Successful reconstructive surgery to alter distorted vaginal axis causing apareunia

Abstract

Abdomino-perineal resection (APR) is a commonly performed surgical procedure in the treatment of colonic and rectal cancer. This operation leaves the patient with a permanent colostomy and a large pelvic floor defect significantly contributing to patient morbidity. Sexual dysfunction, as a complication of APR, is often overlooked, because the focus remains on disease eradication and in most cases, there are limited if any adjunct treatments available. As the incidence of bowel cancer increases in younger populations, this can have a significant impact on the quality of life and wellbeing of women. It is well known that vaginal wall defects, incontinence and sexual dysfunction are expected complications of radical lower gastrointestinal and urological surgery. Vaginal axis deviation secondary to radical surgery is a rarer or perhaps less reported complication, which if left untreated, may have a significant impact on sexual function. To date, most case reports have dealt with concomitant vaginal reconstruction with myocutaneous flaps, but none have addressed surgical options that specifically target vaginal axis deviation. We present the first case of successful reconstructive surgery to alter vaginal axis in an attempt to reverse apareunia years after APR.