39 yo mother of 2 with a 16 year history of uncomfortable sex following her first vaginal delivery was self-referred to the office of Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado through an internet search on painful sex. She has numerous pelvic complaints. Predominately, she is bothered by the aesthetic appearance of her vulva. She also has vaginal dryness, needs to work harder for orgasms, complains of vaginal looseness, and urinary incontinence. She is interested in Vaginal Rejuvenation as well. Dr. Aguirre performed a thorough pelvic examination which revealed the vulva is significant for bilateral labial hypertrophy with hyperpigmentation, redundant lateral prepuce with ptosis, excess perineal skin, and multiple anal skin tags. She was found to be an excellent candidate for fractional CO2 resurfacing of the vagina FemiLift Series, radio-frequency introital tightening with Viveve, and an O-Shot. She was also found to be an excellent candidate for in-office aesthetic vulvar surgery in the form of Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction, and Clitoropexy with PRP to surgical wounds as well as Excision of Multiple Anal Skin Tags. After discussing all surgical and non-surgical options she decided to proceed with the non-surgical feminine rejuvenation options as well as definitive surgical vulvar surgery and scheduled for the next available surgical time. She returned to the office for her regularly scheduled postop appointments with excellent results.