Materiały źródłowe

• #1 Management of vaginal agenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21872517/

  Rokitansky syndrome and complete androgen insensitivity syndrome are the most common causes of vaginal agenesis. Treatment should be deferred until adolescence to allow informed consent and compliance. The best treatment for vaginal agenesis remains controversial although vaginal dilation therapy is still widely considered the first line treatment because success rates are high and associated risks are low. […] A variety of surgical options are also available, each with enthusiastic proponents. Long-term outcome studies on most surgical techniques, however, are still lacking and until recently most studies have reported on success rate in terms of anatomical success only, without including sexual function. Moreover, the medical literature lacks prospective comparative outcome studies, meaning that current choice of surgical procedure relies greatly on the surgeon’s preference and experience.

• #2 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Mllerian agenesis, also referred to as mllerian aplasia, Mayer-Rokitansky-Kster-Hauser syndrome, or vaginal agenesis, has an incidence of 1 per 4,5005,000 females. […] The most important steps in the effective management of mllerian agenesis are correct diagnosis of the underlying condition, evaluation for associated congenital anomalies, and psychosocial counseling in addition to treatment or intervention to address the functional effects of genital anomalies. […] All patients with mllerian agenesis should be offered counseling and encouraged to connect with peer support groups. […] Future options for having children should be addressed with patients: options include adoption and gestational surrogacy. Assisted reproductive techniques with use of a gestational carrier (surrogate) have been shown to be successful for women with mllerian agenesis.

• #3 Vaginal agenesis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-agenesis/diagnosis-treatment/drc-20355741

  Your health care provider may recommend testing, including: […] Treatment for vaginal agenesis often occurs in the late teens or early 20s, but you may wait until you’re older and you feel motivated and ready to participate in treatment. […] You and your health care provider can discuss treatment options. Depending on your individual condition, options may involve no treatment or creating a vagina by self-dilation or surgery. […] Self-dilation is typically recommended as the first option. Self-dilation may allow you to create a vagina without surgery. The goal is to lengthen the vagina to a size comfortable for sexual intercourse. […] If self-dilation doesn’t work, surgery to create a functional vagina (vaginoplasty) may be an option. Types of vaginoplasty surgery include: […] After surgery, use of a mold, dilation or frequent sexual intercourse is needed to maintain a functional vagina. Health care providers usually delay surgical treatments until you feel prepared and able to handle self-dilation. Without regular dilation, the newly created vaginal canal can quickly narrow and shorten, so being emotionally mature and ready to comply with aftercare is critically important. […] Talk to your health care provider about the best surgical option to meet your needs, and the risks and required care after surgery.

• #4 Vaginal Agenesis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23458-vaginal-agenesis

  Vaginal agenesis is a congenital abnormality (birth defect). It happens when a fetus’s vagina doesnt develop properly in the uterus. Treatments like surgery and the use of vaginal dilators can create a vaginal opening and vaginal canal. […] Healthcare providers treat vaginal agenesis with medical devices that gradually dilate the vaginal canal. Sometimes, you need surgery to create a vaginal opening. Depending on which reproductive organs the condition affects, it may not be possible to carry a child. But, with treatment, many women with this condition lead healthy lives and enjoy a normal sex life. […] Treatments are available to help with this condition. Talk to your provider or your childs pediatrician about the right time to start treatment. Some people start treatment during childhood. Others wait until puberty or later in life when they start having sex. This choice is very personal.

• #5 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Mllerian agenesis, also referred to as mllerian aplasia, Mayer-Rokitansky-Kster-Hauser syndrome, or vaginal agenesis, has an incidence of 1 per 4,5005,000 females. […] The most important steps in the effective management of mllerian agenesis are correct diagnosis of the underlying condition, evaluation for associated congenital anomalies, and psychosocial counseling in addition to treatment or intervention to address the functional effects of genital anomalies. […] All patients with mllerian agenesis should be offered counseling and encouraged to connect with peer support groups. […] Future options for having children should be addressed with patients: options include adoption and gestational surrogacy. Assisted reproductive techniques with use of a gestational carrier (surrogate) have been shown to be successful for women with mllerian agenesis.

• #6 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Nonsurgical vaginal elongation by dilation should be the first-line approach. When well-counseled and emotionally prepared, almost all patients (9096%) will be able to achieve anatomic and functional success by primary vaginal dilation. […] Primary vaginal elongation by dilation is the appropriate first-line approach in most patients because it is safer, patient-controlled, and more cost effective than surgery. […] Because primary vaginal dilation is successful for more than 9096% of patients, surgery should be reserved for the rare patient who is unsuccessful with primary dilator therapy or who prefers surgery after a thorough informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s). […] Regardless of the surgical technique chosen, referrals to centers with expertise should be offered. The surgeon must be experienced with the procedure because the initial procedure is more likely to succeed than follow-up procedures.

• #7 Mullerian Duct Anomalies: Overview, Incidence and Prevalence, Embryology

  https://emedicine.medscape.com/article/954110-overview

  Mullerian agenesis, also termed mullerian aplasia, is characterized by an absence or hypoplasia of the uterus, proximal vagina, and, in some cases, the fallopian tubes. The condition has been also referred to as the Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, when it occurs in its most extreme form, both uterine and vaginal aplasia. […] The first-line approach in most patients should be primary vaginal elongation by dilation. Compared with surgery, it is safer, patient-controlled, and more cost-effective. […] Surgery should be reserved for the rare patient who is unsuccessful with primary dilator therapy or who prefers surgery after a thorough informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s). Primary vaginal dilation is successful for more than 90-96% of patients.

• #8 Vaginal Agenesis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23458-vaginal-agenesis

  Treatment for vaginal agenesis includes: […] If you have a vaginal opening or a dimple where the opening should be, your provider may recommend using a dilator to create a vagina. You use a small tube to make an opening and gradually increase the size every day. This usually takes about 20 minutes a day. The dilation may feel uncomfortable, but it shouldnt hurt. You may want to increase the size of the dilator after a bath when your skin is soft and more likely to stretch. […] Your provider may recommend a procedure called a vaginoplasty to construct a vaginal canal. The technique your provider uses will depend on your anatomy and several other factors. Providers can create a vagina by placing a traction device on the absent vagina, using a skin graft or the skin from the inside of your cheek or a portion of your bowel (intestine).

• #9 What Is Agenesis of the Vagina?

  https://www.icliniq.com/articles/womens-health/agenesis-of-the-vagina

  Vaginal agenesis treatment normally takes place during the late teens or early twenties. The health care provider will discuss the treatment options and depending on the individual condition and interest the treatment can be chosen. The treatment includes: […] Vaginal dilators are the most standard and efficient treatment for MRKH. The aim of this technique is to lengthen the vagina to a size that is comfortable for sexual intercourse. In this method, a firm smooth, round rod of plastic shaped similar to a tampon is used to pressure against the skin at the vaginal opening or inside the existing vagina. It is typically used for 10 to 20 minutes about one to three times a day. After a few days, larger dilators are recommended, and to see the visible results, it will take a few months. The main advantage of dilators is that it does not require surgery and the disadvantage is that it requires frequent use of the dilator until the vaginal canal becomes a normal length, problems with urinating, and vaginal bleeding and pain can be experienced in the beginning. Using artificial lubrication and a different type of dilator might be helpful.

• #10 Vaginal Agenesis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23458-vaginal-agenesis

  Treatment for vaginal agenesis includes: […] If you have a vaginal opening or a dimple where the opening should be, your provider may recommend using a dilator to create a vagina. You use a small tube to make an opening and gradually increase the size every day. This usually takes about 20 minutes a day. The dilation may feel uncomfortable, but it shouldnt hurt. You may want to increase the size of the dilator after a bath when your skin is soft and more likely to stretch. […] Your provider may recommend a procedure called a vaginoplasty to construct a vaginal canal. The technique your provider uses will depend on your anatomy and several other factors. Providers can create a vagina by placing a traction device on the absent vagina, using a skin graft or the skin from the inside of your cheek or a portion of your bowel (intestine).

• #11 Vaginal atresia – Wikipedia

  https://en.wikipedia.org/wiki/Vaginal_atresia

  There are several methods of treatment for individuals with vaginal atresia. The first method of treatment that is recommended would be self-dilation of the vagina. A doctor may first recommend that the patient first attempts to create a vagina themselves through the process of self-dilation. The self dilation technique consists of using vaginal dilators, which are small round tubes that vary in size and are similar in size and shape to tampons. Vaginal dilators may be pressed alongside the vaginal area on a regular basis in order to further open the vaginal canal. Frank’s procedure is a technique that used a progressive series of vaginal dilators that are inserted into the dimple of the vagina while using pressure. This will widen any space that exists between the bladder and the rectum. Frank’s procedure can be performed directly by the patient, therefore requiring no surgery or anesthesia. The procedure/technique can take months to complete, with regular compliance necessary. The overall success rate for females who use Frank’s procedure is 80%. If this procedure does not work, then surgery would be the next method of treatment. Another alternative form of treatment would be surgery, or the creation of a new vagina.

• #12 Vaginal atresia – Wikipedia

  https://en.wikipedia.org/wiki/Vaginal_atresia

  There are several methods of treatment for individuals with vaginal atresia. The first method of treatment that is recommended would be self-dilation of the vagina. A doctor may first recommend that the patient first attempts to create a vagina themselves through the process of self-dilation. The self dilation technique consists of using vaginal dilators, which are small round tubes that vary in size and are similar in size and shape to tampons. Vaginal dilators may be pressed alongside the vaginal area on a regular basis in order to further open the vaginal canal. Frank’s procedure is a technique that used a progressive series of vaginal dilators that are inserted into the dimple of the vagina while using pressure. This will widen any space that exists between the bladder and the rectum. Frank’s procedure can be performed directly by the patient, therefore requiring no surgery or anesthesia. The procedure/technique can take months to complete, with regular compliance necessary. The overall success rate for females who use Frank’s procedure is 80%. If this procedure does not work, then surgery would be the next method of treatment. Another alternative form of treatment would be surgery, or the creation of a new vagina.

• #13 Care and Counseling of the Patient with Vaginal Agenesis | Intersex Society of North America

  https://isna.org/node/83/

  Vaginal agenesis involves issues of physical abnormality, body image, sexual identity, and sexual/reproductive functioning that require long-term medical and psychological management. The authors detail the nonsurgical Frank procedure for creating a vagina and discuss counseling techniques for the patient and her family. […] Currently, the two most popular methods for creating a vagina in these cases are the nonsurgical Frank Procedure and the McIndoe split-thickness skin-graft vaginoplasty. […] The Ingram technique is successful in approximately 90% of cases, and surgery should not be considered until the patient has undergone a sufficient trial of this approach. […] Should the nonsurgical technique fail or prove unsuccessful due to lack of motivation, the most popular surgical approach at present is the McIndoe split-thickness skin-graft vaginoplasty.

• #14 Non-surgical Treatment of Vaginal Agenesis Using a Simplified Version of Ingram’s Method

  https://eymj.org/search.php?where=aview&id=10.3349/ymj.2006.47.6.892&code=0069YMJ&vmode=PUBREADER

  Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. Compared to surgical methods, non-surgical vaginal dilation has the advantage of low morbidity, the creation of a more physiologic vaginal milieu, and no surgical scarring. […] Based on satisfactory clinical outcomes and low morbidity, several authors have suggested that non-surgical vaginal dilation should be considered the first-line therapy in patients with vaginal agenesis. […] Ingram’s method overcomes these difficulties by using the sitting position to take advantage of the patient’s body weight. […] In this study, the patient was given instructions to modulate perineal pressure with postural changes instead of using a bicycle seat. […] Following the outcome of this case, an ordinary chair can be considered as a viable alternative to the bicycle seat if the patient is motivated and carefully instructed.

• #15 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Surgical creation of a vagina requires ongoing postoperative dilation or vaginal intercourse to maintain adequate vaginal length and diameter; therefore, it is not a method to avoid vaginal dilator therapy. […] The primary aim of surgery is the creation of a vaginal canal to allow penetrative intercourse. […] Several surgical techniques may be used to create a neovagina. […] The timing of the surgery depends on the patient and the type of procedure planned. […] Patients should be thoroughly counseled about surgical pain and the need for very close postoperative care. […] Compared with primary vaginal dilation, vaginoplasty complications are much more common and include bladder or rectal perforation, graft necrosis, hair-bearing vaginal skin, fistulae, diversion colitis, inflammatory bowel disease, and adenocarcinoma.

• #16 Vaginal agenesis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-agenesis/diagnosis-treatment/drc-20355741

  Your health care provider may recommend testing, including: […] Treatment for vaginal agenesis often occurs in the late teens or early 20s, but you may wait until you’re older and you feel motivated and ready to participate in treatment. […] You and your health care provider can discuss treatment options. Depending on your individual condition, options may involve no treatment or creating a vagina by self-dilation or surgery. […] Self-dilation is typically recommended as the first option. Self-dilation may allow you to create a vagina without surgery. The goal is to lengthen the vagina to a size comfortable for sexual intercourse. […] If self-dilation doesn’t work, surgery to create a functional vagina (vaginoplasty) may be an option. Types of vaginoplasty surgery include: […] After surgery, use of a mold, dilation or frequent sexual intercourse is needed to maintain a functional vagina. Health care providers usually delay surgical treatments until you feel prepared and able to handle self-dilation. Without regular dilation, the newly created vaginal canal can quickly narrow and shorten, so being emotionally mature and ready to comply with aftercare is critically important. […] Talk to your health care provider about the best surgical option to meet your needs, and the risks and required care after surgery.

• #17 Mullerian Duct Anomalies: Overview, Incidence and Prevalence, Embryology

  https://emedicine.medscape.com/article/954110-treatment

  The aim of surgical treatment is to create a neovagina. Although several vaginoplasty methods have been developed, refined, and modified, no definitive surgical approach has been established. […] The modified McIndoe procedure remains the most common surgical approach to vaginoplasty. […] The strategy for vaginoplasty is to develop a space between the bladder and the rectum. In some approaches, a stent or form is placed in the newly created space to ensure patency while healing occurs. […] Surgical techniques for mullerian agenesis (mullerian aplasia, vaginal agenesis) include skin grafting, transposition flaps, and the use of artificial dermis and absorbable adhesion barriers. […] The use of artificial dermis and absorbable adhesion barriers show promise as exogenous graft sources in vaginal reconstruction. […] The modified McIndoe procedure is a highly successful procedure, and patient satisfaction is high. Although most patients cannot obtain full fertility, except through surrogates, they can have normal sexual relations.

• #18 Treatment Options For Women With Vaginal Agenesis – Specialty Surgical Center

  https://specialtysurgerycenter.org/treatment-options-for-women-with-vaginal-agenesis/

  Vaginal agenesis is a complex condition that causes the muscular canal (vagina) within the pelvis to not form properly during fetal development. […] While physicians and researchers are still working on techniques to successfully transplant a healthy uterus into patients with vaginal agenesis, current treatment options for this condition depend on the severity of the disorder itself. […] Generally speaking, treatment for vaginal agenesis includes: […] Self-Dilation: Women with a dimple in the area where the vagina would be could use a small tube called dilator to create a vagina. […] Vaginoplasty With Skin Grafting: A vagina can be created using skin from the patients buttocks or artificial skin. […] Bowel Vaginoplasty: A vagina can be created removing part of the lower colon and inserting in the place where the vaginal opening would be.

• #19 Vaginal Agenesis Turkey – Dr. Burcu Karamürsel

  https://www.burcukaramursel.com/en/vaginal-agenesis

  There are mainly two treatment options for vaginal agenesis: […] Self dilation: You may use small tubes called dilators to gradually create a vagina. They need to be used around 20-30 minutes each day. You may need to increase the size of the dilators as the vaginal opening enlarges. […] Surgery: There are several surgical options for the treatment of vaginal agenesis. The surgery to create a new vagina is named vaginoplasty. The newly created vagina is named as neovagina. […] Mc Indoe Vaginoplasty: Vaginal canal is formed surgically by dissection of tissues between the bladder and the rectum. Skin from buttocks, outer thighs or abdomen may be used as a tissue graft to line the walls of the newly formed vagina. A mold or vaginal dilator is inserted into the vagina so that the new vagina will not close. It may need to stay in the neovagina for a few months after surgery.

• #20 Vaginal Agenesis – a congenital defect | GAURI – Urogynecology Clinic

  https://urogynecology.in/vaginal-agenesis-a-congenital-defect/

  Patients treated with skin grafting method will be advised to wear the dilator for 3 months after the surgery. It can be removed when having sex or during bowel movements. After first 3 months, patient will be advised to wear the dilator for 6 months but only during the nights. In cases of bowel vaginoplasty, dilator may not be necessary unless vagina becomes too tight. […] This depends on what parts of the reproductive system were formed completely at birth. In treatment for Vaginal Agenesis, only the vagina will be constructed but not the internal parts of the reproductive system. If the fallopian tubes, uterus and ovaries are fully formed, the chances of getting pregnant will be high. If the uterus is not well formed, your body can only produce eggs in the ovaries and you may have to opt for surrogacy.

• #21 Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3513253/

  According to the results of our study, to achieve painless and satisfactory sexual intercourse postoperatively, proper and regular mould use is of the utmost importance, especially in patients who engage in irregular or no sexual intercourse, and use the mould regularly for longer periods of time. […] Our findings suggest that the modified McIndoe technique is a simple, effective procedure for the treatment of vaginal agenesis, but proper mould usage after surgery remains the cornerstone of the treatment.

• #22 Vaginal Agenesis Turkey – Dr. Burcu Karamürsel

  https://www.burcukaramursel.com/en/vaginal-agenesis

  Laporoscopic Davydovs Vaginoplasty: In this procedure, peritoneal tissue is used to create neovagina. Laporoscopy is also known as closed surgery or keyhole surgery. This is a sophisticated new technique to create a new vagina in patients with vaginal agenesis. Small cuts made on the abdominal wall are used to insert a camera and other devices to dissect the peritoneum (a thin tissue layer covering the abdominal organs) and relocate this peritoneal tissue to cover the walls of the newly formed vaginal opening, so that this tissue will function as normal vaginal mucosa and the opening will not close again. The walls of the neovagina are lined with the peritoneal tissue flap which is still attached to the abdominal cavity and thus has normal vascularity, due to this vascularity it has better chance to persist than a skin graft. A mold is inserted into the neovagina and needs to stay there for a few months until healing.

• #23 MRKH and Vaginal Agenesis Treatment Options

  https://mrkh-surgeons.com/mrkh-treatment-options.php

  Drs Moore and Miklos utilize a laparoscopic modification of the Davydov procedure. […] In a recent study the procedure had a 96% functional success rate with sexual function scores in the good to very good rate. […] The procedure itself is much less invasive than most of the alternative surgical options and achieves better length with less risk of scarring down. […] Drs. Miklos and Moore have utilized this laparoscopic technique on women throughout the US, including many young women that have had attempts of neovagina by other techniques and other surgeons and have failed. […] Drs. Moore and Miklos are considered world leaders in the laparoscopic approach to create a neovagina and are asked from experts throughout the world to come and lecture and teach on the subject.

• #24 MRKH Treatment Options | Surgical | Non-Surgical Dialation | Miklos & Moore

  https://mrkh.com/treatments/

  Several months may be required to obtain the needed length. […] It is recommended that the vagina be at least 2.5 cm in length to start (i.e. prior to dilating) otherwise the success rates are not adequate. […] There have been many different surgical techniques describe to create a neovagina and most have been very invasive large surgeries with variable success rates. […] Drs Moore and Miklos utilize a laparoscopic modification of the Davydov procedure. […] The procedure itself is much less invasive than most of the alternative surgical options and achieves better length with less risk of scarring down. […] Recovery is rapid and intercourse is able to be achieved in as little as 2 weeks post-operatively. […] Drs. Miklos and Moore have utilized this laparoscopic technique on women throughout the US, including many young women that have had attempts of neovagina by other techniques and other surgeons and have failed. […] Patients that have had previous surgery cannot believe how much easier the approach was with Dr Moore and Miklos and the results they achieved after the procedure resulting in a normal, full length, functioning vagina!

• #25 MRKH Treatment Options | Surgical | Non-Surgical Dialation | Miklos & Moore

  https://mrkh.com/treatments/

  Several months may be required to obtain the needed length. […] It is recommended that the vagina be at least 2.5 cm in length to start (i.e. prior to dilating) otherwise the success rates are not adequate. […] There have been many different surgical techniques describe to create a neovagina and most have been very invasive large surgeries with variable success rates. […] Drs Moore and Miklos utilize a laparoscopic modification of the Davydov procedure. […] The procedure itself is much less invasive than most of the alternative surgical options and achieves better length with less risk of scarring down. […] Recovery is rapid and intercourse is able to be achieved in as little as 2 weeks post-operatively. […] Drs. Miklos and Moore have utilized this laparoscopic technique on women throughout the US, including many young women that have had attempts of neovagina by other techniques and other surgeons and have failed. […] Patients that have had previous surgery cannot believe how much easier the approach was with Dr Moore and Miklos and the results they achieved after the procedure resulting in a normal, full length, functioning vagina!

• #26 MRKH and Vaginal Agenesis Treatment Options

  https://mrkh-surgeons.com/mrkh-treatment-options.php

  Drs Moore and Miklos utilize a laparoscopic modification of the Davydov procedure. […] In a recent study the procedure had a 96% functional success rate with sexual function scores in the good to very good rate. […] The procedure itself is much less invasive than most of the alternative surgical options and achieves better length with less risk of scarring down. […] Drs. Miklos and Moore have utilized this laparoscopic technique on women throughout the US, including many young women that have had attempts of neovagina by other techniques and other surgeons and have failed. […] Drs. Moore and Miklos are considered world leaders in the laparoscopic approach to create a neovagina and are asked from experts throughout the world to come and lecture and teach on the subject.

• #27 Vaginal Agenesis Turkey – Dr. Burcu Karamürsel

  https://www.burcukaramursel.com/en/vaginal-agenesis

  Intestinal vaginoplasty: This is the most radical and invasive procedure to create a new vagina. An incision is made on the abdominal wall and a free segment of bowel is cut away to be inserted into the newly formed vaginal canal. This is also known as free tissue transfer. It needs a special microsurgical technique to attach the vessels of the bowel segment to the vessels of the newly formed vagina. Complications that may be seen after this surgery may be summarised as constipation, paralytic ileus, peritonitis and difficulty in urination. Since the bowel segment secretes a lot of mucus, the patients may have a lot of mucoid discharge from the neovagina and may need to use daily sanitary pads. […] Inserting a medical traction device-Vecchietti Procedure: An olive shaped device is placed at the vaginal opening. Small cuts are made on the abdominal wall to insert a camera (laparoscope) and other instruments to make traction on the olive shaped device up into the abdominal cavity. The traction device will gradually pull the olive inward to create a neovagina.

• #28 Treatment Options For Women With Vaginal Agenesis – Specialty Surgical Center

  https://specialtysurgerycenter.org/treatment-options-for-women-with-vaginal-agenesis/

  Vaginal agenesis is a complex condition that causes the muscular canal (vagina) within the pelvis to not form properly during fetal development. […] While physicians and researchers are still working on techniques to successfully transplant a healthy uterus into patients with vaginal agenesis, current treatment options for this condition depend on the severity of the disorder itself. […] Generally speaking, treatment for vaginal agenesis includes: […] Self-Dilation: Women with a dimple in the area where the vagina would be could use a small tube called dilator to create a vagina. […] Vaginoplasty With Skin Grafting: A vagina can be created using skin from the patients buttocks or artificial skin. […] Bowel Vaginoplasty: A vagina can be created removing part of the lower colon and inserting in the place where the vaginal opening would be.

• #29 Vaginal Agenesis Turkey – Dr. Burcu Karamürsel

  https://www.burcukaramursel.com/en/vaginal-agenesis

  Intestinal vaginoplasty: This is the most radical and invasive procedure to create a new vagina. An incision is made on the abdominal wall and a free segment of bowel is cut away to be inserted into the newly formed vaginal canal. This is also known as free tissue transfer. It needs a special microsurgical technique to attach the vessels of the bowel segment to the vessels of the newly formed vagina. Complications that may be seen after this surgery may be summarised as constipation, paralytic ileus, peritonitis and difficulty in urination. Since the bowel segment secretes a lot of mucus, the patients may have a lot of mucoid discharge from the neovagina and may need to use daily sanitary pads. […] Inserting a medical traction device-Vecchietti Procedure: An olive shaped device is placed at the vaginal opening. Small cuts are made on the abdominal wall to insert a camera (laparoscope) and other instruments to make traction on the olive shaped device up into the abdominal cavity. The traction device will gradually pull the olive inward to create a neovagina.

• #30 Müllerian agenesis – Wikipedia

  https://en.wikipedia.org/wiki/M%C3%BCllerian_agenesis

  Another approach is the use of an autotransplant of a resected sigmoid colon using laparoscopic surgery; results are reported to be very good, with the transplant becoming a functional vagina. […] Uterine transplantation has been performed in a number of people with Mllerian agenesis, but the surgery is still in the experimental stage. […] Since ovaries are present, people with this condition can have genetic children through IVF with embryo transfer to a gestational carrier. Some also choose to adopt. […] Promising research includes the use of laboratory-grown structures, which are less subject to the complications of non-vaginal tissue, and may be grown using the woman’s own cells as a culture source. […] A 2014 study and experiment with laboratory-grown engineered vaginas using the patient’s own cells resulted in fully functional vaginas capable of menstruation, sustaining penetrative sex, and orgasm in 4 patients, showing promise of fully correcting this condition.

• #31 Vaginal Agenesis (Congenital Absence of Vagina): Causes, Symptoms, and Treatment Methods | DocHospitals

  https://dochospitals.com/en/vaginal-agenesis-atc2489/

  The surgeon inserts an olive-shaped device (Vecchietti procedure) or a balloon device (balloon vaginoplasty) into the vaginal opening. […] In bowel vaginoplasty, specialists create a new vagina by moving a section of the colon to an opening in the genital area. […] Vaginoplasty surgeries allow patients to experience greater sexual satisfaction and boost their self-confidence. This significantly improves patients’ quality of life after recovery. […] The complications that can occur during vaginoplasty surgeries vary depending on the extent of the surgery and the method used. Complications that may arise after vaginoplasty surgery for vaginal agenesis include: Painful intercourse, Numbness, Loss of sensation, Infection, Bleeding. […] Women with a missing or underdeveloped uterus may experience infertility. However, if the ovaries are healthy, it is possible to have a child through IVF. The embryo can also be transferred to a surrogate mother. […] If treated, they can also have a functional vagina, enabling penetrative intercourse.

• #32 Müllerian agenesis – Wikipedia

  https://en.wikipedia.org/wiki/M%C3%BCllerian_agenesis

  A number of treatments have become available to create a functioning vagina. Standard approaches use vaginal dilators and/or surgery to develop a functioning vagina to allow for penetrative sexual intercourse. […] A number of surgical approaches have been used. In the McIndoe procedure, a skin graft is applied to form an artificial vagina. After the surgery, dilators are still necessary to prevent vaginal stenosis. The Vecchietti procedure has been shown to result in a vagina that is comparable to a typical vagina. […] In the Vecchietti procedure, a small plastic olive is threaded against the vaginal area, and the threads are drawn through the vaginal skin, up through the abdomen and navel using laparoscopic surgery. There, the threads are attached to a traction device. The traction device is then tightened daily so the olive is pulled inwards and stretches the vagina by approximately 1 cm per day, creating a vagina approximately 7 cm deep in 7 days. The operation takes approximately 45 minutes.

• #33 Vaginal Agenesis Turkey – Dr. Burcu Karamürsel

  https://www.burcukaramursel.com/en/vaginal-agenesis

  Intestinal vaginoplasty: This is the most radical and invasive procedure to create a new vagina. An incision is made on the abdominal wall and a free segment of bowel is cut away to be inserted into the newly formed vaginal canal. This is also known as free tissue transfer. It needs a special microsurgical technique to attach the vessels of the bowel segment to the vessels of the newly formed vagina. Complications that may be seen after this surgery may be summarised as constipation, paralytic ileus, peritonitis and difficulty in urination. Since the bowel segment secretes a lot of mucus, the patients may have a lot of mucoid discharge from the neovagina and may need to use daily sanitary pads. […] Inserting a medical traction device-Vecchietti Procedure: An olive shaped device is placed at the vaginal opening. Small cuts are made on the abdominal wall to insert a camera (laparoscope) and other instruments to make traction on the olive shaped device up into the abdominal cavity. The traction device will gradually pull the olive inward to create a neovagina.

• #34 Müllerian agenesis – Wikipedia

  https://en.wikipedia.org/wiki/M%C3%BCllerian_agenesis

  A number of treatments have become available to create a functioning vagina. Standard approaches use vaginal dilators and/or surgery to develop a functioning vagina to allow for penetrative sexual intercourse. […] A number of surgical approaches have been used. In the McIndoe procedure, a skin graft is applied to form an artificial vagina. After the surgery, dilators are still necessary to prevent vaginal stenosis. The Vecchietti procedure has been shown to result in a vagina that is comparable to a typical vagina. […] In the Vecchietti procedure, a small plastic olive is threaded against the vaginal area, and the threads are drawn through the vaginal skin, up through the abdomen and navel using laparoscopic surgery. There, the threads are attached to a traction device. The traction device is then tightened daily so the olive is pulled inwards and stretches the vagina by approximately 1 cm per day, creating a vagina approximately 7 cm deep in 7 days. The operation takes approximately 45 minutes.

• #35 Recent Advances in Vaginal Atresia: A Literature Review

  https://www.mdpi.com/2227-9059/13/1/128

  Studies indicate that postoperative vaginal stenosis is common following surgical correction of vaginal atresia, especially in patients with longer obstruction distances. […] The frequency of vaginal dilation or use of vaginal molds post-surgery depends on the length of the atretic vagina, in order to prevent re-closure or stenosis. […] Various materials have been used as vaginal coverings in vaginoplasty, including skin flaps, amniotic membrane, peritoneum, intestinal segments, oral mucosa, and biological grafts. […] In tissue engineering, extracellular matrix (ECM) materials are being explored for vaginal reconstruction. […] Amniotic membrane vaginoplasty is an affordable, safe, and simple technique that reconstructs or repairs vaginal structures using the amnion (a component of fetal membranes) as a biological material.

• #36 Mullerian Duct Anomalies: Overview, Incidence and Prevalence, Embryology

  https://emedicine.medscape.com/article/954110-treatment

  The aim of surgical treatment is to create a neovagina. Although several vaginoplasty methods have been developed, refined, and modified, no definitive surgical approach has been established. […] The modified McIndoe procedure remains the most common surgical approach to vaginoplasty. […] The strategy for vaginoplasty is to develop a space between the bladder and the rectum. In some approaches, a stent or form is placed in the newly created space to ensure patency while healing occurs. […] Surgical techniques for mullerian agenesis (mullerian aplasia, vaginal agenesis) include skin grafting, transposition flaps, and the use of artificial dermis and absorbable adhesion barriers. […] The use of artificial dermis and absorbable adhesion barriers show promise as exogenous graft sources in vaginal reconstruction. […] The modified McIndoe procedure is a highly successful procedure, and patient satisfaction is high. Although most patients cannot obtain full fertility, except through surrogates, they can have normal sexual relations.

• #37 Müllerian agenesis – Wikipedia

  https://en.wikipedia.org/wiki/M%C3%BCllerian_agenesis

  Another approach is the use of an autotransplant of a resected sigmoid colon using laparoscopic surgery; results are reported to be very good, with the transplant becoming a functional vagina. […] Uterine transplantation has been performed in a number of people with Mllerian agenesis, but the surgery is still in the experimental stage. […] Since ovaries are present, people with this condition can have genetic children through IVF with embryo transfer to a gestational carrier. Some also choose to adopt. […] Promising research includes the use of laboratory-grown structures, which are less subject to the complications of non-vaginal tissue, and may be grown using the woman’s own cells as a culture source. […] A 2014 study and experiment with laboratory-grown engineered vaginas using the patient’s own cells resulted in fully functional vaginas capable of menstruation, sustaining penetrative sex, and orgasm in 4 patients, showing promise of fully correcting this condition.

• #38 Mayer-Rokitansky-Küster-Hauser Syndrome: Overview

  https://my.clevelandclinic.org/health/diseases/23380-mayer-rokitansky-kuster-hauser-syndrome

  A vaginoplasty is a surgical procedure to create a vagina. There are several ways surgeons perform vaginoplasty, but most involve creating a hole and lining it with tissue from another part of your body. […] A uterine transplant may allow a woman with MRKH syndrome to carry a pregnancy. A uterus transplant is a major surgical procedure that involves placing a donor uterus inside a woman without a uterus. Uterine transplants give people with MRKH an opportunity to carry and deliver a child. Uterus transplants aren’t widely available but could be a promising treatment in the future.

• #39 Müllerian agenesis – Wikipedia

  https://en.wikipedia.org/wiki/M%C3%BCllerian_agenesis

  Another approach is the use of an autotransplant of a resected sigmoid colon using laparoscopic surgery; results are reported to be very good, with the transplant becoming a functional vagina. […] Uterine transplantation has been performed in a number of people with Mllerian agenesis, but the surgery is still in the experimental stage. […] Since ovaries are present, people with this condition can have genetic children through IVF with embryo transfer to a gestational carrier. Some also choose to adopt. […] Promising research includes the use of laboratory-grown structures, which are less subject to the complications of non-vaginal tissue, and may be grown using the woman’s own cells as a culture source. […] A 2014 study and experiment with laboratory-grown engineered vaginas using the patient’s own cells resulted in fully functional vaginas capable of menstruation, sustaining penetrative sex, and orgasm in 4 patients, showing promise of fully correcting this condition.

• #40 Vaginal agenesis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-agenesis/diagnosis-treatment/drc-20355741

  Your health care provider may recommend testing, including: […] Treatment for vaginal agenesis often occurs in the late teens or early 20s, but you may wait until you’re older and you feel motivated and ready to participate in treatment. […] You and your health care provider can discuss treatment options. Depending on your individual condition, options may involve no treatment or creating a vagina by self-dilation or surgery. […] Self-dilation is typically recommended as the first option. Self-dilation may allow you to create a vagina without surgery. The goal is to lengthen the vagina to a size comfortable for sexual intercourse. […] If self-dilation doesn’t work, surgery to create a functional vagina (vaginoplasty) may be an option. Types of vaginoplasty surgery include: […] After surgery, use of a mold, dilation or frequent sexual intercourse is needed to maintain a functional vagina. Health care providers usually delay surgical treatments until you feel prepared and able to handle self-dilation. Without regular dilation, the newly created vaginal canal can quickly narrow and shorten, so being emotionally mature and ready to comply with aftercare is critically important. […] Talk to your health care provider about the best surgical option to meet your needs, and the risks and required care after surgery.

• #41 Vaginal agenesis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/vaginal-agenesis

  If self-dilation doesn’t work, surgery to create a functional vagina (vaginoplasty) may be an option. Types of vaginoplasty surgery include: […] After surgery, use of a mold, dilation or frequent sexual intercourse is needed to maintain a functional vagina. Health care providers usually delay surgical treatments until you feel prepared and able to handle self-dilation. Without regular dilation, the newly created vaginal canal can quickly narrow and shorten, so being emotionally mature and ready to comply with aftercare is critically important. […] Talk to your health care provider about the best surgical option to meet your needs, and the risks and required care after surgery.

• #42 Recent Advances in Vaginal Atresia: A Literature Review

  https://www.mdpi.com/2227-9059/13/1/128

  Studies indicate that postoperative vaginal stenosis is common following surgical correction of vaginal atresia, especially in patients with longer obstruction distances. […] The frequency of vaginal dilation or use of vaginal molds post-surgery depends on the length of the atretic vagina, in order to prevent re-closure or stenosis. […] Various materials have been used as vaginal coverings in vaginoplasty, including skin flaps, amniotic membrane, peritoneum, intestinal segments, oral mucosa, and biological grafts. […] In tissue engineering, extracellular matrix (ECM) materials are being explored for vaginal reconstruction. […] Amniotic membrane vaginoplasty is an affordable, safe, and simple technique that reconstructs or repairs vaginal structures using the amnion (a component of fetal membranes) as a biological material.

• #43 Vaginal Agenesis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23458-vaginal-agenesis

  After treatment, many people have a satisfying sex life. Your partner may not even notice that you had vaginal agenesis or received treatment for the condition. […] Ask your provider if you can carry a child after treatment. If your uterus, fallopian tubes and cervix developed normally, you may still be able to have children.

• #44 Vaginal Agenesis Turkey – Dr. Burcu Karamürsel

  https://www.burcukaramursel.com/en/vaginal-agenesis

  The patients have a totally normal and satisfactory sexual life after vaginoplasty. As a matter of fact, women do not need to have a vagina for a satisfactory sexual life. Because patients with vaginal agenesis have normal external genitalia including the clitoris. Clitoris is the most sensitive part of the female genital organs and it plays an important role in female sexual stimulation and orgasm. Since patients with vaginal agenesis have a normal clitoris, they can have orgasm even without penetrative intercourse. […] However to be able to have penetrative intercourse with a sexual partner, vagina is necessary.

• #45 Vaginal Agenesis Turkey – Dr. Burcu Karamürsel

  https://www.burcukaramursel.com/en/vaginal-agenesis

  The patients have a totally normal and satisfactory sexual life after vaginoplasty. As a matter of fact, women do not need to have a vagina for a satisfactory sexual life. Because patients with vaginal agenesis have normal external genitalia including the clitoris. Clitoris is the most sensitive part of the female genital organs and it plays an important role in female sexual stimulation and orgasm. Since patients with vaginal agenesis have a normal clitoris, they can have orgasm even without penetrative intercourse. […] However to be able to have penetrative intercourse with a sexual partner, vagina is necessary.

• #46 Vaginal Agenesis Treatment in Turkey – Vaginoplasty Clinic

  https://www.vaginoplastyturkey.com/en/vaginal-agenesis-treatment-in-turkey

  You can have surgery to open the vagina when there is vaginal agenesis and the procedure is called as vaginoplasty. The newly formed vagina is called a neovagina. There are several surgical techniques for vaginoplasty: Mc Indoe procedure, Peritoneal vaginoplasty-uses peritoneum (tissue covering abdominal organs) to create the neovagina done by laparoscopic surgery, Intestinal vaginoplasty-uses a section of sigmoid colon to create the neovagina, usually done as a laparoscopic surgery. […] Mc Indoe Procedure is the creation of neovagina by using skin graft usually harvested from the groin area. The skin graft is placed on a vaginal mould and the mould is placed into the space created for neovagina. The patient needs to use the mould regularly so that the vagina stays open. […] Patients with MRKH syndrome can have kids either by gestational surrogacy or adoption. If the patient has ovaries, her eggs can be retrieved by in vitro fertilisation treatment, embryo may be formed by ICSI and the embryo may be transferred to the surrogate mothers uterus. […] Orgasm in MRKH syndrome patients can be achieved by stimulation of the clitoris. Women do not necessarily need to have a vagina to achieve orgasm. After vaginal agenesis treatment, vaginal intercourse will also make it possible to have an orgasm through penetration.

• #47 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Mllerian agenesis, also referred to as mllerian aplasia, Mayer-Rokitansky-Kster-Hauser syndrome, or vaginal agenesis, has an incidence of 1 per 4,5005,000 females. […] The most important steps in the effective management of mllerian agenesis are correct diagnosis of the underlying condition, evaluation for associated congenital anomalies, and psychosocial counseling in addition to treatment or intervention to address the functional effects of genital anomalies. […] All patients with mllerian agenesis should be offered counseling and encouraged to connect with peer support groups. […] Future options for having children should be addressed with patients: options include adoption and gestational surrogacy. Assisted reproductive techniques with use of a gestational carrier (surrogate) have been shown to be successful for women with mllerian agenesis.

• #48 Vaginal Agenesis | Intimate Wellness Institute

  https://iwiva.com/home-page/womens-speciality-care/advanced-gynecology/congenital-abnormalities/vaginal-agenesis/

  Vaginal agenesis can be treated with medical devices that gradually dilate the vaginal canal. […] Sometimes, you need surgery to create a vaginal opening. […] Treatment for vaginal agenesis includes: […] If you have a vaginal opening or a dimple where the opening should be, the IWI team may recommend using a dilator to create a vagina. […] Dr. Guerette may recommend a procedure called a vaginoplasty or a neovagina to construct a vaginal canal depending on the specific issue. […] After the surgery, Dr. Guerette places an insert in the vagina to maintain its shape during early healing. […] Dr. Guerette will examine you to determine when you can safely have sex after treatment for vaginal agenesis. […] After treatment, many people have a satisfying sex life. […] If your uterus, fallopian tubes and cervix developed normally, you may still be able to have children. […] But you may be able to have a child with a surrogate using your own eggs.

• #49 Vaginal Agenesis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23458-vaginal-agenesis

  After treatment, many people have a satisfying sex life. Your partner may not even notice that you had vaginal agenesis or received treatment for the condition. […] Ask your provider if you can carry a child after treatment. If your uterus, fallopian tubes and cervix developed normally, you may still be able to have children.

• #50 Vaginal Agenesis | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/family-resources-education/700childrens/2023/05/vaginal-agenesis

  There are non-surgical and surgical ways to treat vaginal agenesis. […] Nonsurgical Over a span of months, the young woman with vaginal agenesis can create a vagina by daily gradually pushing rounded rods called dilators to widen and deepen the vaginal area. This is often very effective and permits future sexual intercourse. […] Surgical Surgery may also be an option for patients who do not have success with non-surgical vaginal dilation. Surgery to make a vagina is called a vaginoplasty. There are several types of vaginoplasty surgeries. While pediatric urologists and gynecologists can perform this surgery, it is important to find a surgeon with abundant experience in performing vaginoplasty surgery. Surgery and recovery take 1-3 months. […] While young women born with vaginal agenesis can have sex after successful vaginal dilation and/or vaginoplasty surgery, most females with vaginal agenesis do not have a uterus and cannot carry a pregnancy. Since they do have ovaries, their eggs can be used for pregnancy carried by another woman (called surrogacy). Another more recent alternative, uterus transplant, has been performed for these young women. This allows them to carry their own child in the transplanted uterus.

• #51 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Mllerian agenesis, also referred to as mllerian aplasia, Mayer-Rokitansky-Kster-Hauser syndrome, or vaginal agenesis, has an incidence of 1 per 4,5005,000 females. […] The most important steps in the effective management of mllerian agenesis are correct diagnosis of the underlying condition, evaluation for associated congenital anomalies, and psychosocial counseling in addition to treatment or intervention to address the functional effects of genital anomalies. […] All patients with mllerian agenesis should be offered counseling and encouraged to connect with peer support groups. […] Future options for having children should be addressed with patients: options include adoption and gestational surrogacy. Assisted reproductive techniques with use of a gestational carrier (surrogate) have been shown to be successful for women with mllerian agenesis.

• #52 Care and Counseling of the Patient with Vaginal Agenesis | Intersex Society of North America

  https://isna.org/node/83/

  Vaginal agenesis involves issues of physical abnormality, body image, sexual identity, and sexual/reproductive functioning that require long-term medical and psychological management. The authors detail the nonsurgical Frank procedure for creating a vagina and discuss counseling techniques for the patient and her family. […] Currently, the two most popular methods for creating a vagina in these cases are the nonsurgical Frank Procedure and the McIndoe split-thickness skin-graft vaginoplasty. […] The Ingram technique is successful in approximately 90% of cases, and surgery should not be considered until the patient has undergone a sufficient trial of this approach. […] Should the nonsurgical technique fail or prove unsuccessful due to lack of motivation, the most popular surgical approach at present is the McIndoe split-thickness skin-graft vaginoplasty.

• #53 Duzce Medical Journal » Submission » Diagnosis and Treatment Approaches in Vaginal Agenesis

  https://dergipark.org.tr/en/pub/dtfd/issue/86226/1531224

  The psychosexual effects of vaginal agenesis should not be overlooked, and clinical care primarily involves comprehensive counseling and support through open communication with the patient. […] For adult patients, treatment for vaginal agenesis typically starts with therapeutic counseling and education, with non-invasive vaginal dilation being recommended as the first-line approach, or surgery if necessary. […] Consequently, managing these issues often requires a multidisciplinary approach, engaging specialists such as urologists, gynecologists, endocrinologists, and geneticists, among others. […] Early detection and timely intervention can greatly enhance the outlook for individuals with these conditions. […] Besides considering the patient’s expectations, the surgeon’s experience plays a crucial role in selecting the appropriate surgical technique. […] This is because the success of the initial surgery is critical to the effectiveness of any subsequent procedures if required. […] In this review, the evaluation and treatment of vaginal agenesis, which constitutes an important part of congenital anomalies of the vagina, were discussed.

• #54 Recent Advances in Vaginal Atresia: A Literature Review

  https://www.mdpi.com/2227-9059/13/1/128

  For patients with coexisting anomalies such as rectovaginal fistula or anal atresia, the anatomical structures in proximity to vaginal atresia require careful consideration in surgical planning. […] The bidirectional relationship between psychological issues and sexual dysfunction in patients with vaginal atresia has long attracted scholarly attention. […] The fertility outcomes and sexual function of patients with vaginal atresia are important indicators for assessing treatment efficacy and quality of life. […] Research by Reham et al. indicates that only 28.5% of patients with cervical-vaginal atresia achieved clinical pregnancy postoperatively, with a mere 14% resulting in live births. […] In conclusion, research on vaginal atresia should address genetic factors, treatment strategies, and the impact on patients’ psychological well-being and fertility outcomes.

• #55 A Cognitive Behavioural Model and Therapy for Utero-Vaginal Agenesis (Mayer-Rokitansky-Küster-Hauser Syndrome: MRKH) | Behavioural and Cognitive Psychotherapy | Cambridge Core

  https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/cognitive-behavioural-model-and-therapy-for-uterovaginal-agenesis-mayerrokitanskykusterhauser-syndrome-mrkh/E48A4D617142876D0E973215D56FF22C

  Background: Utero-vaginal agenesis, also called the Mayer-Rokitansky-Kster-Hauser Syndrome (MRKH), is a congenital abnormality of the female genital tract, characterized by the non-formation of the vagina and the uterus. It is a common cause of primary amenorrhoea. Little is known about the psychological impact and management of this condition. […] Method: We describe a specific model of the core negative psychological impact of diagnosis and medical treatment of MRKH and a cognitive-behavioural therapy of MRKH based on the model (CBT-MRKH). The Medical Research Council’s (2002) framework for the development and evaluation of complex health interventions was used for intervention development and evaluation. […] Results: Evidence from a recent cross-sectional study and a small randomized controlled trial (RCT) provides preliminary support for the model and treatment (Heller-Boersma, Schmidt and Edmonds, in press; Heller-Boersma, Schmidt and Edmonds, 2007), and this is further validated by extensive qualitative material gathered over the course of the RCT from participants.

• #56 Duzce Medical Journal » Submission » Diagnosis and Treatment Approaches in Vaginal Agenesis

  https://dergipark.org.tr/en/pub/dtfd/issue/86226/1531224

  The psychosexual effects of vaginal agenesis should not be overlooked, and clinical care primarily involves comprehensive counseling and support through open communication with the patient. […] For adult patients, treatment for vaginal agenesis typically starts with therapeutic counseling and education, with non-invasive vaginal dilation being recommended as the first-line approach, or surgery if necessary. […] Consequently, managing these issues often requires a multidisciplinary approach, engaging specialists such as urologists, gynecologists, endocrinologists, and geneticists, among others. […] Early detection and timely intervention can greatly enhance the outlook for individuals with these conditions. […] Besides considering the patient’s expectations, the surgeon’s experience plays a crucial role in selecting the appropriate surgical technique. […] This is because the success of the initial surgery is critical to the effectiveness of any subsequent procedures if required. […] In this review, the evaluation and treatment of vaginal agenesis, which constitutes an important part of congenital anomalies of the vagina, were discussed.

• #57 Vaginal agenesis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-agenesis/diagnosis-treatment/drc-20355741

  Your health care provider may recommend testing, including: […] Treatment for vaginal agenesis often occurs in the late teens or early 20s, but you may wait until you’re older and you feel motivated and ready to participate in treatment. […] You and your health care provider can discuss treatment options. Depending on your individual condition, options may involve no treatment or creating a vagina by self-dilation or surgery. […] Self-dilation is typically recommended as the first option. Self-dilation may allow you to create a vagina without surgery. The goal is to lengthen the vagina to a size comfortable for sexual intercourse. […] If self-dilation doesn’t work, surgery to create a functional vagina (vaginoplasty) may be an option. Types of vaginoplasty surgery include: […] After surgery, use of a mold, dilation or frequent sexual intercourse is needed to maintain a functional vagina. Health care providers usually delay surgical treatments until you feel prepared and able to handle self-dilation. Without regular dilation, the newly created vaginal canal can quickly narrow and shorten, so being emotionally mature and ready to comply with aftercare is critically important. […] Talk to your health care provider about the best surgical option to meet your needs, and the risks and required care after surgery.

• #58 Müllerian Agenesis: Room for Improvement in Care, Counseling – Research Horizons

  https://scienceblog.cincinnatichildrens.org/mullerian-agenesis-room-for-improvement-in-care-counseling/

  “Our findings show room for improvement in the counseling and care of individuals with MRKH, particularly around vaginal lengthening,” Pennesi says. “There is a need to educate healthcare providers so they can support patients in accessing appropriate, comprehensive and longitudinal care.” […] Pennesi and her team at the MRKH Care Center at Cincinnati Children’s aim to increase awareness about Müllerian agenesis among providers and provide comprehensive care to individuals with MRKH.

• #59 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Surgical creation of a vagina requires ongoing postoperative dilation or vaginal intercourse to maintain adequate vaginal length and diameter; therefore, it is not a method to avoid vaginal dilator therapy. […] The primary aim of surgery is the creation of a vaginal canal to allow penetrative intercourse. […] Several surgical techniques may be used to create a neovagina. […] The timing of the surgery depends on the patient and the type of procedure planned. […] Patients should be thoroughly counseled about surgical pain and the need for very close postoperative care. […] Compared with primary vaginal dilation, vaginoplasty complications are much more common and include bladder or rectal perforation, graft necrosis, hair-bearing vaginal skin, fistulae, diversion colitis, inflammatory bowel disease, and adenocarcinoma.

• #60 Vaginal Agenesis (Congenital Absence of Vagina): Causes, Symptoms, and Treatment Methods | DocHospitals

  https://dochospitals.com/en/vaginal-agenesis-atc2489/

  The surgeon inserts an olive-shaped device (Vecchietti procedure) or a balloon device (balloon vaginoplasty) into the vaginal opening. […] In bowel vaginoplasty, specialists create a new vagina by moving a section of the colon to an opening in the genital area. […] Vaginoplasty surgeries allow patients to experience greater sexual satisfaction and boost their self-confidence. This significantly improves patients’ quality of life after recovery. […] The complications that can occur during vaginoplasty surgeries vary depending on the extent of the surgery and the method used. Complications that may arise after vaginoplasty surgery for vaginal agenesis include: Painful intercourse, Numbness, Loss of sensation, Infection, Bleeding. […] Women with a missing or underdeveloped uterus may experience infertility. However, if the ovaries are healthy, it is possible to have a child through IVF. The embryo can also be transferred to a surrogate mother. […] If treated, they can also have a functional vagina, enabling penetrative intercourse.

• #61 Vaginal Agenesis Turkey – Dr. Burcu Karamürsel

  https://www.burcukaramursel.com/en/vaginal-agenesis

  Intestinal vaginoplasty: This is the most radical and invasive procedure to create a new vagina. An incision is made on the abdominal wall and a free segment of bowel is cut away to be inserted into the newly formed vaginal canal. This is also known as free tissue transfer. It needs a special microsurgical technique to attach the vessels of the bowel segment to the vessels of the newly formed vagina. Complications that may be seen after this surgery may be summarised as constipation, paralytic ileus, peritonitis and difficulty in urination. Since the bowel segment secretes a lot of mucus, the patients may have a lot of mucoid discharge from the neovagina and may need to use daily sanitary pads. […] Inserting a medical traction device-Vecchietti Procedure: An olive shaped device is placed at the vaginal opening. Small cuts are made on the abdominal wall to insert a camera (laparoscope) and other instruments to make traction on the olive shaped device up into the abdominal cavity. The traction device will gradually pull the olive inward to create a neovagina.

• #62 Vaginal Agenesis- Causes, Symptoms and Treatment – Best Fertility Centre in Chennai

  https://aakashfertilitycentre.in/vaginal-agenesis-causes-symptoms-and-treatment/

  Vaginal agenesis can present significant challenges for affected individuals, impacting menstrual function, sexual intercourse, and psychological well-being. Treatment options vary depending on the severity of the condition and individual needs, ranging from vaginal dilation techniques to surgical interventions such as vaginoplasty. […] Vaginal Dilation: Non-surgical method involving the gradual stretching of the vaginal opening using dilators to promote tissue expansion. Vaginoplasty: Surgical reconstruction of the vagina using various techniques to create a functional vaginal canal. Hormone Therapy: Administration of estrogen or other hormones to support secondary sexual characteristics and vaginal development. Psychological Support: Counseling or therapy to address emotional challenges and provide coping strategies. Continued Monitoring: Regular follow-up care to assess treatment progress, manage complications, and provide ongoing support.

• #63 What Is Vaginal Agenesis?

  https://www.ocwomenscare.com/blog/514660-what-is-vaginal-agenesis

  Vaginal agenesis is a rare congenital condition that impacts the development of a babys reproductive system. […] An OBGYN may be the first person to diagnose this condition and they will become a valuable part of you or your daughters treatment plan. […] While most patients with vaginal agenesis will not be able to carry a child, if they do have a uterus then they can become pregnant when they choose to have a family. This is something that your OBGYN can discuss once the patient becomes an adult. […] Are there treatment options for vaginal agenesis? Additional testing may need to be performed by your gynecologist before deciding which type of treatments are best for the patient. In most cases, treatment wont be necessary until the late teens or 20s. Two of the most common treatment options for vaginal agenesis include, Self-dilation: Instead of turning to surgery to create a vagina, this device can be placed inside the vagina for hours a day to help stretch the skin and create a vagina.

• #64 What Is Vaginal Agenesis?

  https://www.virginiacenterforwomen.com/blog/458725-what-is-vaginal-agenesis

  Vaginal agenesis is a rare congenital condition that impacts the development of a babys reproductive system. As a result, a baby girl may be born without certain reproductive organs or a vagina. […] An OBGYN may be the first person to diagnose this condition and they will become a valuable part of you or your daughters treatment plan. […] Are there treatment options for vaginal agenesis? Additional testing may need to be performed by your gynecologist before deciding which type of treatments are best for the patient. In most cases, treatment wont be necessary until the late teens or 20s. Two of the most common treatment options for vaginal agenesis include, Self-dilation: Instead of turning to surgery to create a vagina, this device can be placed inside the vagina for hours a day to help stretch the skin and create a vagina. Surgery: If patients dont see results with self-dilation then surgery is often the next step. There are a variety of techniques that can be used during a vaginoplasty, and your gynecologist will fully discuss them with you, so you decide together on the ideal surgical technique to provide the optimal results. Your OBGYN will take an active role in providing you and your teen with any needed care, treatment, and support. Your gynecologist can address your concerns, answer your questions and be an advocate for your health.

• #65 Recent Advances in Vaginal Atresia: A Literature Review

  https://www.mdpi.com/2227-9059/13/1/128

  Studies indicate that postoperative vaginal stenosis is common following surgical correction of vaginal atresia, especially in patients with longer obstruction distances. […] The frequency of vaginal dilation or use of vaginal molds post-surgery depends on the length of the atretic vagina, in order to prevent re-closure or stenosis. […] Various materials have been used as vaginal coverings in vaginoplasty, including skin flaps, amniotic membrane, peritoneum, intestinal segments, oral mucosa, and biological grafts. […] In tissue engineering, extracellular matrix (ECM) materials are being explored for vaginal reconstruction. […] Amniotic membrane vaginoplasty is an affordable, safe, and simple technique that reconstructs or repairs vaginal structures using the amnion (a component of fetal membranes) as a biological material.

• #66 Müllerian agenesis – Wikipedia

  https://en.wikipedia.org/wiki/M%C3%BCllerian_agenesis

  Another approach is the use of an autotransplant of a resected sigmoid colon using laparoscopic surgery; results are reported to be very good, with the transplant becoming a functional vagina. […] Uterine transplantation has been performed in a number of people with Mllerian agenesis, but the surgery is still in the experimental stage. […] Since ovaries are present, people with this condition can have genetic children through IVF with embryo transfer to a gestational carrier. Some also choose to adopt. […] Promising research includes the use of laboratory-grown structures, which are less subject to the complications of non-vaginal tissue, and may be grown using the woman’s own cells as a culture source. […] A 2014 study and experiment with laboratory-grown engineered vaginas using the patient’s own cells resulted in fully functional vaginas capable of menstruation, sustaining penetrative sex, and orgasm in 4 patients, showing promise of fully correcting this condition.

• #67 Müllerian agenesis – Wikipedia

  https://en.wikipedia.org/wiki/M%C3%BCllerian_agenesis

  Another approach is the use of an autotransplant of a resected sigmoid colon using laparoscopic surgery; results are reported to be very good, with the transplant becoming a functional vagina. […] Uterine transplantation has been performed in a number of people with Mllerian agenesis, but the surgery is still in the experimental stage. […] Since ovaries are present, people with this condition can have genetic children through IVF with embryo transfer to a gestational carrier. Some also choose to adopt. […] Promising research includes the use of laboratory-grown structures, which are less subject to the complications of non-vaginal tissue, and may be grown using the woman’s own cells as a culture source. […] A 2014 study and experiment with laboratory-grown engineered vaginas using the patient’s own cells resulted in fully functional vaginas capable of menstruation, sustaining penetrative sex, and orgasm in 4 patients, showing promise of fully correcting this condition.

• #68 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  At present, there is no consensus in the literature regarding the best option for surgical technique to afford the best functional outcome and sexual satisfaction. […] The most important steps in the effective management of mllerian agenesis are correct diagnosis of the underlying condition, evaluation for associated congenital anomalies, and psychosocial counseling in addition to treatment or intervention to address the functional effects of genital anomalies.

• #69 Recent Advances in Vaginal Atresia: A Literature Review

  https://www.mdpi.com/2227-9059/13/1/128

  For patients with coexisting anomalies such as rectovaginal fistula or anal atresia, the anatomical structures in proximity to vaginal atresia require careful consideration in surgical planning. […] The bidirectional relationship between psychological issues and sexual dysfunction in patients with vaginal atresia has long attracted scholarly attention. […] The fertility outcomes and sexual function of patients with vaginal atresia are important indicators for assessing treatment efficacy and quality of life. […] Research by Reham et al. indicates that only 28.5% of patients with cervical-vaginal atresia achieved clinical pregnancy postoperatively, with a mere 14% resulting in live births. […] In conclusion, research on vaginal atresia should address genetic factors, treatment strategies, and the impact on patients’ psychological well-being and fertility outcomes.

• #70 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Nonsurgical vaginal elongation by dilation should be the first-line approach. When well-counseled and emotionally prepared, almost all patients (9096%) will be able to achieve anatomic and functional success by primary vaginal dilation. […] Primary vaginal elongation by dilation is the appropriate first-line approach in most patients because it is safer, patient-controlled, and more cost effective than surgery. […] Because primary vaginal dilation is successful for more than 9096% of patients, surgery should be reserved for the rare patient who is unsuccessful with primary dilator therapy or who prefers surgery after a thorough informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s). […] Regardless of the surgical technique chosen, referrals to centers with expertise should be offered. The surgeon must be experienced with the procedure because the initial procedure is more likely to succeed than follow-up procedures.

• #71 Mullerian Duct Anomalies: Overview, Incidence and Prevalence, Embryology

  https://emedicine.medscape.com/article/954110-overview

  Mullerian agenesis, also termed mullerian aplasia, is characterized by an absence or hypoplasia of the uterus, proximal vagina, and, in some cases, the fallopian tubes. The condition has been also referred to as the Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, when it occurs in its most extreme form, both uterine and vaginal aplasia. […] The first-line approach in most patients should be primary vaginal elongation by dilation. Compared with surgery, it is safer, patient-controlled, and more cost-effective. […] Surgery should be reserved for the rare patient who is unsuccessful with primary dilator therapy or who prefers surgery after a thorough informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s). Primary vaginal dilation is successful for more than 90-96% of patients.

• #72 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Nonsurgical vaginal elongation by dilation should be the first-line approach. When well-counseled and emotionally prepared, almost all patients (9096%) will be able to achieve anatomic and functional success by primary vaginal dilation. […] Primary vaginal elongation by dilation is the appropriate first-line approach in most patients because it is safer, patient-controlled, and more cost effective than surgery. […] Because primary vaginal dilation is successful for more than 9096% of patients, surgery should be reserved for the rare patient who is unsuccessful with primary dilator therapy or who prefers surgery after a thorough informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s). […] Regardless of the surgical technique chosen, referrals to centers with expertise should be offered. The surgeon must be experienced with the procedure because the initial procedure is more likely to succeed than follow-up procedures.

• #73 Duzce Medical Journal » Submission » Diagnosis and Treatment Approaches in Vaginal Agenesis

  https://dergipark.org.tr/en/pub/dtfd/issue/86226/1531224

  The psychosexual effects of vaginal agenesis should not be overlooked, and clinical care primarily involves comprehensive counseling and support through open communication with the patient. […] For adult patients, treatment for vaginal agenesis typically starts with therapeutic counseling and education, with non-invasive vaginal dilation being recommended as the first-line approach, or surgery if necessary. […] Consequently, managing these issues often requires a multidisciplinary approach, engaging specialists such as urologists, gynecologists, endocrinologists, and geneticists, among others. […] Early detection and timely intervention can greatly enhance the outlook for individuals with these conditions. […] Besides considering the patient’s expectations, the surgeon’s experience plays a crucial role in selecting the appropriate surgical technique. […] This is because the success of the initial surgery is critical to the effectiveness of any subsequent procedures if required. […] In this review, the evaluation and treatment of vaginal agenesis, which constitutes an important part of congenital anomalies of the vagina, were discussed.

• #74 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  At present, there is no consensus in the literature regarding the best option for surgical technique to afford the best functional outcome and sexual satisfaction. […] The most important steps in the effective management of mllerian agenesis are correct diagnosis of the underlying condition, evaluation for associated congenital anomalies, and psychosocial counseling in addition to treatment or intervention to address the functional effects of genital anomalies.

• #75 Müllerian Agenesis: Diagnosis, Management, and Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/01/mullerian-agenesis-diagnosis-management-and-treatment

  Mllerian agenesis, also referred to as mllerian aplasia, Mayer-Rokitansky-Kster-Hauser syndrome, or vaginal agenesis, has an incidence of 1 per 4,5005,000 females. […] The most important steps in the effective management of mllerian agenesis are correct diagnosis of the underlying condition, evaluation for associated congenital anomalies, and psychosocial counseling in addition to treatment or intervention to address the functional effects of genital anomalies. […] All patients with mllerian agenesis should be offered counseling and encouraged to connect with peer support groups. […] Future options for having children should be addressed with patients: options include adoption and gestational surrogacy. Assisted reproductive techniques with use of a gestational carrier (surrogate) have been shown to be successful for women with mllerian agenesis.

• #76 Duzce Medical Journal » Submission » Diagnosis and Treatment Approaches in Vaginal Agenesis

  https://dergipark.org.tr/en/pub/dtfd/issue/86226/1531224

  The psychosexual effects of vaginal agenesis should not be overlooked, and clinical care primarily involves comprehensive counseling and support through open communication with the patient. […] For adult patients, treatment for vaginal agenesis typically starts with therapeutic counseling and education, with non-invasive vaginal dilation being recommended as the first-line approach, or surgery if necessary. […] Consequently, managing these issues often requires a multidisciplinary approach, engaging specialists such as urologists, gynecologists, endocrinologists, and geneticists, among others. […] Early detection and timely intervention can greatly enhance the outlook for individuals with these conditions. […] Besides considering the patient’s expectations, the surgeon’s experience plays a crucial role in selecting the appropriate surgical technique. […] This is because the success of the initial surgery is critical to the effectiveness of any subsequent procedures if required. […] In this review, the evaluation and treatment of vaginal agenesis, which constitutes an important part of congenital anomalies of the vagina, were discussed.

• #77 Best Treatment for Vaginal Agenesis in Women, Hyderabad -Rainbow Children’s Hospital

  https://www.rainbowhospitals.in/doctors/vaginal-agenesis-in-women-hyderabad

  How personalized are the treatment plans for Vaginal Agenesis at Rainbow Children’s Hospitals? The hospitals prioritize individualized care, tailoring treatment plans based on thorough evaluations of each patient’s specific condition and needs. This personalized approach ensures that treatments align with the unique requirements of each woman dealing with Vaginal Agenesis.

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