Dilation as treatment for vaginal agenesis and hypoplasia: A pilot exploration of benefits and barriers as perceived by patients

Abstract

Reconstructive surgery has been the traditional treatment for the short vagina. Recently vaginal dilation has been recommended due to its low morbidity. Small retrospective studies have reported success rates of up to 80% but include neither clear definitions of "success" nor exploration of factors associated with compliance and outcome. The first 10 women prescribed vaginal dilation treatment at a specialist gynaecological clinic during the study period were interviewed and asked to complete the Multi-dimensional Sexuality Questionnaire (MSQ), with an assessment of perceived vaginal characteristics. The participants scored lower scores on sexual esteem, sexual assertiveness and sexual satisfaction and higher scores in sexual anxiety, sexual depression and fear of sexual relationships in comparison with the standardisation sample. Dilator treatment must be subject to the same scrutiny as any intervention. Vaginal dilation can have a negative emotional impact on women and psychological intervention may be needed to maximise efficacy.

Normalization of the vagina by dilator treatment alone in Complete Androgen Insensitivity Syndrome and Mayer-Rokitansky-Kuster-Hauser Syndrome

“…Most of all, many of the surgical techniques have to be followed by post-operative vaginal dilation to maintain volume. Surgery may be perceived as a quick and uncomplicated solution to vaginal absence, but psychological barriers to sexual intimacy could remain (Liao et al, 2006). Such barriers could result in emotional avoidance, thereby interfering with the patient's intention to self-manage post-surgical dilation.…”

Mayer-Rokitansky-Küster-Hauser Syndome and Laparoscopic Assisted Creation of Neovagina (Modified Vecchietti)

“…Although accomplished results are announced about this technique, anxiety, lack of compliance, discomfortablity is mentioned as disadvantages (12) .…”

Ambivalent Ambiguity? : A study of how women with 'atypical' sex development make sense of female embodiment

“…It is estimated that about 20% of these individuals are diagnosed when older than 12 years of age (Massa et al, 2005). This condition is, like UVA, included in the DSD label (Lee et al, 2006), but none of my interviewees used DSD, or intersex, when talking about their condition; over surgical alternatives (Callens et al, 2014;Edmonds, 2003;Ismail-Pratt et al, 2007;Liao et al, 2006;Moen, 2000). neither did they relate their condition to such terms or express an awareness about their condition being covered by them.…”

“…The invasiveness of surgical interventions, and the lack of statistically significant differences regarding 'functional' success between non-surgical and surgical methods, are often described as motivating this shift (Callens et al, 2014). However, it has also been noted that success is distinguished in a range of ways in such evaluations (Liao et al, 2006). In some studies functional success is defined as 'satisfaction with sex', which also includes 'non-genital sex' (Callens et al, 2014), or by using the Female Sexual Functional Index (FSFI), which measures desire, arousal, lubrication, orgasm, satisfaction, and comfort (Kuhn et al, 2013;Morcel et al, 2013).…”