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Gynaecology · UK

Fenton’s procedure - widening a tight or scarred vaginal opening.

A short perineal repair for superficial pain at the vaginal entrance, by a consultant gynaecologist with a special interest in vulval and perineal repair - with the non-surgical options considered first.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private Fenton’s procedure costs in the UK.

Indicative ranges across UK private providers. NHS-funded when clinically indicated.

In short

£2,000–£3,500, home the same day.

Procedure Indicative range
Fenton’s procedure under LA + sedation £2,000–£3,500
Fenton’s procedure under short GA £2,800–£4,000
Perineoplasty (more extensive repair) £3,000–£5,500
Z-plasty for radial scar £2,500–£4,500
Consultant vulval / menopause clinic £250–£450
Pelvic-floor physiotherapy (per session) £90–£150

Prices vary by clinic, by the gynaecologist doing the case, by the anaesthetic chosen, and by whether any extra work is added on the day.

The problem

The right clinician, the right diagnosis, the right sequence.

Painful sex at the entrance is one of the most misattributed complaints in gynaecology - often labelled “tight” when the real cause is vaginismus, vulvodynia or a hypertonic pelvic floor. Getting the diagnosis right is what makes a Fenton’s work.

  • Not sure it is surgical?

    A vulval or menopause clinic assessment - with pelvic-floor examination and Q-tip test - comes first. We say if surgery is not the answer.

  • Tried physiotherapy and dilators?

    Non-surgical measures should be optimised before a repair. If they have been tried properly, a Fenton’s becomes a fair option.

  • Want it done properly?

    A named consultant gynaecologist with special-interest in vulval and perineal repair, in a proper day-case theatre with the anaesthetic you choose.

When it helps

When a Fenton’s procedure is the right step.

The situations we see most, and the two important pauses - the misdiagnosis trap and the red flag that changes the appointment.

  • Superficial dyspareunia (entry pain)

    A sharp, burning or tearing pain at the vaginal opening on penetration - the classic reason to consider a Fenton’s.

  • Posterior fourchette scarring

    A tight, pale scar at the back of the vaginal opening after childbirth tear, episiotomy or repeated splitting.

  • Lichen sclerosus with introital stenosis

    Scarring from lichen sclerosus that has narrowed the introitus - after topical steroid treatment has been optimised.

  • Splitting on intercourse

    A scar that tears every time, then heals shorter - a Fenton’s widens the opening perpendicular to the split.

  • Failed conservative measures

    Vaginal oestrogen, dilator therapy, lubrication and pelvic-floor physio have been tried and the pain remains at the introitus.

  • Post-radiotherapy or scleroderma stenosis

    Scarring from pelvic radiotherapy or connective-tissue disease that has narrowed the vaginal entrance.

  • Consider carefully - not everyone

    Vaginismus, vulvodynia and hypertonic pelvic floor feel similar but do not respond to surgery. A careful assessment matters.

  • Red flag: unexplained bleeding or lump

    New vulval bleeding, an ulcer, a lump or a rapidly changing lesion needs same-week gynaecology review, not a repair booking.

Procedure options

A Fenton’s is one option among several.

What each option actually involves - and which fits which problem. Sometimes the right answer is not surgery at all.

  • Fenton’s procedure (classic)

    A longitudinal cut through the scar at the posterior fourchette, closed transversely. Widens the opening on the same principle as a Heineke–Mikulicz pyloroplasty.

  • LA + sedation

    Local anaesthetic infiltration with light sedation. Comfortable, quick, and home the same day - the option most patients choose.

  • Short general anaesthetic

    Asleep for 20 to 40 minutes with an anaesthetist. Preferred if you are very anxious or would rather not be aware.

  • Perineoplasty

    A more extensive repair reshaping the perineal body - considered when the scarring extends beyond the fourchette.

  • Z-plasty

    A tissue-rearrangement technique for radial or contracted scars - used when a straight transverse closure would not release the tension.

  • Vulvar reconstruction for LS

    For advanced lichen sclerosus stenosis, sometimes a more extensive reconstruction is needed - planned with a vulval-disease specialist.

  • Non-surgical pathway

    Vaginal oestrogen, dilator therapy, pelvic-floor physiotherapy and psychosexual support - often the right first step, and sometimes the only step needed.

Safety and recovery

What to expect afterwards - honestly.

A Fenton’s is a common, safe day-case procedure. The things worth planning are your anaesthetic choice, the six-week no-intercourse window, and the follow-through - physiotherapy, dilator work and gentle re-introduction.

  • LA with sedation, or short GA

    Choice matters. Sedation is quick and lets you go home the same day; GA suits those who would rather not be aware at all.

  • Brief bleeding and swelling

    Some spotting, bruising and swelling for one to two weeks is normal. Significant bleeding is uncommon and the team is prepared.

  • No intercourse for six weeks

    The wound needs to heal properly. Sex too early is the commonest cause of stitch problems and scar re-splitting.

  • Dissolvable stitches

    Vicryl Rapide or similar - the stitches dissolve on their own over two to four weeks. No removal appointment is needed.

  • Sitz baths and shower, not baths

    Shower normally from day one and use warm sitz baths for comfort. Avoid soaking baths and swimming for one to two weeks.

  • The scar softens over months

    The repair looks pink and firm at first, then fades and softens over three to six months. Gentle vitamin E oil massage can help.

  • Dehiscence risk in smokers and diabetics

    Wound breakdown is uncommon but more likely if you smoke or have poorly controlled diabetes - worth optimising beforehand.

  • Persistent pain may mean misdiagnosis

    If pain continues after healing, the original problem may have been vulvodynia, vaginismus or a hypertonic pelvic floor - not something surgery could fix.

  • Red flags

    Fever, spreading redness, heavy bleeding or the wound opening are not normal - call the clinic or A&E the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever technique was used, the note the gynaecologist sends you keeps to the same shape.

A UK consultant gynaecologist reviewing a patient’s operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    Indication and method chosen

    Why the procedure was done - post-childbirth scar, lichen sclerosus stenosis, radiotherapy change - and which method was agreed with you.

  2. 02 Technique

    Anaesthetic and surgical technique

    Whether it was done under LA with sedation or a short GA, the incision and closure used, and any adjunctive procedures.

  3. 03 Findings

    Scar, tissue quality, pelvic-floor tone

    Notes on the scar released, the surrounding tissue quality, and observations about pelvic-floor tone under anaesthetic.

  4. 04 Impression

    Recovery, no-sex window, review timing

    Read this first: expected recovery, when it is safe to return to intercourse and exercise, and when your follow-up is.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for a Fenton’s procedure varies by insurer and by indication - usually funded when clinically indicated for dyspareunia.

Frequently asked

Everything we get asked about Fenton’s procedure.

Quick answers on what it is, who it is for, cost, alternatives, and what recovery really looks like.

  • What is a Fenton’s procedure?

    A short surgical repair that widens a tight or scarred vaginal opening. A longitudinal cut is made through the scar at the posterior fourchette and then closed transversely - the transverse closure is what widens the entrance. It is done as a day case, usually under local anaesthetic with sedation or a short GA.

  • Who is a Fenton’s procedure for?

    Women with superficial dyspareunia - sharp entry pain on intercourse - caused by a tight or scarred introitus, typically after a childbirth tear, an episiotomy that healed poorly, or scarring from lichen sclerosus. It is only offered after non-surgical measures have been tried.

  • Should I try other things first?

    Yes. Vaginal oestrogen if you are perimenopausal or postmenopausal, dilator therapy, good lubrication, pelvic-floor physiotherapy for a hypertonic pelvic floor, and psychosexual counselling all matter. A careful assessment first is what separates a Fenton’s that works from one that disappoints.

  • Could my pain be something other than a tight introitus?

    It could. Vaginismus, vulvodynia and a hypertonic pelvic floor all cause pain at the entrance and feel similar to patients, but do not respond to surgery. A dedicated vulval or menopause clinic assessment - with a Q-tip test and digital examination of pelvic-floor tone - helps sort this out.

  • How much does a private Fenton’s cost in the UK?

    Roughly £2,000–£3,500 under LA with sedation and £2,800–£4,000 under a short GA. A more extensive perineoplasty is £3,000–£5,500. It is NHS-funded when clinically indicated.

  • When can I have sex again?

    Not before six weeks. Beyond that, be patient-guided - start with plenty of water-based lubricant, in positions that give you control, and stop if it hurts. Adjunct dilator use in the weeks before resuming intercourse often helps.

  • What is the recovery like?

    Day-case surgery, home the same day. Sitz baths and showers for the first two weeks, no baths or swimming, and no intercourse for six weeks. Most women are back to office work in three to five days. Full comfort with intercourse often takes three to six months, supported by physiotherapy and gentle scar massage.

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