Turkish experts have determined that vaginal reconstruction using a free vascular jejunal flap is a “favorable procedure” for women with vaginal agenesis. Women in their study generally had good long-term results and 55% of them had sexual function restored.
Vaginal agenesis is a congenital condition in which the vagina does not develop completely. It is usually discovered when a girl reaches puberty and does not have menstrual periods, even though she has normal secondary sex characteristics.
According to the American Urological Association, vaginal agenesis affects about 1 in 5,000 females. The most common type of vaginal agenesis is Mayer Rokitansky Kuster Hauser syndrome, which can involve the uterus and fallopian tubes as well as the vagina.
Vaginal agenesis has a great impact on a woman’s fertility and sexuality. Self-dilation – applying pressure to the area with a dilator – is considered a first-line treatment. But when this method fails, reconstructive surgery is the next step.
Researchers from the Akdeniz University School of Medicine in Antalya, Turkey investigated the long-term effects of vaginal construction using a jejunal flap. In this procedure, tissue is taken from the jejunum, a portion of the small intestine.
Thirty-four women between the ages of 16 and 31 participated in the study. They had had vaginal construction for various reasons. Most had had Mayer Rokitansky Kuster Hauser syndrome. Others had isolated vaginal agenesis and androgen sensitivity syndrome. One woman had reconstruction following gynecologic-oncologic surgery. Follow up took place between 20 and 87 months after surgery. (The mean was 50 months.)
None of the surgeries had serious complications, although three of the women needed further surgery. Overall, the flap success rate was 100% and there were no infections. The mean length of the women’s reconstructed vaginas was 9.8 centimeters and the mean width was 3.1 centimeters.
Twenty of the women completed the Female Sexual Function Index (FSFI), a questionnaire that assesses sexual desire, arousal, lubrication, orgasm, satisfaction, and pain over the previous four weeks.
Nine (45%) of the women scored under 25 on the FSFI, indicating sexual dysfunction. The most common problems were desire, orgasm, and satisfaction.
The authors acknowledged that their sample size was small. They added that more research is needed to compare other methods of vaginal reconstruction. However, they concluded that the jejunal flap technique is a viable method for restoring sexual function in women with vaginal agenesis.
The study was published online in July in the Journal of Sexual Medicine.
Resources
American Urological Association (UrologyHealth.org)
“Vaginal Abnormalities: Vaginal Agenesis”
(Last updated: April 2013)
http://www.urologyhealth.org/urology/index.cfm?article=50
The Journal of Sexual Medicine
Akar, Münire Erman, MD, et al.
“Sexual Function and Long-Term Results Following Vaginal Reconstruction with Free Vascular Jejunal Flap”
(Full-text. First published online: July 30, 2013)
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12274/abstract