removed after 1 day. Mild discharge may continue for 3–4 days. Patients typically return to daily life within 1–2 days, and tissue healing completes in about 1 week. Dissolvable sutures are used; there is no need for suture removal. Sexual intercourse and tampon use must be avoided for 4–6 weeks.
Are Results Permanent?
Yes, results are permanent. However, future childbirth, significant weight changes, or aging may cause mild loosening.
Alternative Treatments
Laser Vaginal Rejuvenation (LVR) is an available non-surgical alternative.
Special Patient Conditions
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CONSENT
I have read the information above and have been informed by the physician whose signature appears below. I understand the purpose, risks, and complications of the medical/surgical procedure. Without needing any further explanation and without any pressure, I voluntarily consent to this procedure.
If I lose consciousness or become unable to provide consent during treatment, I authorize the following person to receive information and give consent on my behalf:
…………………………………………………………………………………….
(Write in your own handwriting: “I have read, understood, and accept.”)
Patient
Name–Surname (handwritten): ………………………………………
Signature – Date/Time: …………………………………………….
Legal Representative (if applicable)
Name–Surname (handwritten): ………………………………………
Signature – Date/Time: …………………………………………….
I hereby confirm that I have adequately informed the patient/patient’s representative about the condition, the procedure to be performed, its benefits, postoperative care, possible risks, and—if required—the anesthesia type and its risks. The patient/patient’s representative voluntarily signed this form acknowledging adequate information.
Physician
Name–Surname: ………………………………………
Signature – Date/Time: ………………………………………
Interpreter (if applicable)
Name–Surname: ………………………………………
Signature – Date/Time: ………………………………………