46 yo mother of three from Aurora, Colorado with a 25-year history of vaginal looseness was self-referred to the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar Aguirre of Parker, Colorado. Since her first vaginal delivery she has noticed decreased pleasure with sex. This has worsened with each additional delivery and with aging. Pelvic examination performed with a chaperone present reveals a gaping introitus with an enlarged genital hiatus of 4 cm. There are torn pelvic floor muscles distally. There is excellent uterine and vaginal support otherwise. There are also three anal skin tags present. Dr. Aguirre discussed in detail with the patient, all history and findings along with surgical and nonsurgical options. Both the proposal and surgical plan were given to the patient. After discussing with her husband and obtaining financing she proceeded to schedule the recommended procedure. Dr. Aguirre performed, in an out-patient surgical setting, Vaginoplasty followed by in-office Anal Tag Excision. She returned to the office for her postop appointments with excellent results and healing nicely. She was eager to discuss the possibility of a Labia Majora Puff to address her concerns of deflated labia majora. She will consider this and return for treatment in the near future.