49 yo mother of two from Eagle, Colorado with a five year history of vaginal relaxation symptoms consisting of vaginal looseness and sensation of vagina falling out. She is also bothered by her large labia folds, which have become stretched and create discomfort with formfitting clothing. She located the office of Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado, from a Google search on vaginal looseness. Dr. Aguirre performed a thorough pelvic examination which revealed a parous-appearing perineum with an enlarged genital hiatus. There is a stage II rectocele. Palpation and inspection of the anterior vaginal wall distally reveals extruded midurethral sling into the vagina and she has torn pelvic floor muscles distally. She was also found to have bilateral labial hypertrophy with hyperpigmentation and excess/redundant lateral prepuce with ptosis. All findings and history were discussed in detail with patient along with all surgical and nonsurgical options. She decided to proceed with definitive surgical therapy. Dr Aguirre performed in an out-patient surgery center, Sling Revision, Rectocele Repair, Anal Tag Excision, Vaginoplasty, Laser Reduction Labiaplasty of the Labia Minora, and Clitoropexy. She returned to the office for her regularly scheduled postop appointments with excellent results.