Treatment Of Vaginal Agenesis Research Articles

Diagnosis and Treatment Approaches in Vaginal Agenesis

The development of the female genital system is a complex process that depends on a series of events involving cellular differentiation, migration, fusion, and recanalization. Failure of any of these processes results in congenital anomalies. Developmental anomalies can occur at various stages, resulting in conditions that impact both the urinary and reproductive systems. In younger patients, such malformations can significantly affect their overall health and quality of life, including aspects such as fertility, sexual function, and psychological well-being. The psychosexual effects of vaginal agenesis should not be overlooked, and clinical care primarily involves comprehensive counseling and support through open communication with the patient. For adult patients, treatment for vaginal agenesis typically starts with therapeutic counseling and education, with non-invasive vaginal dilation being recommended as the first-line approach, or surgery if necessary. Consequently, managing these issues often requires a multidisciplinary approach, engaging specialists such as urologists, gynecologists, endocrinologists, and geneticists, among others. Early detection and timely intervention can greatly enhance the outlook for individuals with these conditions. Besides considering the patient's expectations, the surgeon's experience plays a crucial role in selecting the appropriate surgical technique. This is because the success of the initial surgery is critical to the effectiveness of any subsequent procedures if required. In this review, the evaluation and treatment of vaginal agenesis, which constitutes an important part of congenital anomalies of the vagina, were discussed.

Three-dimensional Printer Molds for Vaginal Agenesis: An Individualized Approach as Conservative Treatment.

The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA). A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient. There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27-3.84) and the effect size (95% CI) was 4.58 (2.88-6.28). The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.

Treatment for vaginal agenesis: A prospective and comparative study between vaginal dilation and surgical neovaginoplasty.

To compare, in terms of anatomical, functional, and sexual aspects, two types of treatment for women with vaginal agenesis: progressive dilation or surgical neovaginoplasty. Women with vaginal agenesis underwent either dilation treatment using the Frank method or surgical treatment using the modified Abbé-McIndoe technique with oxidized cellulose. Patients were evaluated 3-6months after treatment for a follow-up including medical history, physical examination, general satisfaction, clinical aspect of the vagina, Female Sexual Function Index, and three-dimensional pelvic floor ultrasound. In total, 20 women with vaginal agenesis were included in the present study; nine in the dilation group and 11 in the surgical group. A comparison between the groups (vaginal dilation and surgical neovaginoplasty) showed efficacy in neovagina formation after both treatments, with a statistically significant difference between the pre- and post-treatment periods (P value pre-×post-dilation group <0.0001 and P value pre-×post-surgical group <0.0001). There were no statistical differences in total vaginal length measurements (P value post-dilation×post-surgical=0.09) or Female Sexual Function Index scores (P=0.72) after both treatments. Both treatments had satisfactory efficacy and positive outcomes for patients with vaginal agenesis concerning anatomical, functional, and sexual aspects, with minimum complications in the surgical group. Dilation treatment can remain the first-line therapy.

Sexual Experience before Treatment for Vaginal Agenesis: ARetrospective Review of 137 Women.

To summarize the self-reported sexual experiences of women with vaginal agenesis before treatment and discuss the clinical implications. A retrospective review of pretreatment baseline sexuality data and medical records of women with vaginal agenesis seeking vaginal construction. A specialist multidisciplinary center for women with genital differences associated with diverse sex development. One hundred thirty-seven women with untreated vaginal agenesis associated with Mayer-Rokitansky-Küster-Hauser Syndrome and complete androgen insensitivity syndrome aged 15 to 41years (mean age, 20years). Gynecological examination and completion of questionnaires. (1) Sexual Experiences Questionnaire; (2) Multidimensional Sexuality Questionnaire; (3) Vaginal Self-Perceptions; and (4) vaginal length. A sizable proportion of women reported having had sexually intimate experiences before any medical intervention on the vagina. Vaginal length, which ranged from dimple to 7cm and averaged 2.7cm for the cohort, was unrelated to the range of sexual experiences. Most women perceived their vagina as being too small, but less than half believed that a sexual partner would notice this. Two-thirds of the cohort subsequently completed the dilation program, which was not predicted by pretreatment vaginal length or sexual experience. Contrary to the assumption that a vagina of certain dimensions is a prerequisite for women to "have sex," many women with Mayer-Rokitansky-Küster-Hauser syndrome and complete androgen insensitivity syndrome reported having experienced genital and nongenital sexual activities with no medical interventions. It is recommended that treatment providers affirm women's capacity for sexual intimacy, relationships, and enjoyment before they introduce the topic of vaginal construction as a non-urgent choice.

Treatment of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome in Denmark: a nationwide comparative study of anatomical outcome and complications

To compare the long-term anatomical outcome and complications in treatments of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. A historical comparative follow-up study using medical chart reviews. Public hospitals. A nationwide cohort of patients diagnosed with MRKH syndrome (n = 168). McIndoe vaginoplasty (n = 54), self-dilation (n = 60), coital dilation (n = 20), Baldwin vaginoplasty (n = 4), Williams vaginoplasty (n = 3), Davydov vaginoplasty (n = 2), or no treatment (n = 29). Mean vaginal depth at follow-up, anatomical treatment success rates at levels of ≥6cm, ≥7cm, and ≥8cm, complications, and resurgery. Mean vaginal depths were 7.4cm (95% confidence interval [CI] 6.8-8.1cm), 7.3cm (95% CI 6.7-7.9cm), and 8.7cm (95% CI 7.9-9.5cm) at follow-up in patients treated by McIndoe vaginoplasty, self-dilation, and coital dilation, respectively. Overall complication rates in the three groups were 35/54 (65%), 21/52 (35%), and 1/20 (5%), respectively. Eighteen (33%) of the patients who underwent McIndoe vaginoplasty needed resurgery. Our findings support the current recommendations of dilation therapy as the first-line treatment of vaginal agenesis and emphasize the relevance of coital dilation in patients able to regularly engage in coital activity. However, further studies of functional outcome and patient satisfaction are needed.

膣前庭粘膜圧伸法(Frank法)が有用であった下部膣欠損症の治療 : 急性腹症で発症した2症例

膣前庭粘膜圧伸法(Frank法)が有用であった下部膣欠損症の治療 : 急性腹症で発症した2症例

Novel Technique of Neovagina Creation with Uterine Serosa in the Treatment of Vaginal Agenesis Associated with Mullerian Agenesis

Novel Technique of Neovagina Creation with Uterine Serosa in the Treatment of Vaginal Agenesis Associated with Mullerian Agenesis

Hymen Tearing in the Treatment of Vaginal Agenesis

Rupture of the hymen before marriage is a significant problem for a woman and her family. The purpose of this article is to present a case report where hymen membrane perforation was required for vaginal agenesis in a 13-year-old adolescent, identify psychosocial issues related to the torn hymen in the Turkish culture, discuss gender inequality affecting health care of women with a torn hymen, identify the impact of a torn hymen on a Turkish woman's social status, and discuss health care implications for the woman and her family. The girl could not understand the situation and experienced feelings of guilt. The parents displayed an intense reaction of shock and denial after being informed about the disorder and treatment process and felt a sense of hopelessness about the future of their daughter. Nurses are expected to fulfill their training, counseling, and advocacy roles about this issue.

Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review

Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review

Use of Physical Therapy to Augment Dilator Treatment for Vaginal Agenesis

: Dilator therapy has been used successfully for many years to treat vaginal agenesis. Our objective was to show how established physical therapy techniques can be used to augment dilator therapy. : A 36-year-old woman desiring nonsurgical management of vaginal agenesis was instructed in the use of vaginal dilators by a pelvic-floor physical therapist. Manual stretching of the vaginal tissues was performed during office visits after application of heat and therapeutic ultrasound to the perineum. In addition, the patient's husband was taught how to perform the vaginal stretching at home in conjunction with dilator therapy. : The patient was able to attempt intercourse after 6 weeks of treatment and achieved full penetration by 9 weeks. At the completion of treatment, she scored 31.9 on the Female Sexual Function Index. The patient and her husband were very satisfied with the treatment approach, especially the encouragement and guidance received in physical therapy. : By using established physical therapy techniques in conjunction with dilator therapy, a faster time to intercourse may be achieved with high patient and spouse satisfaction. We recommend the involvement of a physical therapist specializing in the pelvic floor as an adjunct to standard dilator therapy in the treatment of vaginal agenesis.

A New Technique for Surgical Treatment of Vaginal Agenesis Using Combined Abdominal-Perineal Approach

Optimum therapeutic approach in vaginal agenesis has always been an area of extensive controversies. Although surgical management gained priority due to the evolution of techniques, there is currently no consensus in the literature regarding the best type of surgical approach. The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. In this paper, we describe two cases with vaginal agenesis with functioning uterus who were subjected to surgery by combined abdominal-perineal approach. The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent.

Should Progressive Perineal Dilation be Considered First Line Therapy for Vaginal Agenesis?

In women with vaginal agenesis progressive perineal dilation provides a minimally invasive method to create a functional vagina without the attendant risks or complications of traditional surgical options. We report our 12-year experience with this technique. Patients with vaginal agenesis treated at our institution were analyzed retrospectively and followed prospectively using case report forms and semistructured interviews. Patients diagnosed with vaginal agenesis were counseled on vaginal reconstruction options. Those electing progressive perineal dilation were instructed on the proper use of vaginal dilators by one of us (MRL) and advised to dilate 2 or 3 times daily for 20 minutes. All patients received physician, nursing and social work education and counseling. Parameters reviewed included primary diagnosis, start and end of vaginal dilation, dilation frequency, dilator size, sexual activity and whether the patient experienced pain or bleeding with dilation or sexual activity. Functional success was defined as the ability to achieve sexual intercourse, vaginal acceptance of the largest dilator without discomfort or a vaginal length of 7 cm. Univariate and multivariate analysis was performed to identify factors associated with successful neovaginal creation. From 1996 to 2008 we enrolled 69 females with vaginal agenesis in a progressive perineal dilation program. The primary diagnosis was Mayer-Rokitansky-Küster-Hauser syndrome in 64 patients. Mean age at the start of vaginal dilation was 17.5 years (range 14 to 35) Mean followup was 19 months (range 0 to 100). Four patients (5.7%) were lost to followup. In 7 of the remaining 65 patients (12%) treatment failed due to noncompliance and 50 (88%) achieved functional success at a median of 18.7 months. Patients who dilated frequently (once daily or greater) achieved a functional neovagina at a mean +/- SD of 4.3 +/- 2.4 months. Functional success correlated positively with frequent (once daily or greater) dilation and the initiation of sexual activity. Complications were minor. Three patients reported infrequent pain and 2 reported a single episode of bleeding with dilation. A total of 18 sexually active patients reported satisfactory intercourse without dyspareunia. Progressive perineal dilation for neovaginal creation is a valuable, minimally invasive therapy to create a functional vagina with a high success rate and a much lower complication rate than that in published surgical series. Given these findings, progressive perineal dilation should be offered as first line therapy in adolescents with a congenitally absent vagina.

Adaptation process of the skin graft to vaginal mucosa after McIndoe vaginoplasty

There are many methods of treatment of vaginal agenesis. In this study, patients who underwent McIndoe vaginoplasty were evaluated for development of vaginal mucosa. Vaginal pH measurements, smears, and punch biopsies were obtained from seven patients postoperatively at 3, 6, and 12 months after having McIndoe vaginoplasty. Neovaginal smears indicated no specific data for mucosal development at the 3rd and 6th month after the operation. However, Doderlein bacilli were determined at the 12th month. Histopathological examination of punch biopsies revealed dermal and subdermal thickening at the 3rd month, partial adaptation to mucosa at 6th month, and full adaptation to mucosa at 12th month. Also normal vaginal pH levels were recorded at the 12th month. As a result of the adaptation process, the split thickness skin graft acquired both histological and physiological characteristics of normal vaginal mucosa. Also, neovaginal epithelium was evaluated to be macroscopically similar to normal vaginal mucosa, 12 months after the operation.

Dilation as treatment for vaginal agenesis and hypoplasia: A pilot exploration of benefits and barriers as perceived by patients

SummaryReconstructive surgery has been the traditional treatment for the short vagina. Recently vaginal dilation has been recommended due to its low morbidity. Small retrospective studies have reported success rates of up to 80% but include neither clear definitions of ‘success’ nor exploration of factors associated with compliance and outcome. The first 10 women prescribed vaginal dilation treatment at a specialist gynaecological clinic during the study period were interviewed and asked to complete the Multi-dimensional Sexuality Questionnaire (MSQ), with an assessment of perceived vaginal characteristics. The participants scored lower scores on sexual esteem, sexual assertiveness and sexual satisfaction and higher scores in sexual anxiety, sexual depression and fear of sexual relationships in comparison with the standardisation sample. Dilator treatment must be subject to the same scrutiny as any intervention. Vaginal dilation can have a negative emotional impact on women and psychological intervention may be needed to maximise efficacy.

Vaginal Dilation Is Highly Successful in Patients with Vaginal Agenesis

The appropriate treatment of vaginal agenesis -- the congenital absence of a vagina, seen in approximately 1 of every 5000 women -- has been debated

Treatment of vaginal agenesis with modified Abb�-Mclndoe technique

In a patient with vaginal agenesis reconstruction of the neovagina is very important both functionally and psychologically. The absent vagina can be constructed either by surgery or by an intermittent pressure technique defined by Frank. In this paper simple modification is presented which has good anatomical and functional results. For a young woman without a vagina the ideal operation should create a vagina in one stage and at the same time produce a cosmetically attractive scar. This goal can be achieved by the Abbe-McIndoe technique. A modification using a meshed split thickness skin graft for lining the neovagina is presented. Between 1985–1991 in our clinic, 46 patients were treated. A follow-up study has been performed and biopsies were taken from this neovagina; these showed normal vaginal mucosa.

Treatment of Vaginal Agenesis with Vulvoperineal Fasciocutaneous Flaps

Giraldo, Francisco M.B.; Gaspar, Diego M.B.; Gonzalez, Carlos M.B.; Bengoechea, Michael M.D.; Ferrón, María M.B.

Vaginoplasty: Combination Therapy Using Labia Minora Flaps and Lucite Dilators—Preliminary Report

The treatment of vaginal agenesis is varied. The combination of creating a vaginal cavity with local skin flaps, then progressively dilating to a functional size has been successful in the past. We describe a technique using tubularized labia minora vascularized flaps to create a deep vaginal pouch that is widened and elongated with lucite dilators. The new vagina has an epithelial lining of nonhair-bearing skin. Three teenage girls, 2 with the Mayer-Rokitansky syndrome and 1 with mixed gonadal dysgenesis, underwent this procedure without any postoperative complications. Since neither abdominal surgery nor skin grafting was required there were no extra scars, excessive neovaginal secretions or need for long-term splinting during the 1-year followup period. The patients have almost normal-appearing genitalia postoperatively and neovaginas averaging 2cm. wide and 6.3cm. deep before dilation. We recommend this procedure as first line treatment for teenage girls with vaginal agenesis.

The free-flap vaginoplasty; a new surgical procedure for the treatment of vaginal agenesis

The ideal operation for a young woman born without a vagina would be a one stage procedure, creating a functionally normal vagina without cosmetically unattractive scars, without the need for subsequent dilatation, stents or obturators. This goal was achieved with a free flap vaginoplasty using a full thickness skin graft taken from the scapula region. The blood supply of the graft was maintained by microvascular anastomosis of the graft pedicles to vessels in the groin. The operation has been performed in three young women who were born with uterine hypoplasia and vaginal agenesis. We experienced no unexpected complications, the procedure was well tolerated and left our patients with a good length, fully functional vagina. However, the operation is a major undertaking and needs to be performed by those with expertise in plastic surgery as well as in gynaecology.

Treatment of Vaginal Agenesis with a New Vulvovaginoplasty

The correction of vaginal agenesis requires the creation of a canal that is in the correct axis and ideally of adequate size, texture, and secretion. A simple surgical technique is described which has a good anatomic and functional result with minimal morbidity. It combines the traditional dissection of the rectovesical space described by McIndoe with a significantly modified vulvovaginoplasty based on the Williams method. The technique has been performed with good results and no complications in three patients. Closely monitored vaginal dilatation is essential in the postoperative period. At this stage, only one patient has engaged in intercourse.