Design: Video presentation of a case

Setting: Hospital Operating Room. Patient in lithotomy position.

Patients or Participants: 33yo G3P2012 with a history of a vacuum delivery 5 years ago complicated by a grade 3a perineal laceration, currently reporting dyspareunia and feeling a "bulge" in her introitus, refractory to physical therapy.

Interventions: Posterior colporrhaphy and perineoplasty

Measurements and Main Results: A step-wise approach to a posterior colporrhaphy is depicted. Main steps include dissection of the vaginal epithelium from the underlying muscularis layer, plication of the muscularis layer and reapproximation of the vaginal epithelium with reconstruction of the levator muscles. Preoperative and postoperative measurements are taken of the genital hiatus and vaginal width.

Conclusion: It is important to recognize long-term morbidity associated with OASIS. When opting for surgical repair, one must ensure proper steps are followed to adequately restore anatomy and cosmesis.