In some women, this tear is very small and heals immediately, much like a cut to the inside of the mouth. In other cases, an episiotomy is performed, or a perineal tear or laceration occurs during childbirth. This is most common for a first time mom when a big baby is born, but can really happen at any time.
If the vaginal muscles are torn - a Grade 2 perineal tear or greater - the vagina may feel loose during sex or may appear more open. While a VaJaser treatment - painless laser vaginal rejuvenation - may be helpful for small amounts of looseness, vaginal tightening surgery may be required to restore muscle tone.
A perineoplasty is a smaller procedure that closes the very outer portions of the vagina, the very edge closest to the vaginal opening. A perineoplasty is a good surgery for women with very little looseness, who may have had a minimal mucosal tear during childbirth (Grade 1 perineal tear) or who may simply feel loose during sex. Some women have larger vaginal openings, just like some men have larger penises. Even so, sometimes you may be changing partners. If your partner is smaller, you may desire to seek out a vaginal tightening procedure to make sex feel better.
The best candidates for a vaginoplasty, which is a full muscle repair and includes a perineoplasty, are those who have had a more extensive tear or episiotomy. In these cases, the looseness is more noted, and there is not an adequate seal around the penis during intercourse. This can lead to low sexual satisfaction for both partners.
Of note, some women actually develop internal hernias from severe lacerations during childbirth. These may present as bulges pushing into the vagina from above (the bladder) and below (the rectum). In these cases, a more extensive vaginal repair is required, involving vaginal reconstructive surgery.