What are the treatments for congenital absence of vagina?

What is congenital absence of vagina? Most patients with congenital absence of vagina have congenital absence of vagina syndrome (MRKH), with no vagina and uterus, showing primary amenorrhea or dyspareunia. The incidence of congenital absence of vagina is about 1/5000, which is the result of bilateral hypoplasia of the paramesonephric ducts. Almost all of them are accompanied by no uterus or rudimentary uterus, and occasionally with functional uterus. The bilateral fallopian tubes and ovaries are generally developed normally.

1. Skin flap transplantation: The advantages of this procedure are simple and safe operation with a high success rate. However, it is relatively dry in the vagina and requires a mold to be placed in the vagina day and night for more than half a year. In addition, the skin graft is prone to necrosis and shedding, infection, and granulation, which makes the vagina shallower or the scar on the top of the cave shrinks.

2. Amniotic membrane transplantation: The advantages of this procedure are that it is simpler and has a higher success rate. The resulting vagina is similar to the natural vagina. However, it takes a long time for the artificial vagina to be completely covered by normal mucosa after the operation, and during this period, the vagina often becomes infected and forms scars and shrinks. The vaginal mold must be placed for a long time after the operation, which brings great pain to the patient.

3. Peritoneal vaginal replacement: This procedure is similar to amniotic membrane transplantation. The artificial vagina formed is close to the natural vagina, but the vaginal mold also needs to be placed for a long time.

4. Sigmoid colon replacement for artificial vagina: In comparison, this procedure has the highest success rate, and is very similar to a normal vagina in appearance and function. The vaginal mucosal walls are well-wrinkled, soft and moist, and usually have a little sticky secretion; the width and length are ample, which helps to make sexual life more pleasurable. Compared with the above procedures, it also has the advantage of not having to place a vaginal mold after surgery. This procedure is currently the most ideal procedure. It is especially suitable for patients who have undergone other vaginal shaping procedures before, and have caused vestibule-rectal fistula, bladder (urethra) vaginal fistula after surgery, or surgical cavitation that damaged the rectum, urethra or bladder.