48 yo mother of one from Aurora, Colorado located the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado through an on-line search of Dr. Aguirre’s website. She has a 21 year history of decreased vaginal sensation with intercourse. She presented with her husband, who has also noticed decreased pleasure and frequent falling out of his penis. She also describes pain with initial penetration along her perineal body. She has difficulties achieving a vaginal orgasm and uses a lubricant during intercourse. She is also bothered by her large labia, but her husband is not. Dr. Aguirre performed a thorough pelvic examination with a chaperone present as well as her husband. Exam revealed an enlarged genital hiatus and decreased size perineal body. There is perineal trauma present, right side greater than left, with separation of her musculature. There is stage II posterior compartment relaxation. There is bilateral labial hypertrophy with hyperpigmentation and asymmetry. There is also a large ptotic prepuce. Dr. Aguirre discussed all surgical and nonsurgical options with patient and her husband. Brief discussion was made of future benefit from postoperative O-shot to address her nocturia and orgasm dysfunction as well as a Labiaplasty with hood reduction and pexy, adding local estrogen therapy if not laser vaginal resurfacing. She and her husband were looking for surgical correction, especially with her husband falling out often. They were eager to proceed with Posterior Vaginoplasty with Perineoplasty. Dr. Aguirre performed the procedure in an out-patient surgical setting under spinal anesthesia. She returned to the office for her regularly scheduled postop appointments with great healing and wanting to proceed with the O-Shot which Dr. Aguirre performed at the time of her postop exam.