The primary cause of vaginal aplasia is the Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. The infertility and the lack of normal sexuality associated with this syndrome have a profound impact on body image and self-esteem; one third of patients suffer from depression. In the last 2 decades, numerous techniques creating a neovagina in patients with MRKH syndrome have been investigated. Treatment methods used include both surgical and nonsurgical techniques of vaginal reconstruction. Among these, the nonsurgical Frank method must be considered as first-line therapy and used where possible. Because of the lack of prospective randomized trials, there is no consensus as to the best surgical treatment. The sigmoid graft, which uses a bowel graft to create a neovagina, was long considered a second-line treatment because of its associated morbidity. With advances in antibiotic prophylaxis and colorectal anastomosis, it can now be considered as first-line surgical therapy for MRKH.
This prospective study assessed the functional and sexual outcome of sigmoid vaginoplasty in patients with MRKH syndrome. Participants were 59 women with the syndrome who had been referred to a university hospital between 1992 and 2010; 11 of these patients were treated by the Frank method, and 48 by sigmoid vaginoplasty. Two standardized questionnaires, the Female Sexual Function Index (FSFI) and the revised Female Sexual Distress Scale (FSDS-R), were used to evaluate the primary study outcome measures, functional results, and sexuality. Additional questions assessed body image perception, desire for motherhood, and signs of depression.
Of the 40 patients (68%) who completed and mailed the questionnaire, 35 (73%) underwent surgery, and 5 (45%) were treated by the Frank method. There was no significant difference between groups in the mean total FSFI (P < 0.13) and FSDS-R (P < 0.72) scores: FSFI scores for the surgical group and Frank group were 28 ± 3.1 and 30.3 ± 6.2, respectively, and FSDS-R scores were 21.4 ± 12.1 and 18.4 ± 15.4, respectively.
These findings show that sigmoid vaginoplasty provides nearly normal sexual function in patients with vaginal aplasia. Whatever technique is chosen, appropriate management requires a multidisciplinary team, because sexually related psychological distress persists in most patients.