Medical Consultation Hub

Levator ani plication should not be performed routinely during posterior colpoperineorrhaphy. While it may reduce the genital hiatus and increase vaginal tightness, it does not address the primary defect in posterior compartment prolapse, which is typically a rectovaginal fascial defect rather than levator muscle separation.

Routine levator plication is associated with a significantly increased risk of:

• Postoperative dyspareunia (painful intercourse)
• Chronic pelvic pain
• Obstructed defecation

Current Best Practice: Favors site-specific rectovaginal fascial repair with perineal body reconstruction when indicated. Limited, selective levator plication may be considered only in carefully chosen cases—such as marked levator avulsion—after thorough counseling regarding sexual and functional risks.