40 yo mother of two from Edwards, Colorado located the office of nationally renowned Urogynecologist and master cosmetic surgeon Dr. Oscar Aguirre from Denver, Colorado through an internet search. She has a greater than five year history of undesired cosmetic appearance of her vulva. She first became bothered by her appearance after the delivery of her second baby. She has noticed darker and longer labia and has also experienced vaginal looseness and complains of not as much sensation during sex. Orgasms were never easily achieved but have become even more difficult following the delivery of her children. She states that she has lost interest in sex due to loss of sensation. Dr. Aguirre performed a pelvic examination which revealed a large ptotic prepuce contributing to an aged appearance as well as bilateral labia hypertrophy with hyperpigmentation, excess perineal skin and gapping introitus. There are two anal skin tags as well. All surgical and non-surgical options were discussed with patient and she decided to move forward with definitive surgical therapy. Dr. Aguirre performed in an out-patient surgical center, Vaginoplasty, Labiaplasty of Labia Minora, Clitoral Hood Reduction, Clitoropexy and Anal Tag Excision. At her six week postop appointment she proceeded with having an O-Shot to help with achieving orgasms. She returned to the office for regularly scheduled postop visits, with excellent results and restored confidence in her appearance.