45 yo mother of three from Colorado Springs, Colorado with a lifelong history of undesired cosmetic appearance of her vulva has followed Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado, on RealSelf for two years and has been looking forward to scheduling her consultation. She describes being bothered by the appearance of her labia since the age of 12, when she reached puberty. She has also experienced stress associated urinary incontinence and decreased vaginal sensation for 16 years. She attributes this to her second vaginal delivery but appears to have progressed over time to its current moderate to severe state. She has also noticed increasing difficulties with achieving orgasm. Dr. Aguirre performed a thorough pelvic examination which revealed a parous-appearing perineum with an enlarged genital hiatus, stage II anterior and posterior compartment prolapse with stage I uterine decent. Distally there are torn pelvic floor muscles. There is bilateral labial hypertrophy with hyperpigmentation, right side greater than left as well as redundant lateral prepuce on the left side. There is a vulvar skin tag and anal tag. History and findings were discussed with patient in detail along with all surgical and nonsurgical options. Due to the down time associated with reconstructive pelvic surgery, she decided to proceed with Dr. Aguirre performing in-office aesthetic vulvar surgery in the form of a Laser Reduction Labiaplasty of the Labia Minora, Right Clitoral Hood Reduction, PRP (Platelet Rich Plasma) to Surgical Site, O-Shot and Excision of Vulvar and Anal Tags. She returned to the office for her regularly scheduled postop appointments very happy with her results. She will continue to deliberate the option of pelvic surgery in the form of an anterior and posterior Vaginoplasty in the future.