51 yo mother of two from Sioux Falls, South Dakota was self-referred to Board Certified, Fellowship-Trained Urogynecologist and renowned cosmetic surgeon Dr. Oscar Aguirre of Denver, Colorado after seeing online reviews on Real Self. She has a 20 year history of symptomatic rectocele and greater than 30-year history of bothersome large labia. She feels both symptoms have become worse over the past 10 years. She is required to splint in order to affect bowel movements. Aesthetically she is bothered by the older appearance of her vulva, vaginal looseness and increasing difficulties with orgasm. Dr. Aguirre performed a thorough pelvic examination which revealed a stage II symptomatic rectocele and distally there are torn pelvic floor muscles. She was also found to have bilateral labial hypertrophy with hyperpigmentation, large redundant lateral prepuce with ptosis and gaping introitus. After discussing all surgical and nonsurgical options with the patient and her husband, she desired to proceed with the surgical recommendations of Dr. Aguirre. He performed in an out-patient surgical center, Rectocele Repair, Vaginoplasty, Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction and Clitoropexy. She returned to the office for her regularly scheduled postop appointment at which time Dr. Aguirre performed the O-Shot to help with achieving orgasm.