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Study Objective To report on minor modification of laparoscopic Vecchietti vaginoplasty and to examine the quality of sexual life after the operation. Design A retrospective study to examine the role of minor modification during laparoscopic Vecchietti operation to prevent injuries and to evaluate the sexual function of patients with neovagina. Setting Department of Obstetrics and Gynecology, University of Pecs, Faculty of Medicine, a tertiary supply center in Hungary. Paticipants Twenty-three adolescents or young adults, ages 16 to 26 with vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) were operated. Twenty-five sexually active patients with matched age served as controls. Interventions Laparoscopic Vecchietti operation was modified with the use of endovaginal ultrasound transducer to visualize the narrow vesico-rectal space. The quality of sexual life 2–11 years after the operation was measured by the Female Sexual Function Index (FSFI). Main Outcome Measures Complications occurring during operations; desire, arousal, orgasm, satisfaction, lubrication, and pain during sexual intercourse. Results The technical modification of the operation, with endovaginal transducer, improved the method. Serious injuries of the bladder or rectum could be avoided. Anatomic and functional results shown by the total FSFI scores did not differ from that of the control group. Desire, arousal, orgasm, and satisfaction of the operated patients were similar to controls; however, patients with neovagina tended to have less lubrication and more pain during sexual intercourse. Conclusions Laparoscopic Vecchietti operation modified by the use of endovaginal transducer is a safe procedure to create a neovagina, which guarantees good quality of sexual life with high satisfaction for patients.

Objectives The relationship between climacteric osteoporosis and disturbances in menstrual cycle during adolescence was examined. Methods Seven hundred and seventy-one questionnaires were shared out among women visiting the outpatient department for climacteric complaints for the first time between 2001 and 2004. Questions revealed the age, age at menarche and menopause, the regularity or irregularity of menstrual cycle during adolescence and adult ages. The bone mineral density was examined using the Dual Energy X-ray Absorptiometry (DEXA) method on the lumbar spine. Results Six hundred and thirty-five of the 771 questionnaires were suitable for analysis. Osteoporosis was observed in 30.1% of the cases. Age, age at the menarche or at the menopause did not alter in the subgroups with or without osteoporosis. The incidence and severity of osteoporosis were significantly higher in patients reporting secondary amenorrhea during adolescent ages (42.1%; average BMD of the lumbar spine 71.6 ± 3.9), as compared to the patients with normal cycle (30.4%; average BMD of the lumbar spine 84.8 ± 7.8). No correlation between the occurrence of osteoporosis and the frequency of menstrual cycle during adulthood was observed. Conclusions Secondary amenorrhea during the years of adolescence might play a role in the development of more severe osteoporosis in menopause.

The occurrence of reduced bone mineral density (BMD) among adolescent girls with oligomenorrhea or secondary amenorrhea, due to 'pure' dysfunction of the hypothalamo-pituitary-ovarian (HPO) axis (without anorexia nervosa, excessive sport or ballet, slimming diet, etc.) was examined. The study group consisted of 19 adolescent girls (age 16-18 years) with oligo/amenorrhea. Clinical (height, weight, age at menarche, duration of amenorrhea, body mass index (BMI)), hormonal (follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, testosterone, prolactin), and ion (calcium, sodium, potassium, phosphate, chloride) parameters and the BMD of the lumbar spine were investigated. Correlations between BMD and other parameters were also examined. Twenty healthy volunteers (same age and regular cycles) served as controls. Three girls had osteoporosis, with a BMD below -2 standard deviations (SD). Ten showed osteopenia, with a BMD value between -1 and -2 SD. Only six of the study group had a normal BMD within +/- 1 SD. A positive correlation was observed between the BMD and the BMI (r = 0.73; p < 0.05). All the controls had normal hormonal, ion and BMD parameters. 'Pure' dysfunction of the HPO axis in adolescents, causing oligomenorrhea or secondary amenorrhea, might result in reduced BMD and, consequently, lower peak bone mass. Treatment of menstrual cycle disorders is necessary for the prevention of osteoporosis.