Creation and Maintenance of Neo-Vagina With the Use of Vaginal Dilators as First Line Treatment – Results From a Quaternary Pediatric and Adolescent Gynecology Service in Australia

There are surgical and non- surgical treatment options available to create a neo-vagina for women who have congenital vaginal agenesis or acquired vaginal stenosis. We report our success of vaginal dilator therapy in all suitable aetiologies for women who presented to our facility between January 2005 and June 2015. The therapy was deemed successful if the women were able to have sexual intercourse without pain or if they achieved a vaginal length of greater than 6cm and maximum width using the largest of the dilators throughout the vagina if they were not sexually active. All thirty-one women who presented to this service during the ten and half year period were included in this retrospective clinical audit, where the intervention was the use of Amielle comfort vaginal dilators. Of the presenting diagnoses, 17 had Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH), 2 had cloacal abnormalities, 1 had vaginal narrowing from previous neo-vagina creation surgery as a child, 2 had complete vaginal agenesis, 3 had partial vaginal agenesis, 1 had complete androgen insensitivity (CAIS), 1 had partial androgen insensitivity (PAIS), 1 had 5α reductase deficiency, 1 had hypogonadotrophic hypogonadism, 2 had congenital adrenal hyperplasia (CAH). Out of these 31 women, 8 had to be excluded as they had not started the dilator therapy for reasons varying between being too young to need a vagina in the immediate period, or not being either psychologically or emotionally and physically ready to embark on what was expected to be an intense commitment. Of the remaining 23 women, 18 are satisfied with the results of their dilator therapy, 3 are having ongoing dilator therapy with good progress and 2 are unsatisfied with the results of their dilator therapy and are being considered for multidisciplinary surgery. These two latter patients, one was a patient with Disorder of sexual Differentiation, and is physically not entirely suited to total success with vaginal dilator therapy alone. The other patient had severe psychological barriers to using the dilator therapy despite extensive counselling by the treating specialists. Vaginal dilator therapy is an effective first line treatment for neo-vagina creation, with approximately 90% success to date in our cohort.