56 yo mother of two from Littleton, Colorado was referred to the office of Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado by a local laser tech for vaginal evaluation. She requests for urogynecologic evaluation due to 25-year history of symptomatic fibroid uterus that has contributed to symptoms of pelvic pressure and abnormal bleeding. Upon further questioning she is also bothered by urinary incontinence, difficulties with rectal evacuation, sexual function as well as aesthetic concerns regarding the appearance of her vulva. Dr. Aguirre performed a thorough pelvic examination which revealed stage II cystocele and rectocele. Rectal examination confirms intact external and internal sphincters with normal tone and squeeze. Rectovaginal bimanual examination is significant for 14-16 week-sized fibroid uterus with uterine decent. Inspection of the vulva with the patient observing with a handheld mirror reveals labia majora laxity and deflation as well as labia minora hypertrophy and redundant lateral prepuce with ptosis. Dr. Aguirre discussed with patient all surgical and non-surgical options. After considering all options she decided to move forward with definitive surgical therapy. She decided to proceed with recommended surgical procedures. Dr. Aguirre performed, in a hospital setting, Transvaginal Hysterectomy with Bilateral Salpingo-Oophorectomy, Suburethral Sling, Vaginoplasty and Perineoplasty. She decided to return at a later date for Labiaplasty to address the aesthetic appearance concerns.