Using the Wharton-Sheares-George method to create a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a step-by-step video tutorial

Wharton-Sheares-George vaginoplasty: a safe and efficient technique in patients with Mayer-Rokitansky-Küster-Hauser syndrome

INTRODUCTION AND HYPOTHESIS

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a condition with an underdeveloped or absent vagina and uterus due to embryological growth failure of the Müllerian ducts. Many techniques have been described to construct a neovagina with an acceptable depth that allows penetrative intercourse. This is a step-by-step video tutorial on the Wharton-Sheares-George surgical technique for vaginoplasty in patients with MRKH syndrome.

METHOD

With Wharton-Sheares-George vaginoplasty, the rudimentary Müllerian ducts are incrementally dilated by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. As a result, a neovagina is created and an estriol-coated vaginal mold is inserted for 3 days. The patient receives comprehensive discharge instructions, a self-dilation program three times a day, and a monthly follow-up.

RESULTS

A 3-month follow-up showed a high subjective degree of satisfaction with surgery and sexual satisfaction in both patients.

CONCLUSION

Wharton-Sheares-George vaginoplasty is a safe and efficient technique for creating a neovagina for patients with MRKH syndrome.

Sexual health and sexual well-being of women with Mayer-Rokitansky-Kuester-Hauser syndrome after vaginal reconstruction: a qualitative analysis

BACKGROUND

Contradictory findings on sexual health in women with Mayer-Rokitansky-Kuester-Hauser syndrome (MRKHS) after vaginal reconstruction point toward the need for more profound assessment of this subject, particularly as it is still unclear what constitutes sexual well-being, especially genital self-image or sexual self-esteem, in women with MRKHS and neovagina.

AIM

The aim of this qualitative study was to assess individual sexual health and sexual well-being in the context of MRKHS after vaginal reconstruction, with an emphasis on genital self-image, sexual self-esteem, sexual satisfaction, and coping with MRKHS.

METHODS

Qualitative semistructured interviews were conducted with women with MRKHS after vaginal reconstruction (n = 10) with the Wharton-Sheares-George surgical method and a matched control group without MRKHS (n = 20). Women were surveyed about their previous and current sexual activities, perception of and attitudes toward their genitals, disclosure to others, coping with the diagnosis, and perception of surgery. Data were analyzed through qualitative content analysis and compared with the control group.

OUTCOMES

The primary outcomes of the study were major categories, such as sexual satisfaction, sexual self-esteem, genital self-image, and dealing with MRKHS, as well as subcategories related to the content analysis.

RESULTS

Although half the women in the present study indicated that they were coping well with their condition and were satisfied with sexual intercourse, most felt insecure about their neovagina, were cognitively distracted during intercourse, and showed low levels of sexual self-esteem.

CLINICAL IMPLICATIONS

A better understanding of expectations and uncertainties regarding the neovagina might help professionals to support women with MRKHS after vaginal reconstruction to increase sexual well-being.

STRENGTHS AND LIMITATIONS

This is the first qualitative study focusing on individual aspects of sexual well-being, especially sexual self-esteem and genital self-image, in women with MRKHS and neovagina. The qualitative study indicates good interrater reliability and data saturation. The limitations of this study include the inherent lack of objectivity resulting from the method but also the fact that all the patients had a particular surgical technique, consequently resulting in limited generalizability of these findings.

CONCLUSIONS

Our data indicate that integrating the neovagina into the genital self-image is a prolonged process that is essential for sexual well-being and should thus be the focus of sexual counseling.

Review of Surgical Neovagina Techniques and Management of Vaginal Stricture

STUDY OBJECTIVE

To review the currently available methods for surgical and nonsurgical neovaginal creation with an additional focus on situations requiring vaginal stretching, replacement, or augmentation and the management of vaginal stenosis or stricture.

DESIGN

Review of the existing literature METHODS: PUBMED search with key words vaginal agenesis, neovaginal creation, vaginoplasty, vaginal stretching, vaginal augmentation, vaginal stenosis, outcomes of vaginoplasty, Mullerian anomalies, vaginal anomalies RESULTS: The need to perform vaginal stretching, replacement, or augmentation will vary depending on the underlying reproductive tract condition.

CONCLUSIONS

A variety of techniques have been described to performed vaginal stretching, replacement, or augmentation. There are risks and benefits to each technique. Vaginal stricture and stenosis remain difficult problems given the high rates of these complications in patients undergoing these procedures. Although several techniques can alleviate this problem, they rely on the thickness of the stenosis and the location of the stenosis within the vagina.

Effects of different vaginal mould use approaches after vaginoplasty with artificial dermis in patients with Mayer-Rokitansky-Küster-Hauser syndrome

OBJECTIVE

To assess the therapeutic effects of different vaginal mould use approaches after vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

METHODS

Patients with MRKH syndrome who underwent surgery from 2010 to 2015 in our hospital were retrospectively evaluated. Vaginoplasty was performed with artificial dermis, and vaginal moulds were used for 6 months postoperatively. The patients were divided into an intermittent group and continuous group according to the vaginal mould approach.

RESULTS

Thirty-five patients were evaluated (intermittent group, 19 patients; continuous group, 16 patients). One month postoperatively, the mean vaginal length and width in the intermittent group were 9.26 ± 0.56 and 3.82 ± 0.25 cm, respectively, and those in the continuous group were 9.44 ± 0.51 and 3.86 ± 0.22 cm, respectively. Six months postoperatively, the mean vaginal length and width in the intermittent group were 8.94 ± 0.71 and 3.76 ± 0.26 cm, respectively, and those in the continuous group were 8.69 ± 0.48 and 3.65 ± 0.30 cm, respectively. The mean Female Sexual Function Index scores in the intermittent and continuous groups were 28.61 ± 0.71 and 28.4 80 ±0.79 respectively, after normal sexual life.

CONCLUSION

Both intermittent and continuous use of postoperative vaginal moulds may be effective.

Application of mesocolon rotation and reverse puncture in total laparoscopic sigmoid vaginoplasty

The aim of the present study was to explore the clinical efficacy of mesocolon rotation and reverse puncture in total laparoscopic sigmoid vaginoplasty (LSV). The clinical data of 11 patients (unmarried, n=4; married, n=7) with congenital absence of a vagina who underwent treatment of total laparoscopic sigmoid vaginoplasty at the First Affiliated Hospital of Xinjiang Medical University (Urumqi, China) between March 2013 and March 2016 were retrospectively analyzed. In all patients, the surgical method included sigmoid mesocolon rotation and reverse puncture. The vaginal depth, the first sexual intercourse time and female sexual function indexes were recorded. The average operation time was 187±19 min, the average intra-operative blood loss was 132±24 ml, the time to the first meal after surgery was 4.3±1.1 days, the average post-operative hospital stay was 7.5±1.2 days, the post-operative short-term complication rate was 36.3% and the time to the first sexual intercourse was 3.0±0.3 months. The post-operative follow-up results indicated that the anatomical standard was reached in all of the 11 patients. Among the seven married patients, five patients were satisfied with their sex lives after the operation. In terms of psychosexual desire, only one married patient felt no sexual arousal. The other married patients had good sexual relations, function and satisfaction. In conclusion, the application of mesocolon rotation and reverse puncture in total LSV is safe and feasible.