This San Francisco Bay Area woman saw us with vulvovaginal concerns after delivering two children. She disliked the appearance and color of her labia as well as the wide open perineum. Her husband would slip out accidentally during intercourse as the vagina was too lax. She underwent vaginoplasty, labiaplasty and clitoral hood reduction. Her perineum no longer gapes open and she has much stronger vaginal muscles. There is no further slippage during intercourse.