Neovagina Formation with the Use of Bowel

Abstract

Aims: The aim of this chapter is to present the technique of neovagina formation with the use of bowel for the treatment of women with vaginal aplasia, to review the post-operative functional results and to critically report its potential advantages and limitations. Brief description of the reviewed data: From 1992 to 2014, 88 women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome were referred to our gynecological surgery department for sigmoid vaginoplasty. Twenty-five were redirected toward vaginal dilation (Frank’s method), while 59 had laparatomic and the final four totally laparoscopic vaginoplasties. The surgical technique is described in detail. The functional and sexual outcomes of sigmoid vaginoplasty were assessed in 59 of them (48 treated with sigmoid vaginoplasty and 11 with vaginal dilation). Functional results and sexuality were evaluated with two standardized questionnaires: the Female Sexual Function Index (FSFI) and the revised Female Sexual Distress Scale (FSDS-R). Questions were added to analyze depression, body image perception, and desire for motherhood. Forty patients (68 %) responded to the requested questionnaire and regular sexual intercourse was reported by 30 (73 %) of them. The mean total FSFI score was 28 ± 3.1 in the surgical group and 30 ± 5.3 in the group treated with the Frank method. Their mean FSDS-R scores were 21 ± 12.1 and 18 ± 13.8, respectively. Clinical implications: In view of this evidence, in patients who refused or had unsuccessful vaginal dilation, sigmoid vaginoplasty, performed by experienced specialists in gynecologic and gastrointestinal surgery, appears to be an attractive alternative, having rapid and satisfactory anatomical and sexual results. Open issues for further research: Sigmoid vaginoplasty is an effective technique providing nearly normal sexual function to women with vaginal aplasia. However, further studies are needed to identify women who might benefit from this technique. Furthermore, psychological distress related to sexuality persists in most patients and demonstrates the need for multidisciplinary support.