Abstract
Introduction and hypothesis
To investigate sexual and anatomical outcome after Shears neovagina in patients with Mayer–von Rokitansky–Kuster–Hauser syndrome (MRKH).
Methods
Forty-three consecutive patients with MRKH syndrome underwent surgery creating a neovagina according to Shears. Follow-up was 8 years. Sexual function was assessed using the Female Sexual Function Index (FSFI) as patient reported outcome; anatomical results were assessed measuring anterior, posterior and apical prolapse using the ICS Pelvic Organ Prolapse Score (ICS-POP Score). Pelvic floor contraction was measured applying the Oxford grading system.
Results
Thirty-seven of the patients were regularly sexually active and filled in the FSFI; mean total FSFI was 27.2 (range 24–28). No significant prolapse of the neovagina was noted, 11 patients had a grade I cystocele, rectocele or apical descent that was asymptomatic. Oxford grading of the pelvic floor contraction was 4 in median (range 2–5).
Conclusion
The neovagina according to Shears is a valuable surgical option with good sexual and anatomical outcome 8 years after therapy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fotopoulou C, Sehouli J, Gehrmann N, Schoenborn I, Lichtenegger W (2010) Functional and anatomic results of amnion vaginoplasty in young women with Mayer-Rokitansky-Küster-Hauser syndrome. Fertil Steril 94:317–323
Griffin J, Edwards C, Madden J, Harrod M, Wilson J (1976) Congenital absence of the vagina, Mayer-Rokitansky-Küster-Hauser syndrome. Ann Intern Med 85:224–226
Ulrich U, Schrickel J, Dorn C, Richter O, Lewalter T, Lüderitz B, Rhiem K (2004) Mayer-von-Rokitansky-Küster Hauser syndrome in association of hitherto undescribed variant of the Holt-Oram syndrome with an aorto-pulmonal window. Hum Reprod 19:1201–1203
Giusti S, Fruzzetti E, Perinin D, Fruzzetti F, Giusti P, Bartolozzi C (2011) Diagnosis of a variant of Myer-Rokitansky-Kuster Hauser syndrome: useful MRI findings. Abdom Imaging 36:753–755
Shears BH (1960) Congenital atresia of the vagina: a technique for tunnelling in the space between bladder and rectum and construction of a new vagina by a modified Wharton technique. J Obstet Gynaecol Br Emp 67:24–31
Walch K, Kowarik E, Leithner K, Schätz T, Dörfler D, Wenzl R (2011) Functional and anatomical results after creation of a neovagina according to Wharton-Shears George in patients with Mayer-Rokitansky-Küster-Hauser syndrome—long-term follow-up. Fertil Steril 96(2):492–497
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (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
Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JOL, Klarskov P, Shull BL, Smith ARB (2002) Standardisation of terminology Female Pelvic Organ Prolapse and Pelvic Floor Dysfunction. Am J Obstet Gynecol 175(1006):10–11
BØ K, Finckenhagen HB (2001) Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand 80(10):883–887
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
Edmonds DK (2003) Congenital malformations of the genital tract and their management. Best Pract Res Clin Obstet Gynaecol 17:19–40
Schaffer J, Fabricant C, Carr BR (2002) Vaginal vault prolapsed after surgical and nonsurgical treatment of mullerian agenesis. Obstet Gynecol 99:947–949
Swift S, Woodman PL, O’Boyle A, Kahn M, Valley M, Bland D (1980) Pelvic organ support study (POSST): the distribution, clinical definitions and epidemiologic conditions of pelvic organ support defects. Am J Obstet Gynecol 192(3):795–806
Hage JJ (1999) Vaginoplasty in male-to-female transsexuals by inversion of penile and scrotal skin. In: Ehrlich RM, Alter GJ (eds) Reconstructive and plastic surgery of the external genitalia. Saunders , Philadelphia, pp 294–300
Belgrano E, Lissiani A (1999) La femilizzazione dei genital esterni e la colazione della neovagina. In: Belgrano E Fabris B and Trombetta C (eds) Il transsessualismo. Editrice Kurtis, Milan, pp 87–97
D’Alberton A, Santi F (1972) Formation of a neovagina by coitus. Obstet Gynecol 40:763
Deniz N, Perk H, Serel T (2002) Urethral coitus and urinary incontinence in a case of Mayer-Rokitansky-Kuster-Hauser syndrome: an alternative surgical procedure. Eur J Obstet Gynecol Reprod Biol 103:95
Williams EA (1964) Congenital absence of the vagina: a simple operation for relief. J Obstet Gynaecol Br Commonw 71:511
McIndoe AH, Banister JB (1938) An operation for the cure of congenital absence of the vagina. J Obstet Gynecol Br Commonw 45:490–494
Davydoff SN (1969) Colpopoesis from the peritoneum of the uterorectal space. Akush Gynecol [Mok] 45:55
Vecchietti G (1965) Neovagina nella syndrome di Rokitanski Kuster Hauser attual. Obstet Ginecol 11:131
Czsermely T, Halvax L, Sarkany A, Jeges S, Vizer M, Bosza S, Farkas B, Bodis J (2011) Sexual function after modified laparoscopic Vecchietti’s vaginoplasty. J Pediatr Adolesc Gynecol 24:147–152
Ng CC, Ham WH (2004) Comparison of effectiveness of vaginal and abdominal routes in treating severe uterovaginal or vault prolapse. Singapore Med J 45(10):475–481
Allen L, Lucco KL, Brown CM, Spritzre RF, Kives S (2010) Psychosexual and functional outcomes after creation of a neovagina with laparoscopic Davydoff in patients with vaginal agenesis. Fertil Steril 94:2272–2276
Fedele L, Bianchi S, Frontino G (2008) The laparoscopic Vecchietti’s modified technique in Rokitansky syndrome: anatomic, functional and sexual long term results. Am J Obstet Gynecol 198:377
Darai E, Toullalan O, Besse O (2003) Anatomic and functional results of laparoscopic—perineal neovagina construction by sigmoid colpoplasty in women with Rokitansky’s syndrome. Hum Reprod 18:2454
Ota H, Tanaka J, Murakami M (2000) Laparoscopic assisted Ruge procedure for the creation of a neovagina. Fertil Steril 73:641
Nygard I, Bradley C, Brand D (2004) Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol 104:489–497
Conflicts of interest
None.
Source of financial support
This study was not financially supported, but is investigator-driven.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuhn, A., Neukomm, C., Dreher, E.F. et al. Prolapse and sexual function 8 years after neovagina according to Shears: a study of 43 cases with Mayer–von Rokitansky–Küster–Hauser syndrome. Int Urogynecol J 24, 1047–1052 (2013). https://doi.org/10.1007/s00192-012-1980-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-012-1980-z