536 VAGINAL AGENESIS AND PSYCHOSEXUAL FUNCTIONING: LONG TERM OUTCOME OF A VAGINAL SUBSTITUTION TREATMENT

Abstract

Purpose In congenital vaginal hypo- or aplasia, seen in Complete Androgen Insensitivity Syndrome (CAIS) or Mayer Rokitansky Syndrome (MRS), an absent or blind ending vagina makes sexual intercourse impossible. Operative vaginoplasty and vaginal dilation are both valid vaginal substitution treatments. The ACOG recommends vaginal dilation as a first choice treatment, because of its less invasive character and high success rate. Although a functional vagina has been created, it is estimated that the majority of women experience sexual problems of unknown cause in either treatment group. Only few studies compare the psychosexual functioning after vaginoplasty to that after vaginal dilation. Material and Methods Psychosexual functioning and quality of life (QoL) of 26 women after vaginal dilation (11 CAIS patients) and after vaginoplasty (8 MRS, 7 CAIS patients) was investigated. Questionnaires (FSFI, FSDS-R, TNO/AZL QoL) and a semi-structured interview were used. A gynecological examination was performed. Results No difference in QoL was observed between both treatment groups. After vaginoplasty, patients reported significantly more problems with desire and lubrication than after vaginal dilation. 66.7% had an acceptable vaginal depth after either treatment. In general 59% of the patients had (a) sexual dysfunction(s), mostly on the domains of lubrication and dyspareunia, and experienced sexual distress. Conclusions Both psychological and physical factors are predisposing for sexual difficulties. The clinical management of these women needs to be multidisciplinary and individualy tailored to optimize psychosexual comfort. Vaginal dilatation is a non-invasive, valuable alternative to vaginoplasty, possibly with less side effects and post treatment problems. Further studies are needed to confirm these conclusions.