62 yo female from Aurora, Colorado referred to Urogynecologist and master cosmetic surgeon, Dr. Oscar Aguirre due to a 4 year history of painful intercourse, for which she has undergone numerous evaluations. Upon evaluation by Dr. Aguirre, she was found to have labia hypertrophy with vulvar stricture contributing to her pain with intercourse. Dr. Aguirre recommended aesthetic vaginal vulvar surgery to address her dyspareunia as well as her concerns regarding the aesthetic appearance of her vulva. In an out-patient surgical facility, under general anesthesia, Dr. Aguirre performed Labiaplasty of the Labia Minora, Clitoral Hood Reduction with Clitoropexy, Perineoplasty with Vaginal Flap Advancement and Anal Tag Excision. Patient returned to the office postoperatively very pleased with both the aesthetic results and sexual function. She states she is able to have pain-free sex again.