259 RECTOSIGMOID VAGINOPLASTYAND ITS IMPACT ON PSYCHOSOCIAL AND SEXUAL LIFE IN PATIENTS WITH VAGINAL AGENESIS

Abstract

INTRODUCTION AND OBJECTIVES: The main goal in treatment of patients with Mayer-Rokitansky-K€ uster-Hauser syndrome (vaginal agenesis) is creation of a neovagina that will satisfy patient’s desire. We evaluated sexual and psychosocial outcome after sigmoid vaginoplasty due to vaginal agenesis. METHODS: A total of 60 women were evaluated, aged 19 to 38 years (mean 25), who underwent bowel vaginal replacement from 1997 to 2015. Sexual and psychosocial assessment included the Female Sexual Function Index (FSFI), Beck’s Depression Inventory (BDI) and standardized questionnaires about postoperative satisfaction, social and sexual adjustment. RESULTS: The mean follow-up was 8.5 years (range 9 months to 18 years). Mean FSF Index was 28.3 (range 10.5 35.7) with cut-off score 26.55 for sexual dysfunction. Out of the 60 women, 13 (21.5%) had sexual dysfunction. Mean Beck Depression Inventory (BDI) was 7.5 (cut-off score 0-9 for non-depression). A 45 women (75%) were without symptoms of depression, 12 (BDI ranged from 10-18) had moderate and 3 had severe depression (BDI 42). There was significant level (p<0.01) within high satisfaction score in FSFI and low BDI results, that indicates important predictive variable between one FSFI domain and psychological status. Fifty-one of sixty patients (85%) believed that the surgery was done at the right time, while 93% (56/60) of the patients reported satisfactory femininity with heterosexual orientation. Fifty-three patients (88%) were satisfied with the surgery, while 91% considered that this surgery is the best treatment option. CONCLUSIONS: Sexual function and psychosocial status of patients with vaginal agenesis who underwent sigmoid vaginoplasty is not affected in general and attained complete recovery. Predictive factor for sexual dysfunction is associated with lower orgasm score, while higher desire directly influences positive sexual function on the FSFI. Absence of depression and presence of sexual function precisely correlate with higher satisfaction. Multidisciplinary approach is necessary for successful postoperative outcomes and better quality of life.