Abstract
Historically, sexual satisfaction following the management of vaginal agenesis was assessed subjectively. Standardized sexual function questionnaires are being used more frequently as instruments to accurately and more objectively assess the subjective nature of sexual outcomes as part of a more holistic approach to the care of women with vaginal agenesis. Articles concerning the management of vaginal agenesis were systematically reviewed, with specific focus on those that discussed functional outcomes, sexual satisfaction and psychosomatic outcomes, and in particular attempted to measure these outcomes. A total of 6,691 articles on vaginal agenesis were identified, with 106 of these reporting sexual satisfaction and psychosomatic outcomes. Only 1 randomized control trial (RCT) was identified, the remaining articles being made up of case series or case reports. Only 17 articles used standardized objective assessment of sexual satisfaction. While the bowel technique had the longest vaginal length at 12.87 cm, it had the most number of complaints of dyspareunia (4.8 %), stenosis (10.5 %) and the lowest average subjective sexual satisfaction. The Davydov method used standardized sexual function assessments most frequently. This technique had a higher average score than both the bowel vaginoplasty technique in the only RCT and the Vecchietti method in a prospective assessment. Overall, the management of vaginal agenesis requires a multidisciplinary approach to fully support these patients from initial diagnosis, through management decision-making and long-term follow-up, through transition to adulthood.
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References
Onundarson PT, Gudmundsdottir BR, Arnfinnsdottir AV, Kjeld M, Olafsson O (2001) Von Willebrand factor does not vary during normal menstrual cycle. Thromb Haemost 85(1):183–184
Capraro VJ, Gallego MB (1976) Vaginal agenesis. Am J Obstet Gynecol 124(1):98–107
Frank RT (1938) The formation of an artificial vagina without operation. Am J Obstet Gynecol 35:1035
Vecchietti G (1965) [Creation of an artificial vagina in Rokitansky-Kuster-Hauser syndrome] (Article in Italian). Attual Ostet Ginecol 11(2):131–147
McQuillan SK, Grover SR (2013) Dilation and surgical management in vaginal agenesis: a systematic review. Int J Urogynecol doi: 10.1007/s00192-013-2221-9
Abildgaard CF, Suzuki Z, Harrison J, Jefcoat K, Zimmerman TS (1980) Serial studies in von Willebrand's disease: variability versus "variants". Blood 56:712–716
Salvatore CA, Lodovicci O (1978) Vaginal agenesis: an analysis of ninety cases. Acta Obstet Gynecol Scand 57(1):89–94
Keser A, Bozkurt N, Taner OF, Sensoz O (2005) Treatment of vaginal agenesis with modified Abbe-McIndoe technique: long-term follow-up in 22 patients. Eur J Obstet Gynecol Reprod Biol 121(1):110–116
Folgueira G, Perez-Medina T, Martinez-Cortes L, Martinez-Lara A, Gomez B, Izquierdo J et al (2006) Laparoscopic creation of a neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome by modified Vecchietti's procedure. Eur J Obstet Gynecol Reprod Biol 127(2):240–243
Zhou JH, Sun J, Yang CB, Xie ZW, Shao WQ, Jin HM (2010) Long-term outcomes of transvestibular vaginoplasty with pelvic peritoneum in 182 patients with Rokitansky's syndrome. Fertil Steril 94(6):2281–2285
Wu JX, Li B, Li WZ, Jiang YG, Liang JX, Zhong CX (2009) Laparoscopic vaginal reconstruction using an ileal segment. Int J Gynecol Obstet 107(3):258–261
El Saman AM, Fathalla MM, Nasr AM, Youssef MA (2007) Laparoscopically assisted balloon vaginoplasty for management of vaginal aplasia. Int J Gynecol Obstet 98(2):134–137
Ajmal S, Yusuf K (2010) Vaginoplasty with bilateral islanded pudendal thigh flaps. J Ayub Med Coll Abbottabad 22(1):1–6
Jasonni VM, La Marca A, Naldi S, Matonti G, D'Anna R (2007) The management of vaginal agenesis: report of 104 cases. Fertil Steril 88(6):1653–1656
Hensle TW, Shabsigh A, Shabsigh R, Reiley EA, Meyer-Bahlburg HFL (2006) Sexual function following bowel vaginoplasty. J Urol 175(6):2283–2286
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208
Rust J, Golombok S (1986) The GRISS: a psychometric instrument for the assessment of sexual dysfunction. Arch Sex Behav 15(2):157–165
Marci R, Graziano A, Piva I, Lo Monte G, Soave I, Giugliano E et al (2012) Procreative sex in infertile couples: the decay of pleasure? Health Qual Life Outcomes 10:140
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700
Gauwerky JF, Wallwiener D, Bastert G (1992) An endoscopically assisted technique for construction of a neovagina. Arch Gynecol Obstet 252(2):59–63
Popp LW, Ghirardini G (1992) Creation of a neovagina by pelviscopy. J Laparoendosc Surg 2(3):165–173
Cao L, Wang Y, Li Y, Xu H (2013) Prospective randomized comparison of laparoscopic peritoneal vaginoplasty with laparoscopic sigmoid vaginoplasty for treating congenital vaginal agenesis. Int Urogynecol J 24(7):1173–1179
Bianchi S, Frontino G, Ciappina N, Restelli E, Fedele L (2011) Creation of a neovagina in Rokitansky syndrome: comparison between two laparoscopic techniques. Fertil Steril 95(3):1098–100 e1–3
Kimberley N, Hutson JM, Southwell BR, Grover SR (2011) Well-being and sexual function outcomes in women with vaginal agenesis. Fertil Steril 95(1):238–241
Minto CL, Liao KL-M, Conway GS, Creighton SM (2003) Sexual function in women with complete androgen insensitivity syndrome. Fertil Steril 80(1):157–164
Zhong CX, Wu JX, Liang JX, Wu QH (2012) Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis. Chin Med J (Engl) 125(2):203–208
Creatsas G, Deligeoroglou E, Christopoulos P (2010) Creation of a neovagina after Creatsas modification of Williams vaginoplasty for the treatment of 200 patients with Mayer-Rokitansky-Kuster-Hauser syndrome. Fertil Steril 94(5):1848–1852
Brucker SY, Gegusch M, Zubke W, Rall K, Gauwerky JF, Wallwiener D (2008) Neovagina creation in vaginal agenesis: development of a new laparoscopic Vecchietti-based procedure and optimized instruments in a prospective comparative interventional study in 101 patients. Fertil Steril 90(5):1940–1952
Communal P (2003) Sexuality after sigmoid colpopoiesis in patients with Mayer Rokitansky Kuster Hauser Syndrome. Fertil Steril 80(3):600–606
Dornelas J, Jarmy-Di Bella ZI, Heinke T, Kajikawa MM, Takano CC, Zucchi EV et al (2012) Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation. Eur J Obstet Gynecol Reprod Biol 163(2):204–209
Allen LM, Lucco KL, Brown CM, Spitzer RF, Kives S (2010) Psychosexual and functional outcomes after creation of a neovagina with laparoscopic Davydov in patients with vaginal agenesis. Fertil Steril 94(6):2272–2276
Fedele L, Frontino G, Motta F, Peruzzi E (2011) Davydov's procedure for the treatment of neovaginal prolapse in Rokitansky syndrome. J Minim Invasive Gynecol 18(4):503–506
Fedele L, Frontino G, Restelli E, Ciappina N, Motta F, Bianchi P (2010) Creation of a neovagina by Davydov's laparoscopic modified technique in patients with Rokitansky syndrome. Am J Obstet Gynecol 202(33):e1–e6
Giannesi A, Marchiole P, Benchaib M, Chevret-Measson M, Mathevet P, Dargent D (2005) Sexuality after laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with uterine agenesis or hypoplasia. Hum Reprod 20(10):2954–2957
Gu Y, Zhang X, Kong B, Yu Y (2010) Neovagina constructed with the peritoneum of the anterior abdominal wall. J Obstet Gynaecol Res 36(3):651–655
Liu X, Liu M, Hua K, Li B, Guo SW (2009) Sexuality after laparoscopic peritoneal vaginoplasty in women with Mayer-Rokitansky-Kuster-Hauser syndrome. J Minim Invasive Gynecol 16(6):720–729
Adamian LV, Zurabiani Z, Kiselev SI, Khashukoeva AZ (1996) Laparoscopy in surgical treatment of vaginal aplasia: laparoscopy-assisted colpopoiesis and perineal hysterectomy with colpopoiesis. Int J Fertil Menopausal Stud 41(1):40–45
Ma Y, Qin R, Bi H, Yang X, Zhang J, Yuan J et al (2009) The use of peritoneal tissue mobilised with a novel laparoscopic technique to reconstruct a neovagina. J Plast Reconstr Aesthet Surg 62(3):326–330
Marques Hde S, dos Santos FL, Lopes-Costa PV, dos Santos AR, da Silva BB (2008) Creation of a neovagina in patients with Rokitansky syndrome using peritoneum from the pouch of Douglas: an analysis of 48 cases. Fertil Steril 90(3):827–832
Soong YK, Chang FH, Lai YM, Lee CL, Chou HH (1996) Results of modified laparoscopically assisted neovaginoplasty in 18 patients with congenital absence of vagina. Hum Reprod 11(1):200–203
Tamaya T, Fujimoto J (1997) Comparison between transabdominal-vulvar and transvulvar approaches for peritoneal vaginoplasty in patients with congenital absence of the vagina. Eur J Obstet Gynecol Reprod Biol 72(1):79–81
Ward G, Panda S, Anwar K (1998) Davydov's colpopoeisis: vaginal construction using peritoneum. Curr Obstet Gynaecol 8(4):224–226
Liao LM, Conway GS, Ismail-Pratt I, Bikoo M, Creighton SM (2011) Emotional and sexual wellness and quality of life in women with Rokitansky syndrome. Am J Obstet Gynecol 205(2):117 e1–117 e6
Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM (2005) Female genital appearance: "normality" unfolds. BJOG 112(5):643–646
Schimpf MO, Harvie HS, Omotosho TB, Epstein LB, Jean-Michel M, Olivera CK et al (2010) Does vaginal size impact sexual activity and function? Int Urogynecol J 21(4):447–452
Masters WH, Johnson VE (1966) Human sexual response. Bantam, Toronto
Klingele CJ, Gebhart JB, Croak AJ, DiMarco CS, Lesnick TG, Lee RA (2003) McIndoe procedure for vaginal agenesis: long-term outcome and effect on quality of life. Am J Obstet Gynecol 189(6):1569–1572
Creatsas G, Deligeoroglou E (2010) Creatsas modification of Williams vaginoplasty for reconstruction of the vaginal aplasia in Mayer-Rokitansky-Kuster-Hauser syndrome cases. Womens Health (Lond Engl) 6(3):367–375
Callens N, De Cuypere G, Wolffenbuttel KP, Beerendonk CC, van der Zwan YG, van den Berg M et al (2012) Long-term psychosexual and anatomical outcome after vaginal dilation or vaginoplasty: a comparative study. J Sex Med 9(7):1842–1851
Lindgren TW, Pauly IB (1975) A body image scale for evaluating transsexuals. Arch Sex Behav. 4(6):639–656
Gatti C, Del Rossi C, Lombardi L, Caravaggi F, Casolari E, Casadio G (2010) Sexuality and psychosocial functioning in young women after colovaginoplasty. J Urol 184 [4 Suppl]:1799–1803
Möbus K, Kreienberg F (1996) Long-term results after operative correction of vaginal aplasia. Am J Obstet Gynecol 175(3):617–624
Freundt I, Toolenaar TA, Huikeshoven FJ, Jeekel H, Drogendijk AC (1993) Long-term psychosexual and psychosocial performance of patients with a sigmoid neovagina. Am J Obstet Gynecol 169(5):1210–1214
Ismail-Pratt IS, Bikoo M, Liao LM, Conway GS, Creighton SM (2007) Normalization of the vagina by dilator treatment alone in Complete Androgen Insensitivity Syndrome and Mayer-Rokitansky-Kuster-Hauser Syndrome. Hum Reprod 22(7):2020–2024
Labus LD, Djordjevic ML, Stanojevic DS, Bizic MR, Stojanovic BZ, Cavic TM (2011) Rectosigmoid vaginoplasty in patients with vaginal agenesis: sexual and psychosocial outcomes. Sex Health 8(3):427–430
Vates TS, Fleming P, Leleszi JP, Barthold JS, Gonzalez R, Perlmutter AD (1999) Functional, social and psychosexual adjustment after vaginal reconstruction. J Urol 162(1):182–7
Fliegner JR (1996) Long-term satisfaction with Sheares vaginoplasty for congenital absence of the vagina. Aust N Z J Obstet Gynaecol 36(2):202–204
World Health Organization. WHO Quality of Life—BREF. In: Protocol WQS, ed. WHO (MNH7PSF93.9), 1993.
Liao L, Doyle J, Crouch NS, Creighton SM (2006) Dilation as treatment for vaginal agenesis and hypoplasia: a pilot exploration of benefits and barriers as perceived by patients. J Obstet Gynaecol 26(2):144–148
Frost-Arner L, Aberg M, Jacobsson S (2004) Split skin graft reconstruction in vaginal agenesis: a long-term follow-up. Scand J Plast Reconstr Surg Hand Surg 38(3):151–154
Erman Akar M, Ozkan O, Ozkan O, Colak T, Gecici O (2013) Sexual function and long-term results following vaginal reconstruction with free vascular jejunal flap. J Sex Med doi: 10.1111/jsm.12274
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McQuillan, S.K., Grover, S.R. Systematic review of sexual function and satisfaction following the management of vaginal agenesis. Int Urogynecol J 25, 1313–1320 (2014). https://doi.org/10.1007/s00192-013-2316-3
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DOI: https://doi.org/10.1007/s00192-013-2316-3