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Surgical Management of the Constricted or Obliterated Vagina

Gebhart, John B., MD, MS; Schmitt, Jennifer J., DO

doi: 10.1097/AOG.0000000000001495
Contents: Clinical Expert Series
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Expert Discussion
Spanish Translation

Management of the constricted or obliterated vagina demands an understanding and recognition of the potential etiologies leading to this presentation. A thorough and comprehensive medical and surgical review is required to arrive at an accurate diagnosis, which then will guide medical or surgical intervention. It is paramount to recognize when underlying medical conditions are contributing to these conditions and to begin medical therapy; failure to do so will often yield suboptimal results. When these conditions arise after surgical interventions, compensatory surgical techniques that correct upper and lower vaginal strictures or obliteration include incision through the stricture, vaginal advancement, Z-plasty, skin grafts, perineal flaps, and abdominal flaps and grafts. Postoperative surveillance and dilation are critical to optimize long-term success.

Vaginal constriction and obliteration have multiple causes and often are addressed with a combination of medical and surgical treatment modalities.

Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota.

Corresponding author: John B. Gebhart, MD, MS, Division of Gynecologic Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905; e-mail:

Financial Disclosure Dr. Gebhart has served on the advisory board for Astora and received royalties from UpToDate, Inc, and Elsevier BV. Dr. Schmitt did not report any potential conflicts of interest.

Continuing medical education for this article is available at

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.