Search

Objective: To explore how women with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome experience dilation or surgical vaginal lengthening treatment, and their current sexual well‐being. Design: A qualitative interview study. Setting: Denmark. Population: Women aged ≥25 years diagnosed with MRKH syndrome. Methods: Semi‐structured video interviews were conducted with 18 women. Interviews lasted a median of 92 min and were digitally recorded, transcribed and anonymised. Data were analysed using thematic analysis. Main Outcome Measures: A qualitative analysis of women's experiences. Results: The analysis identified three themes. Firstly, Experiences with dilation treatment revealed dilation as an awkward routine, especially for adolescents living with parents and yet to sexually debut. While some experienced successful vaginal lengthening, others faced treatment failure leading to frustration and self‐blame. Secondly, Experiences with neovaginal surgery described the procedure as extremely painful but resulting in a 'normal size' vagina. Some women felt that the procedure had negatively impacted their self‐confidence, and all underscored the importance of maturity before opting for surgery. Lastly, Current sex life and sexual well‐being indicated a well‐functioning sex life for many women, but with reported low sexual confidence and genital self‐image due to the perceived 'deviance' of their genitalia. Conclusions: For women with MRKH syndrome, vaginal lengthening treatment, whether through dilation or surgery, may result in a 'normal size' vagina. However, according to the women's experiences, vaginal lengthening treatment does not adequately foster positive sexual esteem and genital self‐image. This article includes Author Insights, a video abstract available at: https://1drv.ms/v/c/426d88d9eb0a10fb/ERqbdfeTFeFLkp24xVb9n7ABTZ5VS3f6yxoHlXT7BUPs6A?e=y41xwc. [ABSTRACT FROM AUTHOR]

Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusions Congenital uterine anomalies include a wide diversity of uterine malformations that can compromise reproductive potential. Uterus transplantation (UTx) proposes an innovative treatment for absolute uterine factor infertility; however, there is a lack of standardized protocols to guide clinical management among this population.To describe recipient and donor characteristics and obstetric outcomes in patients undergoing UTx.We performed a literature search using the PubMed database to retrieve available scientific articles. We analyzed the references of included articles to assess additional articles that could be eligible to be included in the review. Likewise, we identified further studies using other methods, including Google Scholar.Titles and abstracts were screened in duplicate to select original reports with information available for the outcomes of interest.This review assessed the advantages and disadvantages of the techniques used, patient characteristics, obstetric and non‐obstetric complications, functional duration of the organ, and neonatal outcomes.Among the 36 reports included in this review we found 55 pregnancies and 38 live births following UTx and a higher success rate for in vivo uterine donations. The most common obstetric complications reported included miscarriage, pre‐eclampsia, and gestational hypertension. The most common non‐obstetric complications reported include episodes of rejection, acute kidney injury, anemia, and cholestasis. Living donors required a comprehensive preoperative workup, decreasing organ rejection, infection, and vascular complications.More studies are needed to standardize the UTx procedure and improve obstetric, fetal, and neonatal outcomes. Further understanding of which recipient and donor characteristics minimize complications will significantly decrease the risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

Aims: To introduce and compare the modified laparoscopic Vecchietti and Davydov techniques for vaginoplasty in patients with Mayer‐Rokitansky‐Küster‐Hauser (MRKH) syndrome. Moreover, the long‐term treatment of vaginal agenesis was followed‐up. Methods: This comparative retrospective cohort study enrolled a total of 53 women with MRKH syndrome. The patients underwent surgical creation of a neovagina including 32 patients who underwent the modified laparoscopic Vecchietti technique, and 21 patients who underwent the modified laparoscopic Davydov technique from January 2009 to February 2019. The perioperative parameters, complications, anatomical, and functional outcomes of the two groups were compared. Patients' sexual functions were evaluated over a long‐term follow‐up using the female sexual function index (FSFI) and the revised female sexual distress scale (FSDS‐R). Results: The medians (25th–75th) of the surgery duration for modified Vecchietti procedures was 50.0 (40.0–59.0) minutes, comparing to 135.0 (117.5–162.5) min for Davydov procedures (p < 0.001). The intraoperative blood loss was 20 (7.5–20.0) mL versus 50.0 (50.0–100.0) mL using the modified Vecchietti and Davydov approaches (p < 0.001), respectively. In the 39 follow‐up cases, the lengths of the neovagina of the patients for Vecchietti group versus Davydov group were 7.9 ± 1.0 cm versus 8.6 ± 1.2 cm at 6 months after the vaginoplasty and 8.3 ± 0.7 cm versus 8.5 ± 0.9 cm after 2 years. There was no statistical difference in the FSFI and FSDS‐R scores between the two groups. Conclusions: Both the modified Davydov and Vecchietti laparoscopic procedures successfully achieved optimal anatomic and functional outcomes in treatments of vaginal agenesis. The modified Vecchietti technique is relatively simpler than the modified Davydov technique. [ABSTRACT FROM AUTHOR]

Background: 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 80 years, 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. Aims: 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. Materials and Methods: Retrospective observational study between January 2005 and June 2015. Results: Of the 23 women, 21 (91.3%) achieved a successful vaginal length defined as achieving vaginal length >6 cm and maximum width using the largest dilator if not sexually active, or ability to have sexual intercourse without discomfort. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objective: To compare, in terms of anatomical, functional, and sexual aspects, two types of treatment for women with vaginal agenesis: progressive dilation or surgical neovaginoplasty. Methods: 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 3–6 months 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

We describe a successful surgical technique of abdominal trachelectomy and re‐vaginoplasty for cervico‐vaginal stenosis following unsuccessful uterovaginal anastomosis and vaginoplasty in a patient with congenital cervical and vaginal aplasia. After the surgical procedure, cervico‐vaginal stenosis was resolved and periodic menstruation without dysmenorrhoea resumed. While long‐term follow‐up is essential to ensure successful pregnancy and delivery, we conclude that this novel surgical procedure is a promising alternative for improvement of the quality of life and normal sexual function, and for preservation of fertility in patients with cervical and vaginal aplasia. [ABSTRACT FROM AUTHOR]

Vaginal creation is the standard treatment for Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. Although non‐surgical method is recommended as a first‐line treatment in the American College of Obstetricians and Gynecologists guidelines for gynecological practice, it is not commonly performed in Japan. At our hospital, vaginal dilation using uterine cervical dilators (Hegar's dilator) is performed for patients with MRKH syndrome. We report four cases successfully treated with vaginal dilation. After the examination, patients were instructed to practice daily self‐dilation at home. The initiation size was No. 13 with 10.5‐mm diameter. After the vaginal cavity was dilated to a depth of 6 cm, the size of dilators was gradually increased until No. 30 with 25‐mm diameter in a tip and 28‐mm diameter in a trunk. The duration required to achieve the outcome was 5–22 months. All cases were successfully treated without any severe complication. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aims of this study were to present the results of using infragluteal folds as a skin graft donor site in cases of Mullerian agenesis undergoing full‐thickness skin graft vaginoplasty and to evaluate the outcomes of the surgical technique. Methods: Demographics and clinical parameters of 24 consecutive Mullerian agenesis patients refusing any dilatational procedure and undergoing neovaginal construction using infragluteal folds skin grafts from May 2004 to July 2015 were analyzed. Results: The mean age of the patients was 21.5 ± 5.7 years. Five patients had nonfunctional rudimentary uterus, one patient had unilateral ovarian agenesis, one patient had unilateral renal agenesis, and one had undergone a previous vaginoplasty. There were no serious complications needing surgical or medical intervention. The depth of the neovagina in patients with a follow‐up period of more than 6 months (n = 17) varied from 7 to 12 cm. Of these patients, the sexually active ones (n = 8) did not complain of dyspareunia or vaginal dryness during sexual intercourse. The resulting scars were satisfactory and acceptable for all patients. Conclusion: It has been our practice to use infragluteal folds as a skin graft donor site for full‐thickness skin graft vaginoplasty. We believe that the results of this study demonstrate that this area is versatile and an excellent alternative to the groins and lower abdomen. Further clinical and histomorphological investigations are necessary for strong statements and results. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effect of adjuvants during intensive vaginal dilator therapy for functional and anatomical neovagina creation in women with Mayer‐Rokitansky‐Kuster‐Hauser syndrome (MRKH). Methods: This retrospective cohort study included 75 women with MRKH undergoing intensive vaginal dilator treatment between 2000 and 2014. One specialist nurse performed non‐surgical vaginal dilation aided by adjuvants, during inpatient admissions for several dilation sessions per day. Following discharge, women continued dilation at home and were advised to attend fortnightly follow‐up appointments. Results: Outcomes from 68 women were analysed. The median age of starting treatment was 18 years (range: 13–36). There was a mean of 3 days per admission (range 1–5) with a median of 10 dilation sessions per admission. Adjuvant treatment was used by 48/68 (71%) women: oestriol cream 29/68 (43%), 50:50 nitrous oxide and oxygen 44/68 (65%), diazepam 8/68 (12%), lidocaine ointment 26/68 (39%), paracetamol 35/68 (51%) and naproxen 2/68 (3%). There were no statistically significant differences for changes in vaginal parameters. Women receiving adjuvants had a median increase of 4.5 cm (0.5–7 cm) in neovaginal length compared with women not receiving adjuvants who had a median increase of 3.25 cm (0–7 cm) during intensive treatment. Women who received adjuvants tolerated more dilation sessions per day (10 vs 6.5 median sessions respectively) than those who did not (P < 0.001). Of those with documented length at discharge, 42/56 (75%) women had an anatomical neovagina of 7 cm or greater length. Conclusions: Vaginal dilation delivered by intensive treatment and supplemented by adjuvant treatments in a multi‐disciplinary centre is a rapid and effective method for creation of a neovagina in women with MRKH. [ABSTRACT FROM AUTHOR]

Objective To examine the management and long-term outcomes of transverse vaginal septae. Design Observational study with cross-sectional and retrospective arms. Setting Tertiary referral centre specialising in Müllerian anomalies. Population Forty-six girls and women with a transverse vaginal septum. Methods Data from medical records of all cases (1998-2013) of transverse vaginal septae were collected and reviewed. Patients over 16 years of age also completed a questionnaire. Main outcome measures Presentation, examination findings, investigations, surgery, and long-term reproductive outcomes. Results The septae in the study were described as follows: 61% (95% CI 0.46-0.74) were imperforate, and presented with obstructed menstruation; 39% (95% CI 0.26-0.54) were perforate, and presented with a variety of concerns; 72% (95% CI 0.57-0.83) were low, 22% (95% CI 0.12-0.36) were mid-vaginal, and 6% (95% CI 0.02-0.18) were high; 33% were managed via an abdominoperineal approach, 59% were managed via a vaginal approach, and 6% had laparoscopic resection (one patient did not have surgery); 11% (95% CI 0.05-0.23) of patients presented with reobstruction, all following abdominoperineal vaginoplasty; 7% presented with vaginal stenosis, two following vaginal resection and one following the abdominoperineal approach; 61% of questionnaires were returned. These results showed that 22/23 patients were menstruating and one had a hysterectomy, 74% had been sexually active, 35% had dyspareunia, and 36% complained of dysmenorrhoea. There were seven pregnancies, with one termination and six live births, all following the vaginal excision of a transverse vaginal septum. Conclusions Transverse vaginal septae resected vaginally or laparoscopically have low complication rates and good long-term outcomes. Complex septae require more extensive surgery, with an increased risk of complications. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to introduce a method for uterus preservation in patients with vaginal agenesia and functional uterus. Material and Methods: Six patients with vaginal agenesia and one patient with cervicovaginal agenesis with functional uterus were enrolled in the study. Laparoscopy, vaginal reconstruction, laparatomy, hematocolpos evacuation and cannulation were carried out between atretic cervix and neovagina using a Pezzer catheter. No sutures or grafts were used. Patients were trained to use a vaginal mold regularly. Pezzer catheter remained in place for 6 months to maintain menstrual drainage and avoid orifice obstruction. Results: The surgical procedure was successful in all cases. Menses returned and abdominal pain was relieved in all patients. Three patients faced stenosis and two cases suffered from infection. One patient became pregnant and delivered at term. Self-image and quality of life were improved in all cases. Conclusions: Uteroneovaginal cannulation using a Pezzer catheter relieves pain, restores regular menses and fertility and reduces symptoms related to retrograde menstruation in patients with vaginal agenesis and functional uterus. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the technical feasibility and anatomical and functional outcomes of laparoscopically assisted sigmoid colon vaginoplasty (LASV) in women with Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome. Design A retrospective review of prospectively collected data. Setting Shanghai First People’s Hospital, Shanghai Jiao Tong University. Population Twenty-six women with MRKH syndrome. Methods A record was made of mean operating time, length of hospital stay, perioperative complications and the anatomical and functional outcomes of surgery. Main outcome measures The perioperative results, complications and anatomical and functional outcomes of LASV (with median 20 months follow up, range 5–48 months). Results The mean operating time and hospital stay were 238 minutes and 9.8 days, respectively. The mean fall in haemoglobin was 2.0 g/dl. The only significant perioperative complications were one case with blood transfusion and three cases with infection (one with urinary tract and two with adjunctive incision). A functioning vagina 10 to 15 cm in length and 4 cm in width was created in all women. Introital stenosis occurred in only two women (2 months later). Twenty-two women subsequently had intercourse and 20 women (91%) were satisfied with the surgery and subsequent sexual activity. Conclusions LASV is an effective approach for women with MRKH syndrome. Both the anatomical and functional outcomes are satisfactory. [ABSTRACT FROM AUTHOR]

Objective: To evaluate surgical, long-term anatomic and functional results of the laparoscopic Vecchietti procedure to treat women with vaginal agenesis.Methods: Retrospective analysis of 86 women treated at the Department of Gynecology and Obstetrics at the University of Verona, Italy. Data were analyzed based on surgical results and postoperative sexual satisfaction. Depth and diameter of the neo-vagina was determined. The characteristics of the neo-vaginal mucosa were investigated by vaginoscopy. Patients reported frequency, satisfaction, and any difficulties found at intercourse.Results: Functional success was obtained in 98.1% and anatomic success in 100%. In all patients, at 1 year, the mucosa was pink, trophic, and moist. Two fingers were introduced easily into the neo-vagina in all cases. All patients, which decided to have sexual intercourse, defined these as satisfying within 6 months.Conclusions: Laparoscopic procedure used in this study is simple, safe, and effective. Anatomical and functional results obtained suggest this laparoscopic procedure as the treatment of choice for this syndrome. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of amniotic membrane grafts in cases of vaginal and cervical agenesis.Methods: Five girls with complete cervical and vaginal agenesis underwent cervicoplasty and vaginoplasty using amniotic membrane grafts.Result: Excellent epithelization and patency of cervix and vagina was achieved in all cases.Conclusion: Amniotic membrane may be used as an allograft in cervical reconstruction. It is inexpensive, readily available, of low antigenicity and does not necessitate repeated cervical dilatation. The performance of the reconstructed cervix during labor is yet to be observed. To the author's knowledge, this is the first series reported in the literature in which amniotic membrane was used for cervical reconstruction. [ABSTRACT FROM AUTHOR]

Objective To report a one‐stage procedure, using a segment of caecum, both to overcome failed previous procedures and for primary vaginal replacement in patients with congenital vaginal aplasia, where primary reconstruction often results in vaginal obstruction and fistula formation. Patients and methods The vagina was reconstructed using a 15‐cm isolated caecal segment placed between the bladder and rectum and anastomosed to the introitus. Between 1985 and 1997 the technique was used in 17 patients (mean age 23 years). Indications included congenital malformations and vaginal loss through anterior exenteration or trauma. Seven of the 17 patients had undergone previous complex reconstructions; four of these had undergone previous fistula formation. Fourteen patients were followed for a mean of 3.6 (1–9) years. The surgical outcome was evaluated using a questionnaire completed by the patients. Results The postoperative course was unremarkable in all patients. Four patients developed an introital stenosis requiring surgical intervention. Two patients were minors at the time of follow‐up, while all the others had had sexual intercourse and reported that they were very satisfied with the functional and cosmetic result. Conclusion In patients in whom previous vaginal reconstruction has failed, the caecal segment should be used to create a neovagina. By considering the patient’s age, the surgeon can optimize the surgical result. [ABSTRACT FROM AUTHOR]

Abstract: The use of nonsurgical techniques for the creation of a neovagina for vaginal agenesis and stenosis has been successful for many patients and is currently recommended as first-line therapy. The Ingram bicycle seat stool technique, a nonsurgical approach, has largely replaced the surgical McIndoe technique as the method of choice for vaginal dilation. It provides an easy and comfortable way for patients to engage in dilation. However, the Ingram bicycle seat stool is not height adjustable. We have created a bicycle seat stool that is height adjustable and will likely provide patients with an improved, more comfortable, and individualized method of dilation. [Copyright &y& Elsevier]

We report a case of hematometra and bilateral hematosalphinx in a 15-year-old mentally handicapped adolescent girl, complicated by vaginal agenesis over cervical atresia in the presence of an ovarian adenoma. The case was managed by abdominal hysterectomy and bilateral salphingectomy of the hematosalphinx, which had formed a tubo-ovarian mass. One ovary was preserved. This case also considers the management of the mentally handicapped patient unable to comprehend pain arising from cryptomenorrhea. [ABSTRACT FROM AUTHOR]

Discusses four cases of agenesis of vagina. Creation of a functional vagina by coital dilatation without use of any artificial instruments; Primary amenorrhea due to Rokitansky syndrome; Vaginal agenesis caused by complete testicular feminization.