Vaginal removal surgery: Will it look weird?

Whoa, stop scrolling — time out! You’ve heard of hysterectomy, but you’re telling me there’s a surgery where you remove the entire vagina?! 

[Clip from the TV show “The Office,” where Dwight asks Meredith if vaginas are removed during a hysterectomy. She tells him no.]

Doctor Rich:

That’s true — with a hysterectomy, you still have a vagina. So this surgery that removes the vagina… does that totally change the way everything looks? Stick around and find out! 

Don’t have time to read this post? Watch the video here instead!

Being a urogynecologist, we do a lot of pelvic reconstructive surgery (meaning that women suffer from their uterus, bladder, rectum, all falling out through the vagina). And normally, we will perform a hysterectomy and suspend the top of the vagina to ligaments in the pelvis. But a surgery where you remove the entire vagina?! Shut down the shop — closed for business? 

So when will we EVER consider the colpocleisis?

Well we’ve brought Papi the Sock Puppet to help us explain!

[Doctor Rich holds up his hand, covered with a tube sock.]

Imagine, if you will, that this sock is the vagina — and my sleeve is the opening to the vagina. 

[Doctor Rich pulls the sock off of his hand, and lets it hang loosely from his sleeve.]

So when prolapse happens, the sock actually turns inside out and hangs outside of the body. With pelvic reconstructive surgery, we simply put this back inside and we stitch it up.

But sometimes that’s not an option, and we actually have to remove the vagina and get rid of it. 

Now, now, now — before you start thinking that there’s a renegade band of surgeons out there just removing everybody’s vaginas, what would be the indication for actually doing this surgery? 

Pelvic organ prolapse can be a very bothersome, painful, disruptive condition where patients really will do anything to resolve the bulge (or the organ falling out through the vagina). Now, this surgery is NOT for everybody. Certainly, if a woman has interest in sexual activity, then the patient and their physician should never consider this surgery. However, statistically, rates of sexual activity decrease from 62% in women aged 57 to 64 down to only 17% of women aged 75 to 85 being sexually active. 

Now, some patients are older and have medical complications — and they’re simply not great candidates for surgery. And in fact, a lot of our pelvic reconstructive surgeries are not an option. 

So rather than having the patient just suffer or have to wear a pessary (or suspension device) indefinitely, here’s a surgery that can be done in half the time of a pelvic reconstruction, under spinal anesthesia, with the highest success rate (upwards of 90 to 95%).

Who would be a good candidate? Well for example, a patient who’s in a nursing home or a long-term care facility with many urinary tract infections and a painful bulge — who just hasn’t been a candidate for traditional pelvic reconstructive surgery. Colpocleisis could provide a great option where we can resolve their symptoms and give them that quality of life back. 

Many patients have the concern that the surgery will be disfiguring. They fear that the external genitals — the labia, the clitoris — will all be altered or removed in some way. This simply isn’t true. All the external genitals will look exactly the way they did prior to surgery. The only difference would be if the labia were separated, there won’t be anything except skin — because all of the vagina (and all of the potential space that organs can prolapse into) is simply gone. This all but eliminates the risk of future prolapse. 

Although the idea of removing an entire vagina is somewhat shocking — it actually has one of the highest satisfaction rates of all of the prolapse surgery options. 

Make sure you share this video with anybody considering pelvic reconstructive surgery (or anybody that likes sock puppets)!