Management of Vaginal Hypoplasia in Disorders of Sexual Development: Surgical and Non-Surgical Options

Abstract

Patients with disorders of sexual development (DSD) requiring vaginal reconstruction are complex and varied in their presentation. Enlargement procedures for vaginal hypoplasia include self-dilation therapy or surgical vaginoplasty. There are many vaginoplasty techniques described, and each method has different risks and benefits. Reviewing the literature on management options for vaginal hypoplasia, the results show a number of techniques available for the creation of a neovagina. Studies are difficult to compare due to their heterogeneity, and the indications for surgery are not always clear. Psychological support improves outcomes. There is a paucity of evidence to inform management regarding the optimum surgical technique to use, and long-term data on success is lacking, particularly with respect to sexual function. In conclusion, vaginal dilators remain the cornerstone of treatment of women with vaginal hypoplasia and should be used as the first-line technique. Surgical vaginoplasty has a role in complex patients with previous failed dilation and surgical intervention, particularly those cases where there is significant scarring from previous surgery. Regardless of the vaginal reconstruction technique, patients should be managed in a multidisciplinary team where there is adequate emotional and psychological support available.

Sexual Life and Sexual Wellness in Individuals with Complete Androgen Insensitivity Syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS)

“…Most procedures (Vecchietti, Davydov, McIndoe, Williams) require post‐op dilation at least until healing is complete. Operations are usually carried out in the patients' late teens or early twenties [14,17,18].…”

Hypoplastic Vagina, Partial Vaginal Septum, and Coexisting Hypogonadotropic Hypogonadism: An Unusual Case of Primary Amenorrhea

“…12 Although the patient in this article did not have complete vaginal agenesis, dilation can benefit women with a hypoplastic vagina. 13 Once a diagnosis of midvaginal obstruction had been made, dilation is not an appropriate treatment option. In these cases, surgery is indicated to relieve outlet obstruction, and to provide adequate vaginal length sufficient to allow intercourse.…”

Should we vaccinate against and test for human papillomavirus infection in adolescent girls and women with a neovagina?

“…Creation of a neovagina can be achieved via a non-surgical or a surgical approach depending on the diagnosis, previous treatment and patient preference 5. Variations in surgical approach and timing of operations exist, with some women having had surgery in infancy and others in adolescence or adulthood.…”