Agenezja pochwy
Zapobieganie i profilaktyka
Agenezja pochwy jest wrodzoną wadą rozwojową, najczęściej związaną z zespołem Mayera-Rokitansky’ego-Küstera-Hausera (MRKH) oraz zespołem całkowitej niewrażliwości na androgeny. Pomimo braku możliwości bezpośredniej profilaktyki, kluczowe jest poradnictwo genetyczne, zwłaszcza u pacjentek z rodzinną historią zaburzeń różnicowania płci. Zaleca się unikanie ekspozycji na czynniki teratogenne, takie jak toksyny, dym papierosowy i zanieczyszczenia środowiskowe, a także prowadzenie zdrowego stylu życia, w tym zbilansowanej diety i unikanie używek w okresie ciąży. Diagnostyka powinna uwzględniać ocenę współistniejących wad wrodzonych oraz zapewnienie wsparcia psychospołecznego, a także omówienie opcji reprodukcyjnych, takich jak adopcja czy surogacja.
Agenezja pochwy – zapobieganie i profilaktyka
Agenezja pochwy jest wrodzoną wadą rozwojową obecną od urodzenia, która powstaje podczas rozwoju płodu w macicy. Ze względu na wrodzony charakter tej anomalii, nie istnieją bezpośrednie metody jej zapobiegania.12 Pomimo to, istnieją pewne działania, które mogą być rozważone w kontekście profilaktyki i zarządzania ryzykiem wystąpienia tej przypadłości.
Poradnictwo genetyczne
Poradnictwo genetyczne odgrywa kluczową rolę w kontekście agenezji pochwy. Dotyczy to zwłaszcza osób z zespołem Mayera-Rokitansky’ego-Küstera-Hausera (MRKH) oraz zespołem całkowitej niewrażliwości na androgeny, które są najczęstszymi przyczynami agenezji pochwy.34 Osoby z rodzinną historią zaburzeń różnicowania płci powinny skonsultować się z lekarzem przed planowaniem rodziny. Konsultacja z doradcą genetycznym przed zajściem w ciążę umożliwia ocenę ryzyka przekazania dziedzicznego schorzenia dziecku.5
Warto zaznaczyć, że agenezja pochwy może wystąpić u osób bez historii rodzinnej tego schorzenia, a w przypadku zespołu MRKH nie zidentyfikowano jednego konkretnego genu odpowiedzialnego za jego wystąpienie.6 Poradnictwo genetyczne pozwala kobietom lepiej zrozumieć ich historię rodzinną i potencjalne czynniki ryzyka, co umożliwia podejmowanie świadomych decyzji dotyczących zdrowia reprodukcyjnego.7
Czynniki środowiskowe
Mimo że bezpośredni związek przyczynowy nie został jednoznacznie ustalony, zaleca się unikanie narażenia na niektóre czynniki środowiskowe, które teoretycznie mogą zwiększać ryzyko wystąpienia wad rozwojowych, w tym agenezji pochwy:8
- Ograniczenie ekspozycji na szkodliwe chemikalia i toksyny
- Unikanie dymu papierosowego
- Minimalizowanie kontaktu z zanieczyszczeniami środowiskowymi
Zdrowy styl życia
Choć nie ma gwarancji, że całkowicie wyeliminuje to ryzyko rozwoju agenezji pochwy, prowadzenie zdrowego stylu życia może potencjalnie zmniejszyć ryzyko wystąpienia wad wrodzonych:10
- Zbilansowana dieta bogata w niezbędne składniki odżywcze
- Regularna aktywność fizyczna
- Unikanie używek i substancji potencjalnie teratogennych podczas ciąży
Postępowanie po diagnozie
Wielodyscyplinarne podejście
Najważniejszymi elementami skutecznego postępowania w przypadku agenezji pochwy są: prawidłowa diagnoza podstawowego schorzenia, ocena pod kątem współistniejących wad wrodzonych oraz poradnictwo psychospołeczne, obok leczenia lub interwencji mających na celu zniwelowanie funkcjonalnych skutków anomalii narządów płciowych.12 Optymalizacja komfortu seksualnego wymaga wielodyscyplinarnego podejścia i indywidualnego dostosowania leczenia.13
Wsparcie psychospołeczne
Wszystkim pacjentkom z agenezją pochwy należy zaoferować poradnictwo psychologiczne i zachęcać do nawiązania kontaktu z grupami wsparcia.14 Ponadto, należy omówić z pacjentkami przyszłe opcje posiadania dzieci, takie jak adopcja i surogacja.15
Metody leczenia pierwszego wyboru
Zgodnie z najnowszymi międzynarodowymi zaleceniami, dla pacjentek zainteresowanych współżyciem z penetracją pochwy, leczeniem pierwszego wyboru w przypadku agenezji pochwy jest wysoce skuteczna, niechirurgiczna opcja stosowania dilatorów pochwowych.16 Niechirurgiczne wydłużanie pochwy poprzez rozszerzanie powinno być podejściem pierwszego rzutu.17
Niechirurgiczne rozszerzanie pochwy jest bezpieczną i skuteczną metodą tworzenia neopochwy u pacjentek z agenezją pochwy.1819 W porównaniu z metodami chirurgicznymi, niechirurgiczne rozszerzanie pochwy ma zaletę niskiej chorobowości, stworzenia bardziej fizjologicznego środowiska pochwy i braku blizn pooperacyjnych.20
Leczenie powinno być odroczone do okresu dojrzewania, aby umożliwić świadomą zgodę i współpracę pacjentki.21 Rozszerzanie pochwy jest bardziej skuteczne u pacjentek w wieku 18 lat lub starszych niż u młodszych pacjentek.22
Badania wykazują, że przy odpowiednim poradnictwie i przygotowaniu emocjonalnym, prawie wszystkie pacjentki (90-96%) mogą osiągnąć anatomiczny i funkcjonalny sukces dzięki pierwotnemu rozszerzaniu pochwy.23 Pierwotne wydłużanie pochwy przez rozszerzanie jest odpowiednim podejściem pierwszego rzutu u większości pacjentek, ponieważ jest bezpieczniejsze, kontrolowane przez pacjentkę i bardziej opłacalne niż operacja.24
Alternatywne metody leczenia
Ponieważ pierwotne rozszerzanie pochwy jest skuteczne u ponad 90-96% pacjentek, operacja powinna być zarezerwowana dla rzadkich przypadków, gdy terapia z użyciem dilatorów jest nieskuteczna, lub dla pacjentek, które preferują operację po dokładnej dyskusji dotyczącej świadomej zgody z lekarzem ginekologiem i odpowiednimi rodzicami lub opiekunami.25
Istnieje wiele opcji chirurgicznych, każda z nich ma swoich entuzjastycznych zwolenników.26 W przypadkach, gdy zdecydowano się na leczenie chirurgiczne, należy oferować skierowania do ośrodków posiadających odpowiednią wiedzę specjalistyczną.27
Jedną z metod chirurgicznych jest zmodyfikowana technika McIndoe’a, która jest prostą i skuteczną procedurą leczenia agenezji pochwy, jednak właściwe stosowanie formy po zabiegu pozostaje kamieniem węgielnym leczenia.28
Inna technika to waginoplastyka z wykorzystaniem jelita grubego, szczególnie esicy. Ta metoda jest proponowana jako leczenie z wyboru ze względu na duży światło, grube ściany odporne na urazy, odpowiednią wydzielinę umożliwiającą nawilżanie, brak konieczności długotrwałego rozszerzania oraz krótki czas rekonwalescencji w porównaniu z waginoplastyką z wykorzystaniem jelita krętego.29
Zapobieganie powikłaniom
Aktywne seksualnie kobiety z agenezją pochwy powinny być świadome, że są narażone na ryzyko infekcji przenoszonych drogą płciową, dlatego podczas stosunku powinny stosować prezerwatywy.30
Innowacyjne podejścia
Badania wskazują na możliwość stosowania uproszczonych wersji metod rozszerzania pochwy. Na przykład, w jednym z badań pacjentce zalecono modulowanie nacisku na krocze poprzez zmiany postawy zamiast korzystania z siodełka rowerowego.31 Na podstawie wyników tego przypadku stwierdzono, że zwykłe krzesło może być uznane za realną alternatywę dla siodełka rowerowego, jeśli pacjentka jest zmotywowana i dokładnie poinstruowana.32
Warto zaznaczyć, że literatura medyczna nie zawiera prospektywnych porównawczych badań wyników, co oznacza, że obecny wybór zabiegu chirurgicznego w dużej mierze zależy od preferencji i doświadczenia chirurga.33 W związku z tym, w oparciu o zadowalające wyniki kliniczne i niską chorobowość, wielu autorów sugeruje, że niechirurgiczne rozszerzanie pochwy powinno być uznane za terapię pierwszego rzutu u pacjentek z agenezją pochwy.34
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Materiały źródłowe
- #1 Vaginal Agenesis: Causes, Symptoms, Diagnosis & Treatmenthttps://my.clevelandclinic.org/health/diseases/23458-vaginal-agenesis
Vaginal agenesis is a congenital abnormality (birth defect). That means its present at birth and happens while a baby is growing in your uterus, so there isnt a way to prevent it. […] If you have a family history of disorders of sex differentiation, talk to your provider before starting a family. You may choose to talk to a genetic counselor before you get pregnant to evaluate your risk of passing an inherited condition to your child.
- #2 Mayer-Rokitansky-Küster-Hauser Syndrome: Overviewhttps://my.clevelandclinic.org/health/diseases/23380-mayer-rokitansky-kuster-hauser-syndrome
There is no way to prevent MRKH syndrome. It can occur in people with no family history of the condition, or it can be genetic (run in your family). No one gene causes MRKH syndrome.
- #3 Management of vaginal agenesis – PubMedhttps://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.
- #4 Vaginal Agenesis: Symptoms, Causes, Treatment | Qwarkhttps://qwarkhealth.com/conditions/vaginal-agenesis
Genetic counseling plays a vital role in preventing Vaginal Agenesis. It allows women to understand their family history and potential risk factors, so that they can make informed decisions about their reproductive health. Genetic counselors can also provide guidance and support to women who are living with Vaginal Agenesis, and help them to manage the condition and optimize their overall health and well-being.
- #5 Vaginal Agenesis: Causes, Symptoms, Diagnosis & Treatmenthttps://my.clevelandclinic.org/health/diseases/23458-vaginal-agenesis
Vaginal agenesis is a congenital abnormality (birth defect). That means its present at birth and happens while a baby is growing in your uterus, so there isnt a way to prevent it. […] If you have a family history of disorders of sex differentiation, talk to your provider before starting a family. You may choose to talk to a genetic counselor before you get pregnant to evaluate your risk of passing an inherited condition to your child.
- #6 Mayer-Rokitansky-Küster-Hauser Syndrome: Overviewhttps://my.clevelandclinic.org/health/diseases/23380-mayer-rokitansky-kuster-hauser-syndrome
There is no way to prevent MRKH syndrome. It can occur in people with no family history of the condition, or it can be genetic (run in your family). No one gene causes MRKH syndrome.
- #7 Vaginal Agenesis: Symptoms, Causes, Treatment | Qwarkhttps://qwarkhealth.com/conditions/vaginal-agenesis
Genetic counseling plays a vital role in preventing Vaginal Agenesis. It allows women to understand their family history and potential risk factors, so that they can make informed decisions about their reproductive health. Genetic counselors can also provide guidance and support to women who are living with Vaginal Agenesis, and help them to manage the condition and optimize their overall health and well-being.
- #8 Vaginal Agenesis: Symptoms, Causes, Treatment | Qwarkhttps://qwarkhealth.com/conditions/vaginal-agenesis
Some preventive measures for Vaginal Agenesis include genetic counseling and avoiding exposure to certain environmental factors. It is very important for women to have a thorough understanding of their family history, as this condition can be passed down through generations. Additionally, exposure to certain chemicals and toxins may increase the risk of Vaginal Agenesis, so it is important to avoid them as much as possible. […] While there is no guaranteed way to completely minimize the risk of developing Vaginal Agenesis, there are some steps that women can take to reduce their chances. This includes maintaining a healthy lifestyle, such as eating a balanced diet and getting plenty of exercise. Additionally, avoiding exposure to harmful chemicals and toxins, such as cigarette smoke and environmental pollutants, can help to reduce the risk.
- #9 Vaginal Agenesis: Symptoms, Causes, Treatment | Qwarkhttps://qwarkhealth.com/conditions/vaginal-agenesis
Some preventive measures for Vaginal Agenesis include genetic counseling and avoiding exposure to certain environmental factors. It is very important for women to have a thorough understanding of their family history, as this condition can be passed down through generations. Additionally, exposure to certain chemicals and toxins may increase the risk of Vaginal Agenesis, so it is important to avoid them as much as possible. […] While there is no guaranteed way to completely minimize the risk of developing Vaginal Agenesis, there are some steps that women can take to reduce their chances. This includes maintaining a healthy lifestyle, such as eating a balanced diet and getting plenty of exercise. Additionally, avoiding exposure to harmful chemicals and toxins, such as cigarette smoke and environmental pollutants, can help to reduce the risk.
- #10 Vaginal Agenesis: Symptoms, Causes, Treatment | Qwarkhttps://qwarkhealth.com/conditions/vaginal-agenesis
Some preventive measures for Vaginal Agenesis include genetic counseling and avoiding exposure to certain environmental factors. It is very important for women to have a thorough understanding of their family history, as this condition can be passed down through generations. Additionally, exposure to certain chemicals and toxins may increase the risk of Vaginal Agenesis, so it is important to avoid them as much as possible. […] While there is no guaranteed way to completely minimize the risk of developing Vaginal Agenesis, there are some steps that women can take to reduce their chances. This includes maintaining a healthy lifestyle, such as eating a balanced diet and getting plenty of exercise. Additionally, avoiding exposure to harmful chemicals and toxins, such as cigarette smoke and environmental pollutants, can help to reduce the risk.
- #11 Vaginal Agenesis: Symptoms, Causes, Treatment | Qwarkhttps://qwarkhealth.com/conditions/vaginal-agenesis
Some preventive measures for Vaginal Agenesis include genetic counseling and avoiding exposure to certain environmental factors. It is very important for women to have a thorough understanding of their family history, as this condition can be passed down through generations. Additionally, exposure to certain chemicals and toxins may increase the risk of Vaginal Agenesis, so it is important to avoid them as much as possible. […] While there is no guaranteed way to completely minimize the risk of developing Vaginal Agenesis, there are some steps that women can take to reduce their chances. This includes maintaining a healthy lifestyle, such as eating a balanced diet and getting plenty of exercise. Additionally, avoiding exposure to harmful chemicals and toxins, such as cigarette smoke and environmental pollutants, can help to reduce the risk.
- #12https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Nonsurgical vaginal elongation by dilation should be the first-line approach.
- #13https://www.ijrcog.org/index.php/ijrcog/article/view/3455
To optimize sexual comfort, the clinical management of women with vaginal agenesis must be multidisciplinary and individually tailored. […] Our findings suggest that the modified Mc Indoes technique is a simple, effective procedure for the treatment of vaginal agenesis, but proper mould usage after surgery remains the cornerstone of the treatment.
- #14https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Nonsurgical vaginal elongation by dilation should be the first-line approach.
- #15https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Nonsurgical vaginal elongation by dilation should be the first-line approach.
- #16 Rokitansky Syndrome – ISShttps://www.iss.it/en/-/rokitansky-syndrome
According to the most recent international recommendations for those interested in vaginal penetrative intercourse, the first-line treatment of vaginal agenesis (partial or total absence of the vagina), is the highly successful, non-surgical option of vaginal dilators. […] Surgery is reserved for those cases where dilator therapy has failed or if the person strongly desires it.
- #17https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Nonsurgical vaginal elongation by dilation should be the first-line approach.
- #18 Non-surgical Treatment of Vaginal Agenesis Using a Simplified Version of Ingram’s Methodhttps://pmc.ncbi.nlm.nih.gov/articles/PMC2687834/
Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. […] 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. […] 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.
- #19 Citedhttps://www.koreamed.org/SearchBasic.php?RID=1777183
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. […] This article reports a case of a 24-year-old woman with Mayer-Rokitansky-Kster-Hauser syndrome whose vaginal agenesis is successfully treated with a simplified version of Ingram’s method.
- #20 Citedhttps://www.koreamed.org/SearchBasic.php?RID=1777183
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. […] This article reports a case of a 24-year-old woman with Mayer-Rokitansky-Kster-Hauser syndrome whose vaginal agenesis is successfully treated with a simplified version of Ingram’s method.
- #21 Management of vaginal agenesis – PubMedhttps://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.
- #22 Vaginal Dilation Is Highly Successful in Patients with Vaginal Agenesislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-bhttps://www.jwatch.org/wh200202190000006/2002/02/19/vaginal-dilation-highly-successful-patients-with
Vaginal dilation was more successful in patients aged 18 or older than in younger patients. […] In my opinion, dilation should be strongly recommended as a first-line approach.
- #23https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Sexually active women with mllerian agenesis should be aware that they are at risk of sexually transmitted infections and, thus, condoms should be used for intercourse.
- #24https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Sexually active women with mllerian agenesis should be aware that they are at risk of sexually transmitted infections and, thus, condoms should be used for intercourse.
- #25https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Sexually active women with mllerian agenesis should be aware that they are at risk of sexually transmitted infections and, thus, condoms should be used for intercourse.
- #26 Management of vaginal agenesis – PubMedhttps://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.
- #27https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Sexually active women with mllerian agenesis should be aware that they are at risk of sexually transmitted infections and, thus, condoms should be used for intercourse.
- #28https://www.ijrcog.org/index.php/ijrcog/article/view/3455
To optimize sexual comfort, the clinical management of women with vaginal agenesis must be multidisciplinary and individually tailored. […] Our findings suggest that the modified Mc Indoes technique is a simple, effective procedure for the treatment of vaginal agenesis, but proper mould usage after surgery remains the cornerstone of the treatment.
- #29https://link.springer.com/article/10.1007/s00192-005-1349-7
The outcome of 11 cases with vaginal agenesis who underwent intestinal vaginoplasties are presented. […] We suggest sigmoid colon vaginoplasty as the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, short recovery time compared with ileum vaginoplasties; and in patients reluctance to prolonged use of dilators or in those who experienced previous failure of the other treatment modalities.
- #30https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_committee_opinion_no__728_summary__m_llerian.35.aspx
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. […] Sexually active women with mllerian agenesis should be aware that they are at risk of sexually transmitted infections and, thus, condoms should be used for intercourse.
- #31 Non-surgical Treatment of Vaginal Agenesis Using a Simplified Version of Ingram’s Methodhttps://pmc.ncbi.nlm.nih.gov/articles/PMC2687834/
Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. […] 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. […] 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.
- #32 Non-surgical Treatment of Vaginal Agenesis Using a Simplified Version of Ingram’s Methodhttps://pmc.ncbi.nlm.nih.gov/articles/PMC2687834/
Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. […] 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. […] 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.
- #33 Management of vaginal agenesis – PubMedhttps://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.
- #34 Non-surgical Treatment of Vaginal Agenesis Using a Simplified Version of Ingram’s Methodhttps://pmc.ncbi.nlm.nih.gov/articles/PMC2687834/
Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. […] 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. […] 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.