Abstract
We thank Dr. Santucci1 for his interest in our work. We agree that meticulous patient selection and preoperative counseling is critical to the success of any revision surgery. When we evaluate patients for vaginal stenosis or loss of depth, a detailed history and physical examination is critical in parsing out introital stenosis, versus a true loss of vaginal vault domain. In our experience, patients with loss of depth often report infrequent dilation or have ceased dilating. Owing to the potentially high rates of concurrent pelvic floor dysfunction in patients undergoing revision vaginoplasty, we routinely refer patients with vaginal stenosis for pelvic floor physical therapy (PFPT) and to increase the frequency of dilation.
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