Authors (including presenting author) :
Ng K (1), Ip NPP (1), Chan SCS (1)
Affiliation :
(1) Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
Introduction :
Vaginal agenesis, also known as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital malformation with hypoplasia of the vagina and the uterus. Part of the management includes creation of a neovagina. With successful vaginal dilation therapy, patients can avoid the morbidities of surgical vaginoplasty. Vaginismus is another disease entity, which psychosexual counselling along with vaginal dilation therapy can be beneficial.
Objectives :
To create a successful program for patients with MRKH and vaginismus and evaluate the outcome of the program.
Methodology :
An outpatient based vaginal dilation (VD) program was implemented for MRKH since 2002 and for vaginismus since 2021. Patients were instructed on how to perform VD in a dayward setting and encouraged to practice at home. The duration of therapy, the vaginal length and width at baseline and the end of the therapy, complications associated were reviewed from medical records.
Result & Outcome :
Total of 23 MRKH women and 4 women with vaginismus attended our service. 21 MRKH women (38.9%) received VD therapy as the first line treatment for the creation of a neovagina, 2 had surgical vaginoplasty, 5 achieved adequate vaginal length with coitus alone. The mean age of commencing VD therapy was 23.7 (15-36) years old for MRKH women and 33.5 (33-34) years old for those with vaginismus. For MRKH women, the baseline vaginal length and width was 1.76±1.4cm and 1.2±0.5cm respectively. The mean duration for completion of vaginal dilation therapy was 16.3 (4-45) weeks with an average of 4 (1-8) follow-ups. Post therapy vaginal length and width was 6.4±1.5cm and 2.7±0.7cm respectively. Two women were not satisfied with the vaginal length after VD and requested for surgical vaginoplasty. The overall success rate for VD for MRKH women was 95%. Vaginal spotting (9.5%) was the most common complication and there were no serious complications. In all, 13 MRKH women were sexually active after VD and 1 reported mild dyspareunia. Whereas for vaginismus patients, 3 sessions were required for 2 of them to have successful coitus after the therapy and 2 are still having ongoing therapy.
VD is an effective first line option for creation of a neovagina in MRKH patients with minimal complication and an effective treatment for women with vaginismus.
