A nonsurgical approach to the treatment of vaginal agenesis (original) (raw)
Related papers
Vaginal Dilators: Issues and Answers
Sexual Medicine Reviews, 2020
Introduction: Vaginal dilators are often prescribed to facilitate an adaptive brain-body connection to decrease anxiety and pain that can be experienced in anticipation of sexual intercourse among populations of women with sexual pain syndromes. Postmenopausal women, cancer survivors, and women with a wide variety of pelvic floor disorders who experience genito-pelvic pain/penetration disorder (GPPPD) are often advised to incorporate vaginal dilators into their pelvic floor rehabilitation program and treatment regimens to enable penetrative intercourse with less pain. However, little is known about the behaviors of dilator users, what treatment protocols are most effective, how patients are currently using their dilators, and how effective are clinicians in helping their patients achieve success with their dilation therapy. Methods: A recent PubMed literature search was performed using the key words vaginal dilator, vaginal dilator therapy, sexual quality of life, vaginal stenosis, vaginal dilation, vaginismus. A total of 29 English articles were reviewed and summarized. Articles were excluded for the following reasons: not in English and unrelated to dilator therapy. Main Outcome Measure: This article will summarize the current research on vaginal dilators and discuss needs for future research to maximize patients' compliance and success with this treatment. Much of the summary data regarding user behavior will come from the early survey data with Milli, a novel, patient-controlled electronic dilator that slowly expands 1 mm at a time from its smallest diameter, 15 mm to a maximum diameter of 40 mm. Milli is currently being used by more than 1,000 women, and 3-month follow-up data were recorded on 335 of those patients. Results: Dilators exist in multiple forms (plastic, latex, and medical grade material), may come individually or in sets, and many have special features such as vibration or the ability to be heated or cooled before use. Little is known about patients' use of dilators and the Milli's 3-month survey serves as an insight to patient dilator behavior. The most common medical goals for patients undergoing dilation treatment were return to penetrative intercourse and pain reduction during coitus. Patients were dilated on average 2.72 days/week; 56.8% of patients had suffered from sexual pain for 2 or more years and 36.3% had previously used static dilators. More than 70% of Milli users purchased Milli and are using Milli without the direct guidance of a clinician. The most common emotions patients used to describe their treatment were not only "anxious," "frustrated," but also "empowered" and "optimistic." The most common dilatory session duration was 6e10 minutes, mostly in the evening/bedtime (68.3%), located in the bedroom (96.8%). Adjunctive treatment included the following: vaginal moisturizers, local estrogen products, coital lubricants, and genital pelvic floor physical therapy. During the dilation sessions, women most often watched TV/videos, practiced mindfulness, or listened to soothing music. Factors that showed trends toward improved patient outcomes were length of dilation treatment (greater than 3 months) and use of meditation and soothing music. Factors not associated with improvement trends were as follows: when/ where patients dilated and patient demographics including age, race, or religious preferences. Conclusion: Patients who purchase dilators have often suffered with their condition for a long time and had difficulty finding a competent health-care clinician well versed in sexual pain syndromes that can help them. When patients did find a clinician, there were no clinically proven standardized protocols or formalized guidelines to give to patients about how to best use their dilators. Larger long-term interventions investigating a standardized dilation protocol are planned in future studies to better elucidate the effective and optimal dilation treatment plans.
Providers' Experiences with Vaginal Dilator Training for Patients with Vaginal Agenesis
Journal of Pediatric and Adolescent Gynecology, 2017
Study Objective: To examine providers' experiences with vaginal dilator training for patients with vaginal agenesis. Design and Setting: Anonymous electronic survey. Participants: Members of the North American Society for Pediatric and Adolescent Gynecology. Interventions and Main Outcome Measures: How providers learn about vaginal dilator training, common techniques, and methods used for patient training, assessment of patient readiness, common patient complaints, issues leading to early discontinuation. Results: There were a total of 55 completed survey responses of which 31 respondents (56%) had been in practice for more than 10 years. Forty-nine were gynecologists (89%), 20 had completed a fellowship in pediatric and adolescent gynecology (36%), and 6 were reproductive endocrinologists (11%). Thirty-one respondents had first learned about vaginal dilator training through lectures (56%) whereas only 9 through mentorship and fellowship (16%). According to respondents, the most common issue leading to early discontinuation was lack of patient motivation and readiness (n 5 42; 76%). The most common complication was pain or discomfort (n 5 45; 82%). More than half of respondents determined dilator therapy was successful when patients reported comfortable sexual intercourse (n 5 30; 55%) and 65% (n 5 35) did not delineate any restrictions to initiation of sexual intercourse. Most respondents (87%) requested further vaginal dilator training at either a clinical meeting (n 5 26; 47%) or with a training video (n 5 22; 40%). Conclusion: Our study in an experienced cohort of pediatric gynecology providers highlights the need for further research and training on vaginal dilation education.
Dilation and surgical management in vaginal agenesis: a systematic review
International Urogynecology Journal, 2013
INTRODUCTION: The management of vaginal agenesis currently is determined by geographical location and surgeon preference. The optimal treatment is unknown and the majority of articles on technique and outcome focus on personal case series with little standardization of reporting and follow up. METHODS: 6691 articles concerning the management of vaginal agenesis were systematically reviewed, with 162 fitting the inclusion criteria. RESULTS: Only 1 randomized control trial was included with the remaining articles made up of case series or case reports. The bowel vaginoplasty method was most commonly reported historically with 945 patients and 45 articles included. The Vecchietti procedure had the shortest operative time but the most number of urological injuries (2.1%). The split thickness procedure had the highest infection rate (4.2%) and re-operative rate (7.84%). CONCLUSION: Overall, the conservative method using dilation had the least number of complications, with an average vaginal length of 6.65 cm (+/-1.39cm). However, with an operative procedure full consent and understanding of the need for postoperative dilation with the majority of techniques is imperative.
New Technique for Management of Relaxed Vagina –Preliminary Study
Anaplastology, 2014
Anaplastology, an open access journal Volume 3 • Issue 1 • 1000124 were asked to contract the muscles. Techniques Under spinal anaesthesia lithotomy position was made. Part was prepared and draped. Examination was done before anaesthesia (Figures 1 and 2) then an incision was made posterior to posterior vaginal opening (Figure 3). Mucosa was cut and dissection was done deeper exposing the muscles and fascia (Figure 4). The muscles and fascia were reefed in midline. Then multiple rugae were created inside vagina mostly in posterior and lateral wall (Figure 5). How to create rugae Rugae creation has not been described in literature. We have for the first time described creation of rugae. For this after the mucosa is dissected a fold of mucosa is held in forceps and vircryl suture is passed from one side to other and then from other side to first side and when it is tied lightly a fold is created which is rugae. After creation of rugae and reefing of muscles the mucosa of vestibule is incised bulbospongiosus muscle dissected on either side and approximated in midline. Excess of mucosa is excised and closed primarily (Figure 6). After completion of operation vagina should barely admit one finger (Figure 7). The ointment is smeared over the stitches and a pad is applied. Postoperative management Postoperatively the pad is changed by patient every time she goes to toilet and ointment is applied. Antibiotic is given for one dose and pain killers are given for few days. Physical relations are advised after three weeks when complete healing had taken place.
Advances in Therapy
Introduction: The aim of this study was to evaluate the dimensions of the vaginal canal in patients undergoing gynaecological brachytherapy and the effect of the use of vaginal dilators (VD) used in the follow-up of pelvic physiotherapy. Methods: A total of 88 patients were randomly allocated to the control group (CG) and intervention group (IG). Three evaluations were performed: pre-brachytherapy, post-brachytherapy and follow-up of 3 months. The CG received standard guidance from the health team while the IG was instructed to use VD for 3 months. The dimensions of the vaginal canal (main outcome) were defined by the length of the vagina (centimetres), width (number of full clockwise turns of the opening thread of a gynaecological speculum) and area (defined by the size of the VD). Quality of life and pelvic floor (PF) functionality were also evaluated. Results: There was no effect of the VD on vaginal length, width and area among the intention-to-treat (ITT) population. However, in the analysis stratified by adhesion, the CG had a significant decrease in the vaginal area. PF was predominantly hypoactive throughout the follow-up. Quality of life improved in both groups, but the reduction of constipation, vaginal dryness and stress urinary incontinence manifested only in the IG. Conclusion: The use of VD did not alter the dimensions of the vaginal canal within the first Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8175365.
BMC Women's Health, 2015
Background: Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes 'performance-based' sexuality which may be detrimental. Despite this, little has been done to seek women's views about their treatment. This study set out to explore women's experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment. Methods: 13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis. Results: Four superordinate themes were elicited and used to draft 'better treatment' guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous 'Journey into treatment', including difficulties asking for help, undergoing physical investigations and negotiating 'the system' of medical referrals. It also describes the sometimes demoralising process of 'being in treatment', which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to 'partner support'. 'Professional support' comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. 'Peer support/helping each other' describes the importance of supportive vaginimus networks and sharing tips with other women. Conclusions: Accessing effective treatment for vaginal penetration difficulties is difficult. The practical and emotional demands of using vaginal trainers may be underestimated by professionals, resulting in inadequate provision of support and information in practice. At times vaginal trainers may be prescribed to women who are unlikely to benefit from this treatment in isolation. Core communication skills like non-judgemental listening are important for supporting women through treatment. However professionals also need greater specialist knowledge, which in turn requires more detailed research. New ways to disseminate specialist knowledge and suggestions for further research are discussed.
An update on surgical and non-surgical treatments for vaginal hypoplasia
Human Reproduction Update, 2014
vaginal capacity, complications and long-term durability in terms of sexual function) of the different surgical and non-surgical reconstruction techniques, we evaluate if vaginal dilation proposed as the first-line technique is justified based on the evidence. results: When anatomical success was defined as a length of ≥7 cm and functional success as coitus, all vaginoplasty techniques yielded significantly higher success rates (.90 versus 75% after vaginal dilation), irrespective of underlying diagnosis or start vaginal length. When functional success was defined as 'satisfaction with sex', including non-genital sex, differences disappeared. Failed dilation therapy does not preclude anatomical (nor functional) success if vaginoplasty afterwards is necessary. Traction vaginoplasty seems to have the highest anatomical (99%) and functional success rates (96%), whereas both split-and full-thickness skin graft procedures and intestinal procedures have the lowest successful outcomes (83-95%). Overall, complication rates were significantly lower within the vaginal dilation groups when compared with the different vaginoplasty techniques. Although no randomized control data exist regarding maintenance dilation, the available evidence suggests that continued dilation is needed to maintain patency in periods of coital inactivity. Despite the expectancy that the probability of further positive outcomes is maximized with psychological counselling, this could not be confirmed. conclusions: As the medical literature lacks high-quality comparative outcome studies and prospective, longitudinal studies are scarce, no evidence-based treatment guidelines can be provided. However, because of the physically low complication rate and an overall success chance of 75%, vaginal dilation as first choice treatment seems to be justified. Overall, the laparoscopic Vecchietti procedure, becoming more and more available in specialized centres, is considered an appropriate surgical option in patients who are poorly compliant and failed dilation therapy, or for those who do not want to start with vaginal dilation therapy. Future approaches need to raise a wider range of psychosexually oriented questions, elucidate the relationship between vaginal depth and satisfactory outcomes and gain additional experience concerning the format of acceptable and efficient psychological care.
Evaluation of vaginal agenesis treated with the modified McIndoe technique: A retrospective study
Journal of the Turkish German Gynecological Association, 2016
Retrospective analysis of cases that have undergone neovagina operation because of congenital vaginal agenesis was objected. Material and Methods: Seven cases applying with the complaints of primary amenorrhea or inability to have sexual intercourse were in the study. The cases were diagnosed with congenital vaginal agenesis and operated at Mustafa Kemal University Training and Research Hospital between 2011 and 2014. Vaginoplasty by the modified McIndoe method was performed in all cases. The main complaint, chromosomal analysis, duration of operation, preoperative and postoperative vaginal length, complications, postoperative treatment, and satisfaction from the sexual intercourse were all evaluated. Results: Average age of our patients was 28.14±8.61 (19-39) years. One patient was 46XX-45X0 mosaic Turner syndrome), 1 patient was 46XY (testicular feminization), and other 5 patients were 46XX. The average duration of operation was 2.7±0.56 (2-3.5 h). Postoperative infection was observed in 1 patient. In this infected patient, graft failure occurred and debridement was performed in reoperation. No early complications were seen in the others. Preoperative and postoperative average vaginal lengths were 1.85±0.62 (1-3 cm) and 8.71±1.11 (7-10 cm), respectively. Dyspareunia occurred in 2 cases that were not able to use dilatator regularly: 1 because of cancelation of marriage and the other because of postoperative infection; regular sexual life was achieved in remaining 5 (71%) cases. Conclusion: Although there is no consensus about the ideal method of making a functioning vagina among different specialties. The modified McIndoe technique is the most applied method by gynecologists and simple, minimally invasive and with low morbidity.
Vaginal Tightening Surgery: A New Technique
Background: There are many surgical and non-surgical procedures designed for tightening the lax or redundant vagina. However, these methods are still experimental with no satisfactory results. This study aimed to report a new simple technique through a traction of bulbocavernosus muscle (BCM) in a trial to satisfy both partners regarding the female cosmetic and sexual purposes. Methods: The procedure was conducted for ten women aged 25-35 years. After a good preoperative preparation, a small perneo-vaginal wall flap was done. Then, traction of BCM of both sides and their approximation using delicate stitches were performed without excision neither mucosa nor muscle neither skin. Results: The post-operative appearance of the perineum was good. Muscles' tone at the vaginal introitus had been improved. There was no detected fibrosis nor reported dyspareunia. The sexual pleasure for both partners was greatly increased by time starting after the first three months postoperatively for all cases. Conclusions: Simple plication of BCMs at the vaginal introitus could be suggested as a simple surgical method for tightening the redundant vagina. Future studies regarding large numbers of volunteers are recommended to accurately evaluate the results of such new technique.
Objective: The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with Vaginal Agenesis (VA). Methods: Sixteen patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, Total Androgen Insensitivity Syndrome and cervicovaginal agenesis), from Federal University of São Paulo, were selected. The production of the devices was carried out in a 3D printer and, as raw material, the polymeric filament of the lactic polyacid (PLA) was used. A personalized treatment was proposed and developed for each patient.Results: Fourteen patients reached a final vaginal length of 6 cm or more. The initial TVL Mean (SD) was 1,81(1,05) and the final TVL Mean (SD) 6,37(0,94); the Difference (IC-95%) was 4,56 (5,27 - 3,84) and the Effect size (IC-95%) was 4,58 (2,88 – 6,28). Therefore, there was a significant difference (P<0.05) between the initial and final measurements. Th...