Psychosexual and functional outcomes after creation of a neovagina with laparoscopic Davydov in patients with vaginal agenesis.

OBJECTIVE: To describe sexual function and satisfaction after laparoscopic Davydov vaginoplasty in patients with an absent vagina due to Mayer-Rokitansky-Kuster-Hauser syndrome or androgen insensitivity syndrome compared with a control female population. DESIGN: A descriptive study of standardized, validated psychosexual and functional outcomes using a self-report questionnaire. SETTING: Two tertiary care hospitals at an academic medical center. PATIENT(S): Six women with Mayer-Rokitansky-Kuster-Hauser syndrome or androgen insensitivity syndrome who underwent laparoscopic Davydov. INTERVENTION(S): Patients postoperatively completed a self-report survey of their medical, surgical, and sexual history and the standardized, validated Female Sexual Function Index (FSFI) and select questions from the Golombok Rust Inventory of Sexual Satisfaction (GRISS). MAIN OUTCOME MEASURE(S): Total scores and domain scores (desire, arousal, lubrication, orgasm, pain, satisfaction) on the FSFI were compared with a published control population of women. Descriptive results of domain questions on the selected questions of the GRISS were identified. RESULT(S): Six patients, aged 20-52 years, returned the questionnaires. Responses to the modified GRISS are represented by visual frequency of response bar graphs. Compared with the control population, the patients' scores were lower for arousability, lubrication, orgasm, and comfort on the FSFI. CONCLUSION(S): Sexual function appears impaired in these six women who underwent laparoscopic Davydov as assessed by the FSFI. This may reflect characteristics of the patient population, as well as the inclusion of all patients' data even if they did not attempt vaginal intercourse in the previous month.

Long-term outcomes of transvestibular vaginoplasty with pelvic peritoneum in 182 patients with Rokitansky's syndrome.

OBJECTIVE: To evaluate the technical feasibility and anatomical and functional outcomes of one-stage transvestibular vaginoplasty with pelvic peritoneum for the patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. DESIGN: A retrospective review of prospectively collected data. SETTING: A university hospital. PATIENT(S): A total of 182 women with MRKH syndrome. INTERVENTION(S): Undergoing transvestibular vaginoplasty with pelvic peritoneum. MAIN OUTCOME MEASURE(S): The perioperative results, complications, and anatomical and functional outcomes of transvestibular vaginoplasty with pelvic peritoneum. RESULT(S): The mean operative time was 72.2 minutes (range 55-150 minutes). Average blood loss was 78.5 mL (range 40-170 mL). The only perioperative complication was one case of rectal-vaginal fistula. Thirty-four patients had vault granulation at the neovagina, which healed after trimming and the mean length of the neovagina was 9 cm (range 7-12 cm) without any shrinkage at the follow-up of 3 months after operation. The neovaginal introitus admitted two fingers in width in all patients. Good functional outcomes were found in the patients at follow-up 15 years after surgery with 80% of the cumulative proportion of sexual satisfactory activity. CONCLUSION(S): Transvestibular vaginoplasty with pelvic peritoneum is an effective and feasible approach for women with MRKH syndrome. The procedure has satisfactory long-term anatomical and functional results.

Intestinal vaginoplasty: seven years' experience of a tertiary center.

OBJECTIVE: To investigate the long-term effects of intestinal vaginoplasty in cases with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. DESIGN: Prospective study. SETTING: Division of Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, at a women's and children disease education and research hospital. PATIENT(S): Between 2003 and 2009, 29 patients with MRKH syndrome underwent intestinal vaginoplasty. INTERVENTION(S): Two of the patients were treated with ileal and 27 with sigmoid vaginoplasty. MAIN OUTCOME MEASURE(S): The age, marital status, associated anomalies, method used for bowel transposition (isoperistaltic/antiperistaltic), type of abdominal incision, and intra- and postoperative complications were evaluated. RESULT(S): One of the patients for whom ileal vaginoplasty was performed had 40 cm ileal necrosis requiring bilateral ileostomy for 2 months. Introital stenosis was detected in 15 cases (79%) who were unmarried, while none of the married cases had introital stenosis. However, all patients responded to finger-dilatation. All married patients were sexually satisfied after operation. An intraluminal abscess developed in the proximal segment of the neovagina owing to stricture occurring above abdominoperineal tunnel 2 years after operation. In another patient who had a rudimentary uterine horn, hematometra developed 3 years after operation and treated with resection. CONCLUSION(S): In our experience, sigmoid vaginoplasty seems to be a favorable procedure which provides excellent long-term results for the patients with vaginal agenesis.