Skip to main content
SpringerLink
Log in

Assessment of Sexual Functioning, Mental Health, and Life Goals in Women with Vaginal Agenesis

  • Clinical Case Report Series
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Vaginal agenesis is a congenital disorder defined by the incomplete formation of the vagina and other reproductive organs, often including the cervix, uterus, and fallopian tubes. For the patient, this frequently means infertility and an underdeveloped vagina with the subsequent difficulty to have vaginal intercourse. The patient with vaginal agenesis and her family then encounter a variety of psychological concerns that must be addressed during diagnosis, including weighing treatment options, managing interventions, and coping with long-term issues following diagnosis and treatment, such as partnership concerns and infertility. In this study, seven patients between the ages of 18 and 34 completed questionnaires assessing demographic information, sexual functioning, mental health, self-esteem, and life goals. Sexual functioning results were highly variable. Participants reported significant emotional reactions at diagnosis as well as anxiety about the disorder, specifically its role in relationships. However, overall, the group showed average levels of mental health and self-esteem. Participants also showed positive coping techniques through conceptualization of life goals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alessandrescu, D., Peltecu, G. C., Buhimschi, C. S., & Buhimschi, I. A. (1996). Neocolpopoiesis with split-thickness skin graft as a surgical treatment of vaginal agenesis: Retrospective review of 201 cases. American Journal of Obstetrics and Gynecology, 175, 131–138.

    Article  PubMed  Google Scholar 

  • Borruto, F., Chasen, S. T., Chervenak, F. A., & Fedele, L. (1999). The Vecchietti procedure for surgical treatment of vaginal agenesis: Comparison of laparoscopy and laparotomy. International Journal of Gynecology & Obstetrics, 64, 153–158.

    Article  Google Scholar 

  • Buttram, V. C. (1983). Mullerian anomalies and their management. Fertilization Sterilization, 40, 159–163.

    Google Scholar 

  • Coney, P. (1992). Effect of vaginal agenesis on the adolescent: Prognosis for normal sexual and psychological adjustment. Adolescent Pediatric Gynecology, 5, 8–12.

    Google Scholar 

  • Communal, P., Chevret-Measson, M., Golfier, F., & Raudrant, D. (2003). Sexuality after sigmoid colpopoiesis in patients with Mayer-Rokitansky-Kuster-Hauser Syndrome. Fertility and Sterility, 80, 600–606.

    Article  PubMed  Google Scholar 

  • Croak, A. J., Beghart, J. B., Klingele, C. J., & Lee, R. A. (2003). Therapeutic strategies for vaginal mullerian agenesis. Journal of Reproductive Medicine, 48, 395–401.

    PubMed  Google Scholar 

  • David, A., Carmil, D., Bar-David, E., & Serr, D. M. (1975). Congenital absence of the vagina: Clinical and psychologic aspects. Obstetrics and Gynecology, 46, 407–409.

    PubMed  Google Scholar 

  • Derogatis, L. R. (1993). Brief symptom inventory (BSI). Administration, scoring, and procedures manual. Minneapolis: National Computer Systems.

    Google Scholar 

  • Derogatis, L. R. (1997). The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): An introductory report. Journal of Sex & Marital Therapy, 23, 291–304.

    Google Scholar 

  • Edmonds, D. K. (2000). Congenital malformation of the genital tract. Obstetrics and Gynecology Clinics of North America, 27, 49–62.

    Article  PubMed  Google Scholar 

  • Edmonds, D. K., & Muram, D. (2001). Sexual developmental anomalies and their reconstruction: Upper and lower tracts. In J. Sanfillippo, D. Muram, J. Dewhurst, & P. Lee (Eds.), Pediatric and adolescent gynecology (pp. 553–583). Philadelphia: W. B. Saunders Company.

    Google Scholar 

  • Foley, S., & Morley, G. W. (1992). Care and counseling of the patient with vaginal agenesis. The Female Patient, 17, 73–80.

    Google Scholar 

  • Frank, R. T. (1938). The formation of an artificial vagina. American Journal of Obstetrics and Gynecology, 35, 1053–1055.

    Google Scholar 

  • Freundt, I., Toolenaar, T., Huikeshoven, F. J. M., Jeekel, H., & Drogendijk, A. C. (1993). Long term psychosexual and psychosocial performance of patients with a sigmoid neovagina. American Journal of Obstetrics and Gynecology, 169, 1210–1214.

    PubMed  Google Scholar 

  • Frost-Arner, L., Aberg, M., & Jacobsson, S. (2004). Split skin graft reconstruction in vaginal agenesis: A long-term follow-up. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 38, 151–154.

    Article  PubMed  Google Scholar 

  • Green, M. S., Naumann, R. W., Elliot, M., Hall, J. B., Higgins, R. V., & Grigsby, J. H. (2000). Sexual dysfunction following vulvectomy. Gynecologic Oncology, 77, 73–77.

    Article  PubMed  Google Scholar 

  • Hecker, B. R., & McGuire, L. S. (1977). Psychosocial function in women treated for vaginal agenesis. American Journal of Obstetrics and Gynecology, 129, 543–547.

    PubMed  Google Scholar 

  • Holt, E., & Slade, P. (2003). Living with and incomplete vagina and womb: An interpretative phenomenological analysis and the experience of vaginal agenesis. Psychology, Health and Medicine, 8, 19–33.

    Article  Google Scholar 

  • Hunt, D. D., & Hampson, J. L. (1980). Transsexualism: A standardized psychosocial rating format for the evaluation of results of sex reassignment surgery. Archives of Sexual Behavior, 8, 255–263.

    Article  Google Scholar 

  • Ingram, J. (1981). The bicycle seat stool in the treatment of vaginal agenesis and stenosis: A preliminary report. American Journal of Obstetrics and Gynecology, 140, 867–872.

    PubMed  Google Scholar 

  • Janda, L. H., & O’Grady, K. E. (1980). Development of a sex anxiety inventory. Journal of Consulting and Clinical Psychology, 48, 169–175.

    Article  PubMed  Google Scholar 

  • Jensen, V. K., & Reiter, S. L. (1999). Psychosocial aspects of congenital female tract anomalies. In G. Gidwani & T. Falcone (Eds.), Congenital malformations of the female genital tract: Diagnosis and management (pp. 223–233). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  • Jones, H. W. (2002). Vaginal creation for mullerian agenesis. Obstetrical and Gynecological Survey, 57, 212–213.

    Article  Google Scholar 

  • Kaplan, E. H. (1968). Congenital absence of vagina. New York State Journal of Medicine, 68, 1937–1941.

    PubMed  Google Scholar 

  • Kim, S. K., Park, J. H., Lee, K. C., Park, J. M., Kim, J. T., & Kim, M. C. (2003). Long-term results in patients after rectosigmoid vaginoplasty. Plastic and Reconstructive Surgery, 112, 143–151.

    Google Scholar 

  • Klingele, C. J., Beghart, J. B., Corak, A. J., DiMarco, C. S., Lesnick, T. G., & Lee, R. A. (2003). McIndoe procedure for vaginal agenesis: Long-term outcome and effect on quality of life. American Journal of Obstetrics and Gynecology, 189, 1569–1573.

    Article  PubMed  Google Scholar 

  • Langer, M., Grunberger, W., & Ringler, M. (1990). Vaginal agenesis and congenital adrenal hyperplasia: Psychosocial sequelae of diagnosis and neovagina formation. Acta Obstetrics and Gynecology Scandinavia, 69, 343–349.

    Google Scholar 

  • Leiblum, S. R. (1997). Infertility: Psychological issues and counseling strategies. New York: Wiley.

    Google Scholar 

  • Letterie, G. S. (1998). Structural abnormalities and reproductive failure. Malden, MA: Blackwell Science.

    Google Scholar 

  • Masters, W. H., & Johnson, V. E. (1961). The artificial vagina: Anatomic, physiologic, psychosexual function. Western Journal of Surgery, Obstetrics and Gynecology, 69, 192–212.

    Google Scholar 

  • McIndoe, A. H., & Bamister, J. B. (1938). Operation for the cure of congenital absence of the vagina. British Journal of Obstetrics and Gynecology, 45, 490.

    Google Scholar 

  • Mobus, V. J., Kortenhorn, K., Kreienberg, R., & Friedberg, V. (1996). Long-term results after operative correction of vaginal aplasia. American Journal of Obstetrics and Gynecology, 175, 617–624.

    Article  PubMed  Google Scholar 

  • Poland, M. L., & Evans, T. N. (1985). Psychologic aspects of vaginal agenesis. Journal of Reproductive Medicine, 30, 340–344.

    PubMed  Google Scholar 

  • Raboch, J., & Hořejší, J. (1982). Sexual life of women with the Küstner-Rokitansky syndrome. Archives of Sexual Behavior, 11, 215–220.

    Article  PubMed  Google Scholar 

  • Roberts, C. P., Haber, M. J., & Rock, J. A. (2001). Vaginal creation for mullerian agenesis. Obstetrical & Gynecological Survey, 57, 212–213.

    Google Scholar 

  • Rock, J. A., Reeves, L. A., Retto, H., Baramki, T. A., Zacur, H. A., & Jones, H. W. (1983). Success following vaginal creation for Mullerian agenesis. Fertilization Sterilization, 39, 809–813.

    Google Scholar 

  • Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Spence, J., Gervaize, P., & Jain, S. (2003). Uterovaginal anomalies: Diagnosis and current management in teens. Current Women's Health Reports, 3, 445–450.

    PubMed  Google Scholar 

  • Strickland, J. L., Cameron, W. J., & Krantz, K. E. (1993). Long-term satisfaction of adults undergoing McIndoe vaginoplasty as adolescents. Adolescent and Pediatric Gynecology, 6, 135–137.

    Google Scholar 

  • Vecchietti, G. (1980). Neovagina in Rokitansky-Küster-Hauser syndrome. Gynakologe, 13, 112–115.

    PubMed  Google Scholar 

  • Woollett, A., & Marshall, H. (2001). Motherhood and mothering. In R. K. Unger (Ed.), Handbook of the psychology of women and gender (pp. 170–182). New York: Wiley.

    Google Scholar 

Download references

Acknowledgments

This research was funded by the University of Michigan Health Systems, Department of Social Work. Most importantly, we thank the women who gave their time to take part in this study. We also thank Dr. Joseph Himle, Lisa Engel Evans, and Sallie Foley for their roles as consultants, the Editor, and the journal's anonymous referees for their helpful comments on the final revision of this article

Author information

Authors and Affiliations

  1. Department of Psychology, University of California, Room 277, Social Sciences 2, Santa Cruz, California, 95064, USA

    Elizabeth M. Morgan

  2. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA

    Elisabeth H. Quint

Authors
  1. Elizabeth M. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisabeth H. Quint
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth M. Morgan.

Appendices

Appendix A. Individual items in the female sexual health measure

  1. 1.

    How satisfied have you been with your overall sex life?

  2. 2.

    How enjoyable do you find sexual activity without sexual intercourse?

  3. 3.

    How enjoyable do you find sexual intercourse?

  4. 4.

    How would you rate your frequency of sexual intercourse?

  5. 5.

    How sexually attractive does your partner find you?

  6. 6.

    How sexually attracted are you to your sexual partner?

  7. 7.

    Do you have pain with intercourse?

  8. 8.

    Do you have pain after intercourse?

  9. 9.

    Do you have bleeding with intercourse?

  10. 10.

    Do you feel unable to have sex due to the size of your vagina?

  11. 11.

    Does sex cause you pain because your vagina is too small?

  12. 12.

    Do the muscles in your vagina contract so much as not to allow penetration or make penetration difficult?

  13. 13.

    Do the muscles in your vagina contract so much as to make pelvic exams at the doctor's office painful?

  14. 14.

    Are you worried that sex may hurt?

  15. 15.

    Do you feel anxious about having sex?

  16. 16.

    Have you had sexual intercourse? (yes/no response)

  17. 17.

    How old were you when you first had sexual intercourse?

  18. 18.

    If you have not had intercourse, when are you interested in having intercourse (check all that apply)

Options: have had intercourse, not interested in having intercourse, as soon as I can, when I am in a committed relationships, when I am married

Note. Questions have a 5- or 6-point Likert response option unless otherwise noted; all questions included a “not applicable” option. The measure included the following prompt: Below is a list of questions that ask about sexual issues in your life. Please read each one carefully and check the box below that best corresponds to your sexual experiences.

Appendix B. Individual items in the life goals measure

  1. 1.

    Do your future goals include being married?

  2. 2.

    Are you interested in raising children?

  3. 3.

    Do you feel that adoption is a good alternative to having your own children?

  4. 4.

    Do you feel that in vitro fertilization with a surrogate (using your eggs and your partner's sperm to create a baby that would grow in another woman's uterus) is a good alternative to having your own children?

  5. 5.

    How important is it to you to have children (1 = not at all; 5 = extremely)

  6. 6.

    Are you planning on pursuing a professional career?

  7. 7.

    What would you like to do for work/career? (open-ended response)

  8. 8.

    What are you education aspirations? (open-ended response)

  9. 9.

    Please rate the importance of these elements in your life from 1 to 6.

    Options: education, staying connected to family (parents, siblings), focus on career/work, marriage/partnership commitment, travel/leisure, physical health/mental health, financial matters, raising children.

  10. 10.

    Have any illnesses/medical issues influenced the way you see the course of your life? If yes, please explain.

Note. Questions have yes/no response options unless otherwise noted. The measure included the following prompt: Please read the questions carefully and circle the answer, check the answer, or fill in the answer that best describes your current expectations, desires, and goals for the next 10 years.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morgan, E.M., Quint, E.H. Assessment of Sexual Functioning, Mental Health, and Life Goals in Women with Vaginal Agenesis. Arch Sex Behav 35, 607–618 (2006). https://doi.org/10.1007/s10508-006-9054-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-006-9054-2

Keywords

Search

Navigation