Creation and maintenance of neo-vagina with the use of vaginal dilators as first line treatment: Results from a quaternary paediatric and adolescent gynaecology service in Australia.

Abstract

Vaginal agenesis is an uncommon condition with an estimated incidence of 1/5000 live female births. There are surgical and non-surgical treatment options for neo-vagina creation. Vaginal dilatation has been used to treat vaginal agenesis for over 80years, but outcome data to date have had poor definitions for 'success'. The optimal method for neo-vagina creation varies with vaginal dilator therapy being the most successful first line therapy in women with Mayer-Rokistansky-Kuster-Hauser syndrome, with little literature to guide best practice in women with more complex congenital conditions. There is a paucity of data from Australian and New Zealand paediatric and adolescent gynaecology services on management of women requiring a functional vagina, for any underlying aetiology. To determine if creation and maintenance of a functional neo-vagina for vaginal agenesis with non-surgical management (via vaginal dilators) should be the first line treatment. Retrospective observational study between January 2005 and June 2015. Of the 23 women, 21 (91.3%) achieved a successful vaginal length defined as achieving vaginal length >6cm and maximum width using the largest dilator if not sexually active, or ability to have sexual intercourse without discomfort. Vaginal dilator therapy remains an effective first line treatment for neo-vagina creation and maintenance and can be achieved in an outpatient setting with appropriate support.