Treatment of Urethral Intercourse and Impact on Female Sexual Function

Abstract

Background Urethral intercourse is a very rare entity which usually presents as urinary incontinence during and after intercourse and is most commonly seen in patients with vaginal agenesis (Mayer–Rokitansky–Hauser Syndrome) or hypoplasia, or other rear vaginal anomalies. Aim To evaluate management and outcomes for vaginal and urethral consequences of urethral intercourse, including urinary incontinence. Methods Between February 2006 and March 2021, 8 women aged from 17 to 22 years underwent genital and urethral reconstruction due to consequences of urethral sexual intercourse. Vaginal reconstruction included sigmoid vaginoplasty and introitoplasty with division of the vaginal septum in cases of vaginal agenesis (5 cases) and vaginal duplication (3 cases), respectively. Incontinence was treated by sling procedures in 5 women with longer history of urethral coitus and evident bladder neck prolapse. Outcomes Sexual and psychosexual outcomes assessment was based on the Female Sexual Function Index and standardized questionnaires. Results Follow-up ranged from 9 to 188 months (mean 78 months). Good esthetical and functional results were achieved in all 8 women. All patients reported satisfactory sexual intercourse. All 5 incontinent women who had underwent sling procedure were continent. In one of 3 nontreated cases, additional sling treatment was indicated 6 months after vaginal reconstruction with satisfactory outcome. One patient with vaginal duplication reported a successful pregnancy with a Caesarean section delivery. Clinical Implications Urinary incontinence with megalourethra in young women, along with the presence of Mullerian anomalies should raise suspicion of urethral coitus. Surgical treatment includes correction of vaginal anomalies and management of consequences. Strengths and Limitations This study represents one of the largest series for urethral intercourse, with assessment of psychosexual outcome. The limitation is the lack of statistical analysis due to small sample size. Conclusion Urethral intercourse is very rare, but it can cause severe consequences. It is important to recognize this occurrence and treat it by well-known vaginal or urethral reconstructive procedures.

Davydov Vaginoplasty in Mayer–Rokitansky–Küster–Hauser Syndrome Patient Presenting With Urethral Dilatation

“…Less than 30 cases of patients who have engaged in intraurethral coitus have been published. Various techniques have been utilized in the creation of a neovagina, ranging from medically supervised self-dilatation [ 20 ] to relatively conservative surgery (Vecchietti procedure) or extensive vaginoplasty (modified McIndoe [ 19 , 21 ] or sigmoid [ 6 , 18 ]). The same is true for the management of a dilated urethra, with strategies such as urethral plication, sling insertion, or vaginal creation from the distal urethra simultaneously with vaginoplasty [ 6 , 15 , 16 ].…”

“…Various techniques have been utilized in the creation of a neovagina, ranging from medically supervised self-dilatation [ 20 ] to relatively conservative surgery (Vecchietti procedure) or extensive vaginoplasty (modified McIndoe [ 19 , 21 ] or sigmoid [ 6 , 18 ]). The same is true for the management of a dilated urethra, with strategies such as urethral plication, sling insertion, or vaginal creation from the distal urethra simultaneously with vaginoplasty [ 6 , 15 , 16 ]. One major disadvantage of the classic Abbè–McIndoe method is the creation of a visible scar at the origin of the skin graft, which is often deemed unacceptable by young women.…”

Megalourethra and bladder foreign body in a female patient

“…Urethral coitus leading to megalourethra in women is a rare phenomenon. It is commonly seen in patients with vaginal anomalies like vaginal agenesis 13 or imperforate hymen. Mayer–Rokitansky–Kuster–Hauser syndrome is the most common presentation of Müllerian anomalies when vagina fails to form 14 .…”