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SHOULD PROGRESSIVE PERINEAL DILATION BE CONSIDERED FIRST LINE THERAPY IN CASES OF VAGINAL AGENESIS?
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SHOULD PROGRESSIVE PERINEAL DILATION BE CONSIDERED FIRST LINE THERAPY IN CASES OF VAGINAL AGENESIS?
Patricio C. Gargollo, MD, Glenn M. Cannon, Jr., MD, David A. Diamond, MD, Phaedra Thomas, BSN, Vicki Burke, BSN, Marc R. Laufer, MD.
Children's Hospital Boston, Boston, MA, USA.
Background
Progressive perineal dilation (PPD) affords patients a minimally invasive method for the creation of a functional vagina without the attendant risks or complications of traditional surgical options. We report our 12 year experience with this technique.
Methods
Patients with vaginal agenesis treated at our institution were analyzed retrospectively and followed prospectively using case report forms and semistructured interviews. Patients diagnosed with vaginal agenesis were counseled on their options for vaginal reconstruction. Those opting for PPD were instructed on the proper use of vaginal dilators by one of the authors (MRL) and were advised to dilate 2 times per day for 20 minutes. All patients received physician, nursing and social work counseling for support. Parameters reviewed included primary diagnosis, start and end of vaginal dilation, size of dilator used, sexual activity (SA) and whether the patient experienced pain or bleeding with either dilation or SA. Functional success was defined as the ability to have sexual intercourse, vaginal acceptance of the largest dilator without discomfort or a vaginal length of 5 cm. Univariate and multivariate analysis was performed to identify factors associated with successful neovagina creation.
Results
From 1996 to 2008, 67 females with vaginal agenesis were enrolled in a program of progressive perineal dilation. The primary diagnosis was MRKH in 62. Median age at start of vaginal dilation was 17 yrs (range 14-35) Median follow up time was 9 months (range 0-100). Twelve patients (18%) were lost to follow up. Of the remaining 55 patients, 5 (9%) failed treatment due to non-compliance and 44 (89.9%) achieved functional success at a median of 17 months. Three patients reported infrequent pain and 2 reported single episodes of bleeding with dilation. Eighteen patients who are sexually active report satisfactory intercourse without dyspareunia. Functional success was positively correlated with frequent (once per day or greater) dilation, age > 18 at start of dilation and initiation of sexual activity.
Conclusion
PPD for neovagina creation provides a valuable, minimally invasive alternative for vaginal reconstruction with a high success rate and much lower complication rate than that published in surgical series. Given these findings PPD should be offered as a first line therapy in adolescents with vaginal agenesis.
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