The size of the genital opening is directly related to the size of the perineum. When patients complain of a large genital opening (gaping introits) they explains that the opening to their female genitalia is widened. This is usually the result of childbirth.
Patients complain of three problems when it comes to the genital opening (introitis). The first problem is a cosmetic issue – the genital opening looks to large or feels large. When the patient is questioned as to when this condition began the most common answer is since giving birth. The second problem is the genital opening is too small or the patient complains of pain with intercourse/sex. When the patient is questioned as to when the problem began the most common answer is after the delivery of my last child. Usually she will describe having a tear and repair or an episiotomy. On exam the surgeon can usually reproduce the pain that she feels during intercourse. This usually means the patient has excess scar tissue at the opening. The third problem is a patient will complain of less friction during intercourse and often will ask about making her genital opening smaller so she can feel more during intercourse. The patient needs to be told that fixing the just opening of her female genitalia will not enhance friction with intercourse. She should consider surgical repair of the internal female genitalia as well as the opening. This technique is called genital rejuvenation.
The operation to fix both a small genital opening and a large genital opening are both called a perineoplasty. The term perineum is the area between the opening of the anus and vagina. The term plasty means surgery and does not necessarily mean making it specifically larger or smaller.
If a patient has an enlarged genital opening the perineum must be reconstructed to build up its integrity. When this is done it will narrow the opening of the vagina. See the surgery below.